ABSTRACT
Objective: To reduce the incidence density of ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI) in the intensive care unit (ICU) using the Improvement Science method. Methods: This was a single-center retrospective cohort study. A collaborative quality improvement team developed and implemented local changes to HAI-related processes and protocols. Pre-intervention, intervention, and post-intervention periods were compared. The study was conducted at the Adult ICU of a hospital in southern Brazil. Variables were analyzed using interrupted time series analysis with segmented linear regression, simple correlation, and hypothesis testing. Results: There was a reduction in the incidence density of all infections. VAP was reduced from 27.2% to 7.2% (p < 0.001), CLABSI from 3.0% to 0.9% (p = 0.017), and CAUTI from 8.3% to 1.8% (p < 0.001). The ICU stay was also reduced from 6.7 to 6 days (p = 0.018). Conclusion: There was an improvement in all the evaluated parameters. Ongoing monitoring of related indicators and adherence to implemented measures are essential to sustain improvements. Applying the Improvement Science methodology can reduce the incidence of HAIs in the ICU.
Subject(s)
HumansABSTRACT
Nosocomial infections are a great problem in the ICUs and hand washing is the best way to control it. The objective of this study is to evaluate the efficacy of an educative method in the routine of hand washing in the ICU before and after having contact with the patient The study was perfomed in a general ICU with eight beds and is composed of two parts. In the firs part an anonymous observer checked all the times an ICU professional had contact with the patients and washed or not his hands before and after this contact. This was repeated in the second part of the study after a doctor had oriented the professionals with lecture, written material and posters. At none part of the professionals were noticed about its existence. At the first part there were 515 contacts. Hand washing occurred in 25 (4,8 por cento) opportunities before and in 62 (12 por cento) after contact with the patients. In the second part there were 473 contacts with hand washing in 87 (18,5 por cento) times before and 141 (29,6 por cento) after having the contact. The aderence to hand washing was significantly better after orientation (p menor 0,0001) before and after the contacts but still is very unsatisfactory, showing the importance of frequently remembering the importance of this habit