Partnership among hospitals to reduce healthcare associated infections: a quasi-experimental study in Brazilian ICUs

• Published in: BMC infectious diseases 2021-02, Vol.21 (1), p.212-212, Article 212
• Main Authors: de Melo, Ladjane Santos Wolmer, de Abreu, Maria Verônica Monteiro, de Oliveira Santos, Bernuarda Roberta, das Graças Washington Casimiro Carreteiro, Maria, de Souza, Maria Fernanda Aparecida Moura, de Albuquerque, Maria Carolina Andrade Lins, de Lacerda Vidal, Claudia Fernanda, Lacerda, Heloisa Ramos
• Format: Article
• Language: English
• Subjects: Adult; Brazil - epidemiology; Breakthrough series; Catheter-Related Infections - epidemiology; Catheter-Related Infections - prevention & control; Catheters; Collaboration; Collaborative; Continuity (mathematics); Cross infection; Cross Infection - epidemiology; Cross Infection - prevention & control; Data collection; Developed countries; Developing countries; Health care; Healthcare-associated infections; Hospitals; Hospitals - standards; Hospitals - statistics & numerical data; Humans; Hypotheses; Incidence; Infections; Infectious diseases; Intensive care; Intensive care units; Intensive Care Units - standards; Intensive Care Units - statistics & numerical data; LDCs; Management; Medical cooperation; Medical instruments; Methods; Mortality; Nosocomial infections; Partnerships; Patient safety; Pneumonia, Ventilator-Associated - epidemiology; Pneumonia, Ventilator-Associated - prevention & control; Prevention; Prevention bundles; Professional ethics; Public health; Public-Private Sector Partnerships - organization & administration; Public-Private Sector Partnerships - standards; Public-Private Sector Partnerships - statistics & numerical data; Quasi-experimental methods; Safety and security measures; Security; Teams; Urinary tract
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-021-05896-0

Healthcare-associated infections (HAIs) are relevant in developing countries where frequencies can be at least 3 times higher than in developed countries. The purpose of this research was to describe the intervention implemented in intensive care units (ICUs) to reduce HAIs through collaborative project and analyze the variation over 18 months in the incidence density (ID) of the three main HAIs: ventilator associated pneumonia (VAP), central line-associated bloodstream infections (CLABSIs) and catheter-related urinary tract infections (CAUTIs) and also the length of stay and mortality in these ICUs. A quasi-experimental study in five public adult clinical-surgical ICUs, to reduce HAIs, through interventions using the BTS-IHI "Improvement Model", during 18 months. In the project, promoted by the Ministry of Health, Brazilian philanthropic hospitals certified for excellence (HE), those mostly private, certified as excellence and exempt from security contributions, regularly trained and monitored public hospitals in diagnostics, data collection and in developing cycles to improve quality and to prevent HAIs (bundles). In the analysis regarding the length of stay, mortality, the IDs of VAP, CLABSIs and CAUTIs over time, a Generalized Estimating Equation (GEE) model was applied for continuous variables, using the constant correlation (exchangeable) between assessments over time. The model estimated the average difference (β coefficient of the model) of the measures analyzed during two periods: a period in the year 2017 (prior to implementing the project) and in the years 2018 and 2019 (during the project). A mean monthly reduction of 0.427 in VAP ID (p = 0.002) with 33.8% decrease at the end of the period and 0.351 in CAUTI ID (p = 0.009) with 45% final decrease. The mean monthly reduction of 0.252 for CLABSIs was not significant (p = 0.068). Length of stay and mortality rates had no significant variation. Given the success in reducing VAP and CAUTIs in a few months of interventions, the achievement of the collaborative project is evident. This partnership among public hospitals/HE may be applied to other ICUs including countries with fewer resources.