EFFECTIVENESS OF A COLLABORATIVE APPROACH IN REDUCING HEALTHCARE-ASSOCIATED INFECTIONS AND IMPROVING SAFETY IN BRAZILIAN ICUS: THE SALUS VITAE STORY

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Background Healthcare-associated infections (HAI) are a common preventable complication of hospital care and represent a major threat to patient safety, especially in low- and middle-income countries. In June 2015, in partnership with IHI, a Brazilian health system launched a program to reduce HAI and improve patient safety in 13 intensive care units (ICUs) from 12 hospitals using a collaborative approach. Objectives To reduce the rate of central line-associated bloodstream infections (CLABSI), ventilator-associated pneumonias (VAP) and catheter-associated urinary tract infections (CAUTI) by 50% by December 2016. Methods We used an 18-month Breakthrough Collaborative Series (BTS) approach that promoted the adoption of bundles of care, coupled with leadership engagement, innovation and capacity building. Results 13 ICUs participated in the collaborative. Gaps in infrastructure, staffing, and critical care knowledge were identified. Four learning sessions were held. Data from July 2016 shows a 49% reduction in the CLABSI rate, 33% in the VAP rate and 45% in the CAUTI rate. Conclusions The BTS approach proved to be effective in reducing HAI in ICUs in Brazil. Based on the results to date, our degree of belief that the Collaborative will achieve its goals for CLABSI and CAUTI is high, but not for VAP. Reducing VAP proved to be more challenging because it demands multidisciplinary teamwork and specific knowledge about certain elements of the bundle such as weaning and sedation. Future collaboratives in these settings might benefit from assessing and closing the gaps in clinical knowledge and infrastructure capacity, and from assessing teams9 readiness for quality improvement prior to their implementation.

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