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Sustained reduction of healthcare-associated infections after the introduction of a bundle for prevention of ventilator-associated pneumonia in medical-surgical intensive care units

BACKGROUND: Infection control interventions can be erroneously interpreted if outcomes are assessed in short periods. Also, statistical methods usually applied to compare outcomes before and after interventions are not appropriate for analyzing time series. AIMS: To analyze the impact of a bundle di...

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Autores principales: Fortaleza, Carlos Magno Castelo Branco, Filho, Sebastião Pires Ferreira, Silva, Marina de Oliveira, Queiroz, Sandra Mara, Cavalcante, Ricardo de Souza
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9392082/
https://www.ncbi.nlm.nih.gov/pubmed/32949494
http://dx.doi.org/10.1016/j.bjid.2020.08.004
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author Fortaleza, Carlos Magno Castelo Branco
Filho, Sebastião Pires Ferreira
Silva, Marina de Oliveira
Queiroz, Sandra Mara
Cavalcante, Ricardo de Souza
author_facet Fortaleza, Carlos Magno Castelo Branco
Filho, Sebastião Pires Ferreira
Silva, Marina de Oliveira
Queiroz, Sandra Mara
Cavalcante, Ricardo de Souza
author_sort Fortaleza, Carlos Magno Castelo Branco
collection PubMed
description BACKGROUND: Infection control interventions can be erroneously interpreted if outcomes are assessed in short periods. Also, statistical methods usually applied to compare outcomes before and after interventions are not appropriate for analyzing time series. AIMS: To analyze the impact of a bundle directed at reducing the incidence of ventilator-associated pneumonia (VAP) and other device-associated infections in two medical-surgical intensive care units (ICU) in Brazil. METHODS: Our study had a quasi-experimental design. Interrupted time series analyses (ITS) was performed assessing monthly rates of overall healthcare-associated infections (HCAI), VAP, laboratory-confirmed central line associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI), from January 2007 through June 2019. Moreover, multivariate ITS was adjusted for seasonality in Poisson regression models. An intervention based on a bundle for VAP prevention was introduced in August 2010. FINDINGS: The intervention was followed by sustained reduction in overall HCAI, VAP and CLABSI in both ICU. Continuous post-intervention trends towards reduction were detected for overall HCAI and VAP. CONCLUSION: Interventions aimed at preventing one specific site of infection may have sustained impact on other HCAI, which can be documented using time series analyses.
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spelling pubmed-93920822022-08-23 Sustained reduction of healthcare-associated infections after the introduction of a bundle for prevention of ventilator-associated pneumonia in medical-surgical intensive care units Fortaleza, Carlos Magno Castelo Branco Filho, Sebastião Pires Ferreira Silva, Marina de Oliveira Queiroz, Sandra Mara Cavalcante, Ricardo de Souza Braz J Infect Dis Original Article BACKGROUND: Infection control interventions can be erroneously interpreted if outcomes are assessed in short periods. Also, statistical methods usually applied to compare outcomes before and after interventions are not appropriate for analyzing time series. AIMS: To analyze the impact of a bundle directed at reducing the incidence of ventilator-associated pneumonia (VAP) and other device-associated infections in two medical-surgical intensive care units (ICU) in Brazil. METHODS: Our study had a quasi-experimental design. Interrupted time series analyses (ITS) was