ABSTRACT
BACKGROUND: Hospital acquired infections (HAI) and liberal use of broad-spectrum antibiotics are common in intensive care unit(ICU)s of low-middle income countries. We investigated the long-term association of a stepwise multifaceted educational program with the incidence of HAIs and antibiotics use in a Brazilian ICU. We also evaluated the program's cost impact. METHODS: We retrieved data from a prospective daily collected database of a twelve bedrooms ICU, all admitted patients within a period of eleven years were enrolled. FINDINGS: From 03/15/2007 to 09/11/2019, we admitted 3059 patients where 2406 (79%) survived the ICU stay. Median age was 51 years-old, and median SAPS3 was 53. The initial density of catheter related blood infection (4.3 events / 1000 patients-day), urinary tract infection (9.2 event / 1000 patients-day) and ventilator associated pneumonia (54.9 events / 1000 patients-day) felt during the observed period to (0.35 events / 1000 patients-day), (0 events / 1000 patients-day), and (1.5 events / 1000 patients-day) respectively. The days of antibiotic therapy also decreased from 797.9 days of therapy / 1000 patients day to 292.3 days of therapy / 1000 patients day. The total cost per patient also decreased. The adjusted mortality rate was steady during the studied period from 23.2% to 22.9%. INTERPRETATION: A stepwise multifaceted educational program is an effective way to reduce hospital-associated infections, improve the rational use of antibiotics, and reduce costs. This impact occurred in a long term, and is probably consistent.
Subject(s)
Anti-Bacterial Agents , Cross Infection , Intensive Care Units , Tertiary Care Centers , Humans , Brazil/epidemiology , Middle Aged , Anti-Bacterial Agents/therapeutic use , Male , Female , Cross Infection/prevention & control , Cross Infection/epidemiology , Prospective Studies , Adult , Aged , Urinary Tract Infections/drug therapy , IncidenceABSTRACT
Este estudo objetivou visualizar a dinâmica da porta de entrada, saída e processo de trabalho em um serviço de emergência que integra o Programa SOS Emergências. O método utilizado foi o descritivo/ retrospectivo, desenvolvido no Pronto-Socorro Central da Irmandade da Santa Casa de Misericórdia de São Paulo (PSC-ISCMSP). A amostra foi coletada por meio de fichas de atendimentos e prontuários, na experiência de um dia na emergência. Dos 392 atendimentos, 76% foram liberados nas primeiras 24 horas, considerando a demanda de porta e os classificados como pouco urgente (22,3%) que permaneceram em observação. Dos 8 usuários que permaneceram internados na emergência após 72 horas, a maioria era por indisponibilidade de leito de retaguarda. Conclui-se que o Programa SOS Emergências tem alcançado resultados positivos na gestão de leitos, da qualidade da assistência e do acesso aos usuários, porém falta melhorar a gestão das portas de entrada e dos processos de saída.
This study aimed to observe the dynamics of the input, throughout and output in an emergency service thatis part of the SOS Emergencies Program. It was used a descriptive/retrospective method, developed at the Emergency Department of Santa Casa de São Paulo. The sample was collected using data sheets andmedical records, during one day in the emergency room. In the total of 392 calls, 76% were discharged within the first 24 hours, considering the demand and those classified as not urgent (22.3%) who remained under observation. Regarding the eight members who remained hospitalized in emergency after 72 hours, most of them were due to lack of bed in other departments. It is concluded that the SOS Emergencies Program has achieved positive results in the management of beds, quality of care and access to users but it could improve the management of input and output processes.
