Implementation of tailored interventions in a statewide programme to reduce central line-associated bloodstream infections

Autor(es)

Assis, D. B. ^[1] ; Madalosso, G. ^[1] ; Padoveze, M. C. ^[2] ; Lobo, R. D. ^[3] ; Oliveira, M. S. ^[3] ; Boszczowski, I ^[3] ; Singer, J. M. ^[4] ; Levin, A. S. ^{[5, 6, 2, 7]}

Afiliação do(s) autor(es)

^[1] Sao Paulo State Hlth Dept, Ctr Dis Control, Ctr Epidemiol Surveillance Prof Alexandre Vranjac, Div Nosocomial Infect, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Sch Nursing, Dept Collect Hlth Nursing, Sao Paulo - Brazil

^[3] Univ Sao Paulo, Hosp Clin, Dept Infect Control, Sao Paulo - Brazil

^[4] Univ Sao Paulo, Dept Stat, Sao Paulo - Brazil

^[5] Univ Sao Paulo, Inst Trop Med, Sao Paulo - Brazil

^[6] Univ Sao Paulo, Dept Infect Dis, Sao Paulo - Brazil

^[7] Univ Sao Paulo, LIM54, Sao Paulo - Brazil

• Tipo de documento: Artigo Científico
• Fonte: Journal of Hospital Infection; v. 100, n. 3, p. E163-E168, NOV 2018.
• Citações Web of Science: 1

Resumo

Background: There have been few studies exploring implementation strategies to central line-associated bloodstream infections (CLABSIs) in low- or middle-income countries. Aim: To implement tailored interventions to reduce CLABSI rates in adult intensive care units. Methods: The implementation strategy of the State Health Department was performed in Sao Paulo State, Brazil, over two cycles. Cycle 1 (56 hospitals) was exploratory and cycle 2 (77 hospitals) was designed to confirm the hypothesis generated by the first cycle, with three phases each (pre-intervention, intervention, post-intervention). Cycles included: evaluation of healthcare workers' knowledge, observation of practices, and CLABSI rates monthly report. In cycle 1, a log-normal mixed model was used to select variables significantly associated with the reduction of CLABSI. In cycle 2, CLABSI rates were evaluated. Findings: Healthcare workers' practices improved after intervention. In cycle 1, reduction of CLABSI rates was more pronounced in hospitals with initial CLABSI rates >7.4 per 1000 catheter-days (P < 0.001) and those that introduced the use of peripherally inserted central catheters (P= 0.01). For hospitals with high CLABSI initial rates, simulation demonstrated that the rates were expected to decrease by 36% (95% CI: 9-63), no matter the type of intervention. In cycle 2, there was an overall decrease in CLABSI rates during the intervention period; whereas the mean rate fell further post-intervention, rates at the 90th percentile increased. Conclusion: The implementation strategy may have had an effect on infection rates independently of the specific interventions implemented; however, the sustainability of reduction in the post-intervention period remains a challenge. (C) 2018 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved. (AU)

• Processo FAPESP: 12/11294-2 - Avaliação do impacto de medidas de intervenção em unidades de terapia intensiva do estado de São Paulo
• Beneficiário: Anna Sara Shafferman Levin
• Modalidade de apoio: Auxílio à Pesquisa - Regular