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Saavedra Bravo MA, Santos GCSD, Petenate AJ, Westphal PJ, Souza LGDA, Marques RG, Morosov EDM, Gushken AKF, Franco FF, Silva WG, de Moura RM, de Lima AL, Dos Santos RG, Andrade KDC, Hamada APS, Cristalda CMR, Ue LY, de Barros CG, Vernal S. Adapting lean management to prevent healthcare-associated infections: a low-cost strategy involving Kamishibai cards to sustain bundles' compliance. Int J Qual Health Care 2023; 35:mzad100. [PMID: 38157269 DOI: 10.1093/intqhc/mzad100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/31/2023] [Accepted: 12/07/2023] [Indexed: 01/03/2024] Open
Abstract
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.
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Affiliation(s)
| | | | - Ademir Jose Petenate
- Universidade Estadual de Campinas - UNICAMP, Cidade Universitária Zeferino Vaz - Barão Geraldo, Campinas, SP, 13083-970, Brazil
| | - Patrick Jacobsen Westphal
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 910 - Moinhos de Vento, Porto Alegre, RS 90035-000, Brazil
| | | | - Roberta Gonçalves Marques
- Hospital Israelita Albert Einstein, Avenida Paulista, 2300 - Bela Vista, Sao Paulo, SP 01310-300, Brazil
| | | | | | - Flavia Fernanda Franco
- Hospital Israelita Albert Einstein, Avenida Paulista, 2300 - Bela Vista, Sao Paulo, SP 01310-300, Brazil
| | - Wladimir Garcia Silva
- Hospital Alemão Oswaldo Cruz, Rua Treze de Maio, 1815 - Bela Vista, Sao Paulo, SP 01323-020, Brazil
| | - Rafaela Moraes de Moura
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 910 - Moinhos de Vento, Porto Alegre, RS 90035-000, Brazil
| | - Andreia Lopes de Lima
- BP - A Beneficência Portuguesa de São Paulo, Rua Maestro Cardim, 769 - Bela Vista, Sao Paulo, SP 01323-001, Brazil
| | | | | | - Andreza Pivato Susin Hamada
- Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91 - Bela Vista, Sao Paulo, SP 01308-050, Brazil
- BP - A Beneficência Portuguesa de São Paulo, Rua Maestro Cardim, 769 - Bela Vista, Sao Paulo, SP 01323-001, Brazil
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 910 - Moinhos de Vento, Porto Alegre, RS 90035-000, Brazil
- Hospital Alemão Oswaldo Cruz, Rua Treze de Maio, 1815 - Bela Vista, Sao Paulo, SP 01323-020, Brazil
- Hospital Israelita Albert Einstein, Avenida Paulista, 2300 - Bela Vista, Sao Paulo, SP 01310-300, Brazil
- Hcor, Rua Desembargador Eliseu Guilherme, 147 - Paraíso, Sao Paulo, SP 04004-030, Brazil
| | | | - Luciana Yumi Ue
- Ministério da Saúde, Esplanada dos Ministérios - Bloco G, Brasília, DF 70058-900, Brazil
| | - Claudia Garcia de Barros
- Hospital Israelita Albert Einstein, Avenida Paulista, 2300 - Bela Vista, Sao Paulo, SP 01310-300, Brazil
| | - Sebastian Vernal
- Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91 - Bela Vista, Sao Paulo, SP 01308-050, Brazil
- BP - A Beneficência Portuguesa de São Paulo, Rua Maestro Cardim, 769 - Bela Vista, Sao Paulo, SP 01323-001, Brazil
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 910 - Moinhos de Vento, Porto Alegre, RS 90035-000, Brazil
- Hospital Alemão Oswaldo Cruz, Rua Treze de Maio, 1815 - Bela Vista, Sao Paulo, SP 01323-020, Brazil
- Hospital Israelita Albert Einstein, Avenida Paulista, 2300 - Bela Vista, Sao Paulo, SP 01310-300, Brazil
- Hcor, Rua Desembargador Eliseu Guilherme, 147 - Paraíso, Sao Paulo, SP 04004-030, Brazil
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Silva WG, Metzger JP, Simões S, Simonetti C. Relief influence on the spatial distribution of the Atlantic Forest cover on the Ibiúna Plateau, SP. BRAZ J BIOL 2008; 67:403-11. [PMID: 18094822 DOI: 10.1590/s1519-69842007000300004] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2005] [Accepted: 05/08/2007] [Indexed: 11/22/2022] Open
Abstract
Several studies suggest that, on a large scale, relief conditions influence the Atlantic Forest cover. The aim of this work was to explore these relationships on a local scale, in Caucaia do Alto, on the Ibiúna Plateau. Within an area of about 78 km(2), the distribution of forest cover, divided into two successional stages, was associated with relief attribute data (slope, slope orientation and altitude). The mapping of the vegetation was based on the interpretation of stereoscopic pairs of aerial photographs, from April 2000, on a scale of 1:10,000, while the relief attributes were obtained by geoprocessing from digitalized topographic maps on a scale of 1:10,000. Statistical analyses, based on qui-square tests, revealed that there was a more extensive forest cover, irrespective of the successional stage, in steeper areas (>10 degrees) located at higher altitudes (>923 m), but no influence of the slope orientation. There was no sign of direct influence of relief on the forest cover through environmental gradients that might have contributed to the forest regeneration. Likewise, there was no evidence that these results could have been influenced by the distance from roads or urban areas or with respect to permanent preservation areas. Relief seems to influence the forest cover indirectly, since agricultural land use is preferably made in flatter and lower areas. These results suggest a general distribution pattern of the forest remnants, independent of the scale of study, on which relief indirectly has a strong influence, since it determines human occupation.
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Affiliation(s)
- W G Silva
- Department of Ecology, Biosciences Institute, University of São Paulo, São Paulo, SP 05508-900, Brazil.
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