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Oliveira RMC, de Sousa AHF, de Salvo MA, Petenate AJ, Gushken AKF, Ribas E, Torelly EMS, Silva KCCD, Bass LM, Tuma P, Borem P, Ue LY, de Barros CG, Vernal S. Estimating the savings of a national project to prevent healthcare-associated infections in intensive care units. J Hosp Infect 2024; 143:8-17. [PMID: 37806451 DOI: 10.1016/j.jhin.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/14/2023] [Accepted: 10/03/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) have a significant impact on patients' morbidity and mortality, and have a detrimental financial impact on the healthcare system. Various strategies exist to prevent HAIs, but economic evaluations are needed to determine which are most appropriate. AIM To present the financial impact of a nationwide project on HAI prevention in intensive care units (ICUs) using a quality improvement (QI) approach. METHODS A health economic evaluation assessed the financial results of the QI initiative 'Saúde em Nossas Mãos' (SNM), implemented in Brazil between January 2018 and December 2020. Among 116 participating institutions, 13 (11.2%) fully reported the aggregate cost and stratified patients (with vs without HAIs) in the pre-intervention and post-intervention periods. Average cost (AC) was calculated for each analysed HAI: central-line-associated bloodstream infections (CLABSIs), ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infections (CAUTIs). The absorption model and time-driven activity-based costing were used for cost estimations. The numbers of infections that the project could have prevented during its implementation were estimated to demonstrate the financial impact of the SNM initiative. RESULTS The aggregated ACs calculated for each HAI from these 13 ICUs - US$8480 for CLABSIs, US$10,039 for VAP, and US$7464 for CAUTIs - were extrapolated to the total number of HAIs prevented by the project (1727 CLABSIs, 3797 VAP and 2150 CAUTIs). The overall savings of the SNM as of December 2020 were estimated at US$68.8 million, with an estimated return on investment (ROI) of 765%. CONCLUSION Reporting accurate financial data on HAI prevention strategies is still challenging in Brazil. These results suggest that a national QI initiative to prevent HAIs in critical care settings is a feasible and value-based approach, reducing financial waste and yielding a significant ROI for the healthcare system.
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Affiliation(s)
| | | | - M A de Salvo
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - A J Petenate
- Institute for Healthcare Improvement, Cambridge, MA, USA
| | | | - E Ribas
- Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | | | - L M Bass
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - P Tuma
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil; Institute for Healthcare Improvement, Cambridge, MA, USA
| | - P Borem
- Institute for Healthcare Improvement, Cambridge, MA, USA
| | - L Y Ue
- Ministério da Saúde, Brasilia, Brazil
| | - C G de Barros
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - S Vernal
- Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil; Hcor, Sao Paulo, Brazil; Hospital Israelita Albert Einstein, Sao Paulo, Brazil; Hospital Moinhos de Vento, Porto Alegre, Brazil; Hospital Sírio-Libanês, Sao Paulo, Brazil.
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Nascimento GM, Gomes Rodrigues DL, Mangas Catarino DG, Piastrelli FT, Cheno MY, Braz KCC, Oliveira Alves LB, Avezum Á, Veiga VC, Zavascki AP, Tomazini B, Besen B, Pereira AJ, Marques de Pinho APN, De Oliveira Junior HA. Application of ventilator-associated events (VAE) in ventilator-associated pneumonia (VAP) notified in Brazil (IMPACTO MR-PAV): a protocol for a cohort study. BMJ Open 2023; 13:e076047. [PMID: 38070904 PMCID: PMC10729162 DOI: 10.1136/bmjopen-2023-076047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Certain criteria for ventilator-associated events (VAE) definition might influence the type of an event, its detection rate and consequently the resource expenditure in intensive care unit. The Impact of Infections by Antimicrobial-Resistant Microorganisms - Ventilator-Associated Pneumonia (IMPACTO MR-PAV) aims to evaluate the incidence and diagnostic accuracy of ventilator-associated pneumonia (VAP) using the current criteria for VAP surveillance in Brazil versus the VAE criteria defined by the US National Healthcare Safety Network-Center for Diseases Control and Prevention (CDC) criteria. METHODS AND ANALYSIS The study will be conducted in around 15 centres across Brazil from October 2022 to December 2023. Trained healthcare professionals will collect data and compare the incidence of VAP using both the current criteria for VAP surveillance in Brazil and the VAE criteria defined by the CDC. The accuracy of the two criteria for identifying VAP will also be analysed. It will also characterise other events associated with mechanical ventilation (ventilator-associated condition, infection-related ventilator-associated complication) and adjudicate VAP reported to the Brazilian Health Regulatory Agency (ANVISA) using current epidemiological diagnostic criteria. ETHICS AND DISSEMINATION This study was approved by the Institutional Review Board under the number 52354721.0.1001.0070. The study's primary outcome measure will be the incidence of VAP using the two different surveillance criteria, and the secondary outcome measures will be the accuracy of the two criteria for identifying VAP and the adjudication of VAP reported to ANVISA. The results will contribute to the improvement of VAP surveillance in Brazil and may have implications for other countries that use similar criteria. TRIAL REGISTRATION NUMBER NCT05589727; Clinicaltrials.gov.
