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Original Article
Success factors of a collaborative project to reduce healthcare-associated infections in intensive care units in Northeastern Brazil
- Ladjane Santos Wolmer de Melo
, - Thaís Moreira Estevão ,
- Juliana Sousa de Castro Chaves ,
- Janaina Maria Silva Vieira ,
- Marialba de Morais Siqueira , [ … ],
- Heloisa Ramos Lacerda
Abstract
Original ArticleSuccess factors of a collaborative project to reduce healthcare-associated infections in intensive care units in Northeastern Brazil
Rev Bras Ter Intensiva. 2022;34(3):327-334
DOI 10.5935/0103-507X.20220070-en
- Ladjane Santos Wolmer de Melo ,
- Thaís Moreira Estevão ,
- Juliana Sousa de Castro Chaves ,
- Janaina Maria Silva Vieira ,
- Marialba de Morais Siqueira ,
- Iêda Ludmer Guedes Alcoforado ,
- Cláudia Fernanda de Lacerda Vidal ,
- Heloisa Ramos Lacerda
Views1ABSTRACT
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.
Keywords:Health evaluationHealthcare-associated pneumoniaImplementation scienceInfectionsIntensive care unitsOutcome and process assessment (Health Care)Outcome assessment, health carePatient safetyProgram developmentQuality improvementRespiration, artificialSee moreViews1
Abstract
Original ArticleSuccess factors of a collaborative project to reduce healthcare-associated infections in intensive care units in Northeastern Brazil
Rev Bras Ter Intensiva. 2022;34(3):327-334
DOI 10.5935/0103-507X.20220070-en
- Ladjane Santos Wolmer de Melo ,
- Thaís Moreira Estevão ,
- Juliana Sousa de Castro Chaves ,
- Janaina Maria Silva Vieira ,
- Marialba de Morais Siqueira ,
- Iêda Ludmer Guedes Alcoforado ,
- Cláudia Fernanda de Lacerda Vidal ,
- Heloisa Ramos Lacerda
Views1ABSTRACT
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.
Keywords:Health evaluationHealthcare-associated pneumoniaImplementation scienceInfectionsIntensive care unitsOutcome and process assessment (Health Care)Outcome assessment, health carePatient safetyProgram developmentQuality improvementRespiration, artificialSee more
- Ladjane Santos Wolmer de Melo
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Original Articles
Characteristics and outcomes of patients treated with drotrecogin alpha and other interventions of the “Surviving Sepsis” campaign in clinical practice
Rev Bras Ter Intensiva. 2008;20(2):135-143
Abstract
Original ArticlesCharacteristics and outcomes of patients treated with drotrecogin alpha and other interventions of the “Surviving Sepsis” campaign in clinical practice
Rev Bras Ter Intensiva. 2008;20(2):135-143
DOI 10.1590/S0103-507X2008000200004
Views0See moreBACKGROUND AND OBJECTIVES: To face the high mortality of sepsis, interventions grouped as “Surviving Sepsis Campaign” have been suggested. The aim of the study was to describe the application of glycemic control, corticoid use in septic shock, inotropics and drotrecogin-alpha in sepsis. METHODS: We studied 110 patients with sepsis from Recife/Brazil, who received drotrecogin-alpha between 2003/2006. Data on management of sepsis considering Surviving Sepsis Campaign, drotrecogin-alpha, mortality at 28 days and severe bleeding were recorded. RESULTS: Mean APACHE II was 25.6 and mean SOFA was 9.2. Around 95% of the patients presented two or more organ dysfunctions and 98% presented septic shock. The majority (56%) were under 65 years. Abdominal (48%) and respiratory (28%) focus of infection were the most prevalent. Hydrocortisone was used in 61% of the patients, and 29 (48.3%) died. Of the 38 patients with prolonged shock that did not receive it, 28 (73.7%) died. Of the 97 patients who presented uncontrolled glycemia only 65% achieved strict glycemic control and the mortality was 51.6%. Fluid gain ranged from 600 ml to 9,400 ml in the first 24h. In only 30 patients was myocardial dysfunction detected. The infusion of drotrecogin alpha started within 24h in 45%, between 24 and 48h in 35% and after 48h in 20%. Death occurred in 57% and severe bleeding in 9%. CONCLUSIONS: Discrepancy between the recommendations of Surviving Sepsis Campaign and clinical practice was observed. Death rate was 57%, similar to that found in the literature for septic shock irrespective of the use of drotrecogin-alpha.
