A National Implementation Project to Prevent Healthcare-Associated Infections in Intensive Care Units: A Collaborative Initiative Using the Breakthrough Series Model
Authors: Tuma Paula , Vieira Junior Jose M , Ribas Elenara , Silva Karen C C D , Gushken Andrea K F , Torelly Ethel M S , de Moura Rafaela M , Tavares Bruno M , Prandini Cristiana M , Borem Paulo , Delgado Pedro , Ue Luciana Y , de Barros Claudia G , Vernal Sebastian ,   Collaborative Study Group “Saúde em Nossas Mãos”, Petenate Ademir Jose , Teixeira Adriana Melo , Martins Alex , Toniolo Alexandra do Rosário , Brenner Aline , Pedroso Aline Cristina , de Pinho Ana Paula Neves Marques , Neto Antonio Capone , Ramos Beatriz , Weber Bernadete , Teixeira Cassiano , Saghabi Cilene , Silva Claudia Vallone , da Silva Kawski Cristiane Tejada , da Silva Daiana Barbosa , Peres Daniel , da Silva de Jesus Daniela Duarte , Regagnin Dejanira Aparecida , Rodrigues Eloiza Andrade Almeida , Morosov Erica Deji Moura , Bozola Fernanda Justo Descio , Fernandes Fernanda Paulino , Pereira Fernando Enrique Arriel , de Menezes Fernando Gatti , Franco Flavia Fernanda , Santos Giselle Franco , dos Santos Guilherme Cesar Silva Dias , de Paula Pinto Schettino Guilherme , dos Santos Helena Barreto , de Carvalho Andrade Karina , Ferraz Leonardo Jose Rolim , Hoffmeister Louise Viecili , de Albuquerque Souza Luciana Gouvea , Hammes Luciano , Oblonczyk Marcia Maria , de Camillis Márcio Luiz Ferreira , Yamashita Maria , da Silva Marianilza Lopes , de Souza Nidia Cristina , de Souza Pâmella Oliveira , dos Santos Bopsin Patrícia , Neto Pedro Aurélio Mathiasi , Kiehl Pryscila Bernardo , Rosa Regis Goulart , Tanjoni Renato , de Camargo Barp Roberta Cordeiro , Marques Roberta Gonçalves , Kelian Rogerio , Oliveira Roselaine Maria Coelho , Felix Thais Galoppini , Chaves Tuane Machado , Bezerra Vania Rodrigues , Baia Wania Regina Mollo , de Almeida Youri Eliphas 
Published: March 2023

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 &lt; .001, respectively), VAP prevention bundle (R = −0.69, P &lt; .001), and CA-UTI insertion and maintenance bundle (R = −0.82, P &lt; .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.