Eleven years impact of a stepwise educational program on healthcare associated infections and antibiotics consumption in an intensive care unit of a tertiary hospital in Brazil

Jakeline Neves Giovanetti; Pedro Henrique Della Libera; Matheus Liguori Feliciano da Silva; Ícaro Boszczowski; Luis Carlos Maia Cardozo Junior; Yuri de Albuquerque Pessoa Dos Santos; Daniel Neves Forte; Raquel de Nardi; Rogerio Zigaib; Marcelo Park

doi:10.1016/j.jcrc.2024.154783

Eleven years impact of a stepwise educational program on healthcare associated infections and antibiotics consumption in an intensive care unit of a tertiary hospital in Brazil

J Crit Care. 2024 Mar 19:82:154783. doi: 10.1016/j.jcrc.2024.154783. Online ahead of print.

Affiliations

¹ Intensive Care Unit, Emergency Department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
² Infection Control Department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
³ Intensive Care Unit, Emergency Department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil. Electronic address: marcelo.park@hc.fm.usp.br.

PMID: 38507842
DOI: 10.1016/j.jcrc.2024.154783

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.

Keywords: Anti-bacterial agents; Antimicrobial stewardship; Critical care outcomes; Intensive care unit; Mortality.