Views0Abstract
Original ArticlesCharacteristics and outcomes of patients treated with drotrecogin alpha and other interventions of the “Surviving Sepsis” campaign in clinical practice
Rev Bras Ter Intensiva. 2008;20(2):135-143
DOI 10.1590/S0103-507X2008000200004
Views0See moreBACKGROUND AND OBJECTIVES: To face the high mortality of sepsis, interventions grouped as “Surviving Sepsis Campaign” have been suggested. The aim of the study was to describe the application of glycemic control, corticoid use in septic shock, inotropics and drotrecogin-alpha in sepsis. METHODS: We studied 110 patients with sepsis from Recife/Brazil, who received drotrecogin-alpha between 2003/2006. Data on management of sepsis considering Surviving Sepsis Campaign, drotrecogin-alpha, mortality at 28 days and severe bleeding were recorded. RESULTS: Mean APACHE II was 25.6 and mean SOFA was 9.2. Around 95% of the patients presented two or more organ dysfunctions and 98% presented septic shock. The majority (56%) were under 65 years. Abdominal (48%) and respiratory (28%) focus of infection were the most prevalent. Hydrocortisone was used in 61% of the patients, and 29 (48.3%) died. Of the 38 patients with prolonged shock that did not receive it, 28 (73.7%) died. Of the 97 patients who presented uncontrolled glycemia only 65% achieved strict glycemic control and the mortality was 51.6%. Fluid gain ranged from 600 ml to 9,400 ml in the first 24h. In only 30 patients was myocardial dysfunction detected. The infusion of drotrecogin alpha started within 24h in 45%, between 24 and 48h in 35% and after 48h in 20%. Death occurred in 57% and severe bleeding in 9%. CONCLUSIONS: Discrepancy between the recommendations of Surviving Sepsis Campaign and clinical practice was observed. Death rate was 57%, similar to that found in the literature for septic shock irrespective of the use of drotrecogin-alpha.
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Characteristics of septic patients in an intensive care unit of a tertiary private hospital from Recife, northeast of Brazil
Rev Bras Ter Intensiva. 2006;18(1):52-58
Abstract
Characteristics of septic patients in an intensive care unit of a tertiary private hospital from Recife, northeast of Brazil
Rev Bras Ter Intensiva. 2006;18(1):52-58
DOI 10.1590/S0103-507X2006000100010
Views0See moreBACKGROUND AND OBJECTIVES: Establish the clinical, epidemiological and laboratorial characteristics of septic patients in an intensive care unit (ICU) of a tertiary care private hospital from Pernambuco, in the northeast of Brazil. METHODS: Cohort study without intervention that included adult patients admitted in the ICU with sepsis or that developed it during ICU stay, during a 6-month period. The patients were followed during all ICU stay period. Laboratory and clinical data were collected after sepsis diagnosis. ICU admission APACHE II score and the SOFA score during the three first days after inclusion in the study were collected. RESULTS: The study included 199 patients, of whom 67.8% were older than 65 years of age. More than a half (56.3%) survived the septic episode, mean APACHE II was 18.2 ± 6.3 and mean SOFA score was 6.3 ± 3.7. The disease related to the admission in ICU was medical in 85.4%, and the majority of patients had a chronic associated disease. In 79.3% the lungs were the source of sepsis and in 40% of patients the etiologic agent of sepsis was isolated. Amongst laboratory tests, thrombocytopenia (platelets < 100.000/mm³) was observed on 20.6%, fibrinogen was elevated (> 300 mg/dL) on 81.7%, and the activity of antithrombin was low (< 70%) on 32.5% of patients. CONCLUSIONS: The epidemiology of sepsis in this study, in a private hospital of Recife, was no different from what was recently described in Southeast and South of Brazil, United States and Europe.
