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

Paula Tuma; Jose M Vieira Junior; Elenara Ribas; Karen C C D Silva; Andrea K F Gushken; Ethel M S Torelly; Rafaela M de Moura; Bruno M Tavares; Cristiana M Prandini; Paulo Borem; Pedro Delgado; Luciana Y Ue; Claudia G de Barros; Sebastian Vernal; Collaborative Study Group “Saúde em Nossas Mãos”

doi:10.1093/ofid/ofad129

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

Open Forum Infect Dis. 2023 Mar 9;10(4):ofad129. doi: 10.1093/ofid/ofad129. eCollection 2023 Apr.

Authors

Paula Tuma^{1

2}, Jose M Vieira Junior³, Elenara Ribas⁴, Karen C C D Silva⁵, Andrea K F Gushken⁶, Ethel M S Torelly³, Rafaela M de Moura⁴, Bruno M Tavares⁵, Cristiana M Prandini⁶, Paulo Borem², Pedro Delgado², Luciana Y Ue⁷, Claudia G de Barros¹, Sebastian Vernal^{5

6

1

4

3}; Collaborative Study Group “Saúde em Nossas Mãos”

Collaborators

Collaborative Study Group “Saúde em Nossas Mãos”:
Ademir Jose Petenate, Adriana Melo Teixeira, Alex Martins, Alexandra do Rosário Toniolo, Aline Brenner, Aline Cristina Pedroso, Ana Paula Neves Marques de Pinho, Antonio Capone Neto, Beatriz Ramos, Bernadete Weber, Cassiano Teixeira, Cilene Saghabi, Claudia Vallone Silva, Cristiane Tejada da Silva Kawski, Daiana Barbosa da Silva, Daniel Peres, Daniela Duarte da Silva de Jesus, Dejanira Aparecida Regagnin, Eloiza Andrade Almeida Rodrigues, Erica Deji Moura Morosov, Fernanda Justo Descio Bozola, Fernanda Paulino Fernandes, Fernando Enrique Arriel Pereira, Fernando Gatti de Menezes, Flavia Fernanda Franco, Giselle Franco Santos, Guilherme Cesar Silva Dias Dos Santos, Guilherme de Paula Pinto Schettino, Helena Barreto Dos Santos, Karina de Carvalho Andrade, Leonardo Jose Rolim Ferraz, Louise Viecili Hoffmeister, Luciana Gouvea de Albuquerque Souza, Luciano Hammes, Marcia Maria Oblonczyk, Márcio Luiz Ferreira de Camillis, Maria Yamashita, Marianilza Lopes da Silva, Nidia Cristina de Souza, Pâmella Oliveira de Souza, Patrícia Dos Santos Bopsin, Pedro Aurélio Mathiasi Neto, Pryscila Bernardo Kiehl, Regis Goulart Rosa, Renato Tanjoni, Roberta Cordeiro de Camargo Barp, Roberta Gonçalves Marques, Rogerio Kelian, Roselaine Maria Coelho Oliveira, Thais Galoppini Felix, Tuane Machado Chaves, Vania Rodrigues Bezerra, Wania Regina Mollo Baia, Youri Eliphas de Almeida

Affiliations

¹ Hospital Israelita Albert Einstein, São Paulo, Brazil.
² Institute for Healthcare Improvement, Cambridge, Massachusetts, USA.
³ Hospital Sírio-Libanês, São Paulo, Brazil.
⁴ Hospital Moinhos de Vento, Porto Alegre, Brazil.
⁵ Hospital Alemão Oswaldo Cruz, São Paulo, Brazil.
⁶ Hospital do Coração, São Paulo, Brazil.
⁷ Ministério da Saúde, Brasília, Brazil.

Abstract

Background: Although there are simple and low-cost measures to prevent healthcare-associated infections (HAIs), 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. In this study, our aim is to present the implementation of a project to prevent HAIs in intensive care units (ICUs) 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 1-year preintervention analysis was conducted to determine the incidence density baseline of the 3 main HAIs: central line-associated bloodstream infections (CLABSIs), ventilation-associated pneumonia (VAP), and catheter-associated urinary tract infections (CA-UTIs). 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 3 HAIs showed a significant decrease of 43.5%, 52.1%, and 65.8% for CLABSI, VAP, and CA-UTI, respectively. A total of 5140 infections were prevented. Adherence to bundles inversely correlated with the HAI incidence densities: CLABSI insertion and maintenance bundle (R = -0.50, P = .010 and R = -0.85, P < .001, respectively), VAP prevention bundle (R = -0.69, P < .001), and CA-UTI insertion and maintenance bundle (R = -0.82, P < .001 and R = -0.54, P = .004, respectively).

Conclusions: Descriptive data from the evaluation of this project show that the BTS methodology is a feasible and promising approach to preventing HAIs in critical care settings.

Keywords: central line-associated bloodstream infection; healthcare-associated infection; quality improvement; urinary tract infection; ventilator-associated pneumonia.