Estimating the savings of a national project to prevent healthcare-associated infections in intensive care units.

BACKGROUND: Healthcare-associated infections (HAIs) have a significant impact on patients' morbidity and mortality, and have a detrimental financial impact on the healthcare system. Various strategies exist to prevent HAIs, but economic evaluations are needed to determine which are most appropriate. AIM: To present the financial impact of a nationwide project on HAI prevention in intensive care units (ICUs) using a quality improvement (QI) approach. METHODS: A health economic evaluation assessed the financial results of the QI initiative 'Saúde em Nossas Mãos' (SNM), implemented in Brazil between January 2018 and December 2020. Among 116 participating institutions, 13 (11.2%) fully reported the aggregate cost and stratified patients (with vs without HAIs) in the pre-intervention and post-intervention periods. Average cost (AC) was calculated for each analysed HAI: central-line-associated bloodstream infections (CLABSIs), ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infections (CAUTIs). The absorption model and time-driven activity-based costing were used for cost estimations. The numbers of infections that the project could have prevented during its implementation were estimated to demonstrate the financial impact of the SNM initiative. RESULTS: The aggregated ACs calculated for each HAI from these 13 ICUs - US$8480 for CLABSIs, US$10,039 for VAP, and US$7464 for CAUTIs - were extrapolated to the total number of HAIs prevented by the project (1727 CLABSIs, 3797 VAP and 2150 CAUTIs). The overall savings of the SNM as of December 2020 were estimated at US$68.8 million, with an estimated return on investment (ROI) of 765%. CONCLUSION: Reporting accurate financial data on HAI prevention strategies is still challenging in Brazil. These results suggest that a national QI initiative to prevent HAIs in critical care settings is a feasible and value-based approach, reducing financial waste and yielding a significant ROI for the healthcare system.

Aortic reconstruction with crimped bovine pericardial conduits.

BACKGROUND AND AIM OF THE STUDY: A bovine pericardial conduit processed in glutaraldehyde was designed, incorporating the principle of crimping used for synthetic vascular prostheses. The crimping process did not affect the integrity of collagen fibers and tissue structure. This conduit, designed for aortic reconstruction, is available in different sizes, with or without a biological valve. METHODS: Between October 1989 and May 1997, 40 patients with aortic dissection, aortic aneurysm, aortic coarctation or aortoiliac occlusive disease underwent aortic reconstruction using this vascular substitute. Procedures included total reconstruction of the ascending aorta and aortic valve with reimplantation of coronary arteries (nine patients), single ascending thoracic aorta (six), descending thoracic aorta (two), aortic arch (one) and thoracoabdominal aorta (one); the abdominal aorta was reconstructed in 21 cases, including those undergoing aortoiliac or aortofemoral bypass. RESULTS: The hospital mortality rate was 20% (eight patients); causes of deaths were low cardiac output, recurrence of aortic dissection, multiple organ failure and bleeding. Mean follow up was 3.6 years; total follow up was 114 patient-years. Late conduit-related complications occurred in four patients, including a limb obstruction in one patient subjected to aortofemoral bypass and infection of three resulting in pseudoaneurysm (incidence of 3.5 +/- 1.8% per patient-year). All underwent reoperation. There were four late deaths due to sudden death, coronary artery disease, pneumonia and metabolic complications of diabetes and renal failure (incidence of 3.5 +/- 1.8% per patient year). The eight-year actuarial survival rate was 63.7 +/- 11.6%, including hospital mortality, and the eight-year actuarial freedom from conduit failure due to primary tissue structural degeneration was 100%. CONCLUSIONS: The crimping design provides a circular tube which makes construction of the anastomosis easier, retains its shape with bending, and avoids kinking. The material is very soft, easy to handle and suture, coapts nicely to suture lines resulting in a hemostatic anastomosis. The eight-year follow up demonstrated a satisfactory performance without report of fibrosis, calcification or aneurysmal dilation.