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Affiliation(s)
| | | | | | | | - Maysa Yukari Cheno
- Sustainability and Social Responsibility, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil
| | | | | | - Álvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil
| | - Viviane C Veiga
- Hospital Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil
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Schmitt BL, Leal BF, Leyser M, de Barros MP, Trentin DS, Ferreira CAS, de Oliveira SD. Increased ompW and ompA expression and higher virulence of Acinetobacter baumannii persister cells. BMC Microbiol 2023; 23:157. [PMID: 37246220 DOI: 10.1186/s12866-023-02904-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/19/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Acinetobacter baumannii is one of the main causes of healthcare-associated infections that threaten public health, and carbapenems, such as meropenem, have been a therapeutic option for these infections. Therapeutic failure is mainly due to the antimicrobial resistance of A. baumannii, as well as the presence of persister cells. Persisters constitute a fraction of the bacterial population that present a transient phenotype capable of tolerating supra-lethal concentrations of antibiotics. Some proteins have been suggested to be involved in the onset and/or maintenance of this phenotype. Thus, we investigated the mRNA levels of the adeB (AdeABC efflux pump component), ompA, and ompW (outer membrane proteins) in A. baumannii cells before and after exposure to meropenem. RESULTS We found a significant increase (p-value < 0.05) in the expression of ompA (> 5.5-fold) and ompW (> 10.5-fold) in persisters. However, adeB did not show significantly different expression levels when comparing treated and untreated cells. Therefore, we suggest that these outer membrane proteins, especially OmpW, could be part of the mechanism of A. baumannii persisters to deal with the presence of high doses of meropenem. We also observed in the Galleria mellonella larvae model that persister cells are more virulent than regular ones, as evidenced by their LD50 values. CONCLUSIONS Taken together, these data contribute to the understanding of the phenotypic features of A. baumannii persisters and their relation to virulence, as well as highlight OmpW and OmpA as potential targets for drug development against A. baumannii persisters.
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Affiliation(s)
- Brenda Landvoigt Schmitt
- Laboratório de Imunologia e Microbiologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
- Programa de Pós-Graduação em Biologia Celular e Molecular, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
| | - Bruna Ferreira Leal
- Laboratório de Imunologia e Microbiologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
| | - Mariana Leyser
- Laboratório de Imunologia e Microbiologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
- Programa de Pós-Graduação em Biologia Celular e Molecular, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
| | - Muriel Primon de Barros
- Laboratório de Bacteriologia e Modelos Experimentais Alternativos, Departamento de Ciências Básicas da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre, UFCSPA, R. Sarmento Leite, 245, Porto Alegre, RS, 90050-170, Brazil
| | - Danielle Silva Trentin
- Laboratório de Bacteriologia e Modelos Experimentais Alternativos, Departamento de Ciências Básicas da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre, UFCSPA, R. Sarmento Leite, 245, Porto Alegre, RS, 90050-170, Brazil
| | - Carlos Alexandre Sanchez Ferreira
- Laboratório de Imunologia e Microbiologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, Brazil.
- Programa de Pós-Graduação em Biologia Celular e Molecular, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, Brazil.
| | - Sílvia Dias de Oliveira
- Laboratório de Imunologia e Microbiologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, Brazil.
- Programa de Pós-Graduação em Biologia Celular e Molecular, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, Brazil.
