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Research article
Heloisa Ramos Lacerda
Corresponding Author
ORCiD: https://orcid.org/0000-0001-9275-9935
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Background: 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.
Methods: A quasi-experimental study in 5 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 of 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).
Result: 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.
Conclusions: 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.
Trial registration: Promoted by Brazilian Ministry of Health. Approved by the Hospital das Clínicas – UFPE Ethics Committee (No. 3,307,293).
Keywords
Healthcare-associated infections, Breakthrough Series, collaborative, intensive care units, prevention bundles
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CURRENT STATUS: Published
View the published article at BMC Infectious Diseases.
No community comments so far
Editorial decision: Accept
On 10 Feb, 2021
Editor assigned
On 13 Jan, 2021
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On 13 Jan, 2021
Editor invited
On 13 Jan, 2021
Version 3
Posted 13 Jan, 2021
No comments provided
Editorial decision: Minor revision
On 13 Jan, 2021
Editor assigned
On 03 Jan, 2021
Submission checks complete
On 03 Jan, 2021
Editor invited
On 03 Jan, 2021
No comments provided
Editorial decision: Minor revision
On 29 Dec, 2020
Review #1 received
Received 15 Dec, 2020
Reviewers invited
Invitations sent on 26 Nov, 2020
Reviewer #1 agreed
On 26 Nov, 2020
Editor assigned
On 24 Sep, 2020
Submission checks complete
On 23 Sep, 2020
Editor invited
On 23 Sep, 2020
No comments provided
Editorial decision: Major revision
On 03 Sep, 2020
Review #2 received
Received 23 Aug, 2020
Review #1 received
Received 15 Aug, 2020
Reviewer #3 agreed
On 10 Aug, 2020
Reviewer #2 agreed
On 06 Aug, 2020
Reviewer #1 agreed
On 28 Jul, 2020
Reviewers invited
Invitations sent on 16 Jul, 2020
Editor assigned
On 09 Jul, 2020
Submission checks complete
On 08 Jul, 2020
Editor invited
On 08 Jul, 2020
First submitted
On 07 Jul, 2020
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PDF Downloads: ...
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Subject Areas
Infectious Diseases
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See the published version of this preprint at BMC Infectious Diseases.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Heloisa Ramos Lacerda
Corresponding Author
ORCiD: https://orcid.org/0000-0001-9275-9935
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Infectious Diseases.
No community comments so far
Editorial decision: Accept
On 10 Feb, 2021
Editor assigned
On 13 Jan, 2021
Submission checks complete
On 13 Jan, 2021
Editor invited
On 13 Jan, 2021
Version 3
Posted 13 Jan, 2021
No comments provided
Editorial decision: Minor revision
On 13 Jan, 2021
Editor assigned
On 03 Jan, 2021
Submission checks complete
On 03 Jan, 2021
Editor invited
On 03 Jan, 2021
No comments provided
Editorial decision: Minor revision
On 29 Dec, 2020
Review #1 received
Received 15 Dec, 2020
Reviewers invited
Invitations sent on 26 Nov, 2020
Reviewer #1 agreed
On 26 Nov, 2020
Editor assigned
On 24 Sep, 2020
Submission checks complete
On 23 Sep, 2020
Editor invited
On 23 Sep, 2020
No comments provided
Editorial decision: Major revision
On 03 Sep, 2020
Review #2 received
Received 23 Aug, 2020
Review #1 received
Received 15 Aug, 2020
Reviewer #3 agreed
On 10 Aug, 2020
Reviewer #2 agreed
On 06 Aug, 2020
Reviewer #1 agreed
On 28 Jul, 2020
Reviewers invited
Invitations sent on 16 Jul, 2020
Editor assigned
On 09 Jul, 2020
Submission checks complete
On 08 Jul, 2020
Editor invited
On 08 Jul, 2020
First submitted
On 07 Jul, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Infectious Diseases
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Infectious Diseases.
Background: 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.
Methods: A quasi-experimental study in 5 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 of 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).
Result: 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.
Conclusions: 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.
Trial registration: Promoted by Brazilian Ministry of Health. Approved by the Hospital das Clínicas – UFPE Ethics Committee (No. 3,307,293).
Figure 1
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