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Observational Study
. 2022 Sep 12;34(3):327-334.
doi: 10.5935/0103-507X.20220070-pt. eCollection 2022.

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

[Article in Portuguese, English]
Ladjane Santos Wolmer de Melo  1 , Thaís Moreira Estevão  2 , Juliana Sousa de Castro Chaves  3 , Janaina Maria Silva Vieira  1 , Marialba de Morais Siqueira  4 , Iêda Ludmer Guedes Alcoforado  5 , Cláudia Fernanda de Lacerda Vidal  1 , Heloisa Ramos Lacerda  6
Affiliations
Observational Study

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

[Article in Portuguese, English]
Ladjane Santos Wolmer de Melo et al. Rev Bras Ter Intensiva. .

Abstract
in English, Portuguese

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.

Objetivo: Descrever a implementação e os resultados da colaborativa PROADI-SUS, do Ministério da Saúde Brasileiro, para redução das infecções relacionadas à assistência à saúde: pneumonia associada à ventilação mecânica, infecção primária da corrente sanguínea associada ao cateter venoso central e infecção do trato urinário associada ao cateter vesical de demora.

Métodos: Estudo observacional prospectivo que pesquisou as etapas da implementação e dos resultados por 18 meses, em cinco unidades de terapia intensiva de Recife. As reduções de infecções relacionadas à assistência à saúde em cada unidade foram calculadas pelas medianas anteriores comparadas ao período do estudo.

Resultados: A meta de redução das três infecções relacionadas à assistência à saúde, ou seja, 30% em 18 meses, foi obtida em no mínimo uma das infecções relacionadas à assistência à saúde nas cinco unidades de terapia intensiva, sendo ainda atingida para duas infecções relacionadas à assistência à saúde em dois hospitais e nas três infecções relacionadas à assistência à saúde em apenas um hospital; este último atingiu a meta prevista para 36 meses. Foram ações consideradas essenciais pelas equipes gestoras locais a implantação dos bundles e o acompanhamento dos resultados pelos profissionais. Também, aquisição de insumos e disponibilização junto aos leitos, sinalização, checklists, conscientização da equipe, adaptação, criação de times, treinamento e comemoração de conquistas foram avaliados como relevantes para redução das infecções relacionadas à assistência à saúde.

Conclusão: A colaborativa reduziu infecções relacionadas à assistência à saúde, apesar da adesão parcial aos bundles. A hipótese é a de que o êxito se relacione com a metodologia do projeto e equipes multiprofissionais motivadas, especialmente a enfermagem.

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Conflict of interest statement

Conflicts of interest: None.

Figures

Figure 1
Figure 1
Incidence density of ventilator-associated pneumonia in the five intensive care units, from January 2017 to June 2019.
Figure 3
Figure 3
Incidence density of primary bloodstream infection in the five intensive care units, from January 2017 to June 2019.
Figure 2
Figure 2
Incidence density of urinary tract infection in the five intensive care units, from January 2017 to June 2019.
See this image and copyright information in PMC

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