A National Implementation Project to Prevent Healthcare-Associated Infections in Intensive Care Units: A Collaborative Initiative Using the Breakthrough Series Model

Abstract

Background Although there are simple and low-cost measures to prevent healthcare-associated infections (HAI), they remain a major public health problem. Quality issues and a lack of knowledge about HAI control among healthcare professionals may contribute to this scenario. Aim To present the implementation of a project to prevent HAI in intensive care units (ICU) using the quality improvement (QI) collaborative model Breakthrough Series (BTS). Methods A QI report was conducted to assess the results of a national project in Brazil between January/2018 and February/2020. A one-year pre-intervention analysis was conducted to determine the incidence density baseline of the three main HAI: central line-associated bloodstream infections (CLABSI), ventilation-associated pneumonia (VAP), and catheter-associated urinary tract infections (CA-UTI). The BTS methodology was applied during the intervention period to coach and empower healthcare professionals providing evidence-based, structured, systematic, and auditable methodologies and QI tools to improve patients’ care outcomes. Results A total of 116 ICUs were included in this study. The three HAI showed a significant decrease of 43.5%, 52.1%, and 65.8% for CLABSI, VAP, and CA-UTI, respectively. A total of 5,140 infections were prevented. Adherence to bundles inversely correlated with the HAI incidence densities: CLABSI insertion and maintenance bundle (R = -0.50, P-value = 0.010 and R = -0.85, P-value <0.001, respectively), VAP prevention bundle (R = -0.69, P-value <0.001), and CA-UTI insertion and maintenance bundle (R = -0.82, P-value <0.001 and R = -0.54, P-value = 0.004, respectively). Conclusion Descriptive data from the evaluation of this project show that the BTS methodology is a feasible and promising approach to preventing HAI in critical care settings.

The impact of the coronavirus disease 2019 (COVID-19) pandemic on a national project preventing healthcare-associated infections in intensive care units

“…Overall, despite pandemic repercussions, based on the intervention impact on historical baselines until the end of the SNM 3-year project, we achieved a 31.6% reduction in CLABSI, a 41.8% reduction in CAP, and a 68.8% reduction in CAUTI. Additionally, an estimated 7,634 infections might have been prevented, and assuming a mortality rate for each HAI analyzed as previously reported, 4 we calculated the potential of 2,687 lives saved.…”

“…Further detailed information on QI methodology, patient care, and relevant clinical indicators of the SNM project are available in a previous publication. 4…”

“…Time-series modeling (ARIMA) and correlation between bundles and HH compliance were calculated as previously reported. 4…”

“…Time-series modeling (ARIMA) and correlation between bundles and HH compliance were calculated as previously reported. 4 Ethics This study was approved by the local Human Research Ethics Committee (CAAE no. 39657220.8.0000.5330).…”

“…Additionally, an estimated 7,634 infections might have been prevented, and assuming a mortality rate for each HAI analyzed as previously reported, 4 we calculated the potential of 2,687 lives saved.…”