Views0Abstract
Characteristics of septic patients in an intensive care unit of a tertiary private hospital from Recife, northeast of Brazil
Rev Bras Ter Intensiva. 2006;18(1):52-58
DOI 10.1590/S0103-507X2006000100010
Views0See moreBACKGROUND AND OBJECTIVES: Establish the clinical, epidemiological and laboratorial characteristics of septic patients in an intensive care unit (ICU) of a tertiary care private hospital from Pernambuco, in the northeast of Brazil. METHODS: Cohort study without intervention that included adult patients admitted in the ICU with sepsis or that developed it during ICU stay, during a 6-month period. The patients were followed during all ICU stay period. Laboratory and clinical data were collected after sepsis diagnosis. ICU admission APACHE II score and the SOFA score during the three first days after inclusion in the study were collected. RESULTS: The study included 199 patients, of whom 67.8% were older than 65 years of age. More than a half (56.3%) survived the septic episode, mean APACHE II was 18.2 ± 6.3 and mean SOFA score was 6.3 ± 3.7. The disease related to the admission in ICU was medical in 85.4%, and the majority of patients had a chronic associated disease. In 79.3% the lungs were the source of sepsis and in 40% of patients the etiologic agent of sepsis was isolated. Amongst laboratory tests, thrombocytopenia (platelets < 100.000/mm³) was observed on 20.6%, fibrinogen was elevated (> 300 mg/dL) on 81.7%, and the activity of antithrombin was low (< 70%) on 32.5% of patients. CONCLUSIONS: The epidemiology of sepsis in this study, in a private hospital of Recife, was no different from what was recently described in Southeast and South of Brazil, United States and Europe.
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Artigos originais
Risk factors associated to mortality on septic patients in an intensive care unit of a general private hospital from Pernambuco
Rev Bras Ter Intensiva. 2007;19(1):23-30
Abstract
Artigos originaisRisk factors associated to mortality on septic patients in an intensive care unit of a general private hospital from Pernambuco
Rev Bras Ter Intensiva. 2007;19(1):23-30
DOI 10.1590/S0103-507X2007000100003
Views0See moreBACKGROUND AND OBJECTIVES: Verify the association between clinical, epidemiological and laboratorial characteristics with mortality of septic patient in an Intensive Care Unit (ICU) from Pernambuco, northeast of Brazil, to improve the attention for patients with sepse which are in risk of developing organ dysfunction. METHODS: Case-control study, without intervention, that included adults’ patients admitted in ICU with sepsis or that developed it during ICU stay. RESULTS: It was included 199 patients. After logistic regression, the length of hospital stay more than 72 hours before admission in ICU, evidence of associated co-morbidities, more than three organ failures, and lactate more than 4 mmol/L were associated with mortality. The SOFA score with more than 12 points was associated with precocity mortality (< 72hours). CONCLUSIONS: The septic patients admitted ICU with less than 72h of hospital stay have a better prognosis, and those with a great number of organ failure, and co-morbidities have a superior mortality rate. Between laboratory results, only the high concentration of lactate is associated with mortality.
Views0Abstract
Artigos originaisRisk factors associated to mortality on septic patients in an intensive care unit of a general private hospital from Pernambuco
Rev Bras Ter Intensiva. 2007;19(1):23-30
DOI 10.1590/S0103-507X2007000100003
Views0See moreBACKGROUND AND OBJECTIVES: Verify the association between clinical, epidemiological and laboratorial characteristics with mortality of septic patient in an Intensive Care Unit (ICU) from Pernambuco, northeast of Brazil, to improve the attention for patients with sepse which are in risk of developing organ dysfunction. METHODS: Case-control study, without intervention, that included adults’ patients admitted in ICU with sepsis or that developed it during ICU stay. RESULTS: It was included 199 patients. After logistic regression, the length of hospital stay more than 72 hours before admission in ICU, evidence of associated co-morbidities, more than three organ failures, and lactate more than 4 mmol/L were associated with mortality. The SOFA score with more than 12 points was associated with precocity mortality (< 72hours). CONCLUSIONS: The septic patients admitted ICU with less than 72h of hospital stay have a better prognosis, and those with a great number of organ failure, and co-morbidities have a superior mortality rate. Between laboratory results, only the high concentration of lactate is associated with mortality.
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Case reports Child Coronavirus infections COVID-19 Critical care Critical illness Extracorporeal membrane oxygenation Infant, newborn Intensive care Intensive care units Intensive care units, pediatric mechanical ventilation Mortality Physical therapy modalities Prognosis Respiration, artificial Respiratory insufficiency risk factors SARS-CoV-2 Sepsis