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

Data quality review of the Brazilian nosocomial infections surveillance system

BACKGROUND

Surveillance of healthcare-associated infections (HAIs) is an essential component of hospital infection prevention and control systems. We aimed to assess the quality of the data compiled by the Brazilian HAI Surveillance System from pediatric (PICUs) and neonatal intensive care units (NICUs), between 2012 and 2021.

METHODS

Data Quality Review, including adherence, completeness, internal consistency, consistency over time, and consistency of population trend, were computed at both national and state levels based on quality metrics from World Health Organization Toolkit. Incidence rates (or incidence density) of ventilator-associated pneumonia (VAP) and central line-associated bloodstream infection (CLABSI) were obtained from the Brazilian National Nosocomial Infections Surveillance (NNIS) system. Data on sepsis-related mortality, spanning the period from 2012 to 2021, were extracted from the Brazilian National Health Service database (DATASUS). Additionally, correlations between sepsis-related mortality and incidence rates of VAP or CLABSI were calculated.

RESULTS

Throughout the majority of the study period, adherence to VAP reporting remained below 75%, exhibiting a positive trend post-2016. Widespread outliers, as well as inconsistencies over time and in population trends, were evident across all 27 states. Only four states maintained consistent adherence levels above 75% for more than 8 years regarding HAI incidence rates. Notably, CLABSI in NICUs boasted the highest reporting adherence among all HAIs, with 148 periods out of 270 (54.8%) exhibiting reporting adherence surpassing 75%. Three states achieved commendable metrics for CLABSI in PICUs, while five states demonstrated favorable results for CLABSI in NICUs.

CONCLUSIONS

While adherence to HAI report is improving among Brazilian states, an important room for improvement in the Brazilian NNIS exists. Additional efforts should be made by the Brazilian government to improve the reliability of HAI data, which could serve as valuable guidance for hospital infection prevention and control policies.

Adapting lean management to prevent healthcare-associated infections: a low-cost strategy involving Kamishibai cards to sustain bundles' compliance

Lean healthcare visual management has been successfully integrated into infection control programs, leading to lower healthcare-associated infection (HAI) rates and greater provider compliance with evidence-based prevention practices; however, its implementation during quality improvement (QI) initiatives in limited-resource settings has not yet been well exploited. We aimed to describe a low-cost strategy involving Kamishibai cards to sustain bundles' adherence to prevent HAIs in a middle-income country. This descriptive case study evaluated the implementation of a lean healthcare visual management tool-Kamishibai board (K-board)-during a nationwide QI collaborative preventing three critical HAIs in 189 adult and pediatric/neonatal intensive care units (ICUs) from September 2021 to January 2023. Considering a limited-resource setting, our team adapted a K-board using simple, cheap, and easy-to-handle materials for routine monitoring of QI procedures, including safety bundles' compliance. After test prototypes, the final K-board version was implemented. The chart materials and assembly cost BRL 80.00 (USD 15.48). Before launching, expert working group meetings were held to shape the contents, refine technical issues, and prepare the ICU teams for implementation. After starting, plan-do-study-act cycles were conducted according to the Breakthrough Series model. Participating ICU teams, including leaders and front-line health workers, performed bedside audits following a weekly chronogram. Two indicators were calculated: the percentage of ICUs in which K-boards were being implemented and whether bundles' compliance was addressed in the K-board. Audit data were recorded in 'SimpleQI'. After 17 months of this initiative, 177 (93.7%) participating ICUs had included this visual management tool in their daily care routines. When more than 94 (>50%) ICUs posted K-board data, the mean compliance for the bundles for each HAI was sustained above 85%. A lean healthcare visual management tool can be adapted to local settings, including healthcare facilities with limited resources. K-board seems to be a feasible method for auditing evidence-based practices in medical care, including safety bundles to simultaneously prevent three types of HAIs.

Success factors of a collaborative project to reduce healthcare-associated infections in intensive care units in Northeastern Brazil

OBJECTIVE

To describe the implementation and results of the collaborative PROADI-SUS project by the Brazilian Ministry of Health to reduce healthcare-associated infections: ventilator-associated pneumonia, primary central line-associated bloodstream infection and catheter-associated urinary tract infections.

METHODS

This was a prospective observational study that investigated the implementation stages and outcomes during 18 months in five intensive care units in the city of Recife. Reductions in healthcare-associated infections in each unit were calculated using previous medians compared to those of the study period.

RESULTS

The goal of reducing the three healthcare-associated infections, i.e., 30% in 18 months, was achieved in at least one of the healthcare-associated infections and was also achieved for two healthcare-associated infections in two hospitals and three healthcare-associated infections in just one hospital; the latter reached the target of 36 months. Implementing the bundles and monitoring the results by the professionals were considered essential actions by the local management teams. In addition, the acquisition of supplies and their availability alongside the beds, signage, checklists, staff awareness, adaptation, team building, training and celebration of achievements were assessed as being relevant for reducing healthcare-associated infections.

CONCLUSION

The collaborative approach reduced healthcare-associated infections, despite partial adherence to the bundles. The hypothesis is that success is related to the project methodology and motivated multidisciplinary teams, especially nursing teams.