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Wang Y, Ren J, Yao Z, Wang W, Wang S, Duan J, Li Z, Zhang H, Zhang R, Wang X. Clinical Impact and Risk Factors of Intensive Care Unit-Acquired Nosocomial Infection: A Propensity Score-Matching Study from 2018 to 2020 in a Teaching Hospital in China. Infect Drug Resist 2023; 16:569-579. [PMID: 36726386 PMCID: PMC9885966 DOI: 10.2147/idr.s394269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/05/2023] [Indexed: 01/27/2023] Open
Abstract
Purpose Nosocomial infection (NI) is associated with poor prognosis. The present study assessed the clinical and microbiological characteristics of NI patients in the intensive care unit (ICU) and investigated the clinical impact and risk factors for NI in ICU patients. Patients and Methods An observational study was conducted in an adult general ICU. The electronic medical records of all patients admitted to the ICU for >2 days from 2018-2020 were analyzed retrospectively. Multivariate regression models were used to analyze the risk factors for NI in ICU patients. Propensity score-matching (PSM) was used to control the confounding factors between the case and control groups, thus analyzing the clinical impact of NIs. Results The present study included 2425 patient admissions, of which 231 (9.53%) had NI. Acinetobacter baumannii (33.0%) was the most common bacteria. Long-term immunosuppressive therapy, disturbance of consciousness, blood transfusion, multiple organ dysfunction syndromes (MODS), treatment with three or more antibiotics, mechanical ventilation (MV), tracheotomy, the urinary catheter (UC), nasogastric catheter, and central venous catheter (CVC) were risk factors for NI in the ICU patients. After PSM, patients with NI had a prolonged length of stay (LOS) in the ICU and hospital, significant hospitalization expenses (all p<0.001), increased mortality (p=0.027), and predicted mortality (p=0.007). The differences in the ICU and hospital LOSs among three pathogens were statistically significant (p<0.001); the results of the Escherichia coli infection group were lower than the other two pathogenic groups. Conclusion NI was associated with poor outcomes. The risk factors for NI identified in this study provided further insight into preventing NI.
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Affiliation(s)
- Yanhui Wang
- College of Pharmacy, Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Jian Ren
- Department of Pharmacy, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Zhiqing Yao
- College of Pharmacy, Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Wei Wang
- Intensive Care Unit, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Siyang Wang
- Department of Pharmacy, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Junfang Duan
- Intensive Care Unit, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Zhen Li
- College of Pharmacy, Chonnam National University, Gwangju, Korea
| | - Huizi Zhang
- College of Pharmacy, Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Ruiqin Zhang
- Department of Pharmacy, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China,Correspondence: Ruiqin Zhang; Xiaoru Wang, Email ;
| | - Xiaoru Wang
- Intensive Care Unit, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
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YAZICI G, BULUT H, BAYRAK KAHRAMAN B, PALTEKİ T. Bir yoğun bakım ünitesinde sık görülen enfeksiyonların önlenmesi için bir bakım paketinin etkinlik ve maliyetinin analizi: Yarı deneysel bir öntest-sontest tasarım çalışması. KONURALP TIP DERGISI 2022. [DOI: 10.18521/ktd.1109974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Amaç
Sağlık hizmeti ilişkili enfeksiyonlar hasta güvenliğini tehdit etmekte, hastanede yatış süresinin uzamasına, morbidite, mortalite ve maliyetlerin artmasına neden olmaktadır. Bu çalışma, sağlık hizmeti ilişkili enfeksiyonları önlemeye yönelik müdahalelerin etkinliğini ve bu müdahalelerin maliyete etkisini değerlendirmek amacıyla yapılmıştır.
Metod
Bu araştırma bir yoğun bakım ünitesinde 1 Ocak – 30 Haziran 2018 ile 1 Ekim 2018 – 31 Mart 2019 tarihleri arasında 27 eğitim öncesi ve 27 eğitim sonrası olmak üzere toplam 54 hasta ile yarı deneysel ön test-son test tasarım çalışması olarak yapılmıştır.
Bulgular
Çalışmada enfeksiyon oranları Ocak-Mart 2018'de 20.34, Nisan-Haziran 2018'de 25.7, Ekim-Aralık 2018'de 20.97 ve Ocak-Mart 2019'da 17.77 olarak bulunmuştur. Dört farklı dönemin enfeksiyon oranları karşılaştırıldığında, eğitim öncesine göre eğitim sonrasında enfeksiyon oranlarında azalma olduğu ancak bu düşüşün istatistiksel olarak anlamlı olmadığı saptanmıştır (p>0.05). Eğitim öncesi ortalama maliyet 11361.35₺, eğitim sonrası ortalama maliyet 9149.87₺ olarak belirlenmiştir. Tüm maliyetlerin en önemlisi olan ortalama yatak maliyeti eğitim öncesine göre %95 güven aralığında %25,7 oranında azalmıştır. (5241.86₺-13251.50₺, sırasıyla 3489.03₺-10257.41₺).
Sonuç
Sonuç olarak, çalışmada eğitimin yoğun bakım hemşirelerinin sağlık hizmeti ilişkili enfeksiyonlara ilişkin puanlarında anlamlı bir artış sağladığı, sağlık hizmeti ilişkili enfeksiyon oranlarında, hastanede kalış sürelerinde ve eğitim sonrası maliyette istatistiksel olarak anlamlı olmasa da azalma sağladığı belirlenmiştir.
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Affiliation(s)
- Gülay YAZICI
- ANKARA YILDIRIM BEYAZIT UNIVERSITY, FACULTY OF HEALTH SCIENCES
| | - Hülya BULUT
- Gazi University Health Sciences Faculty Nursing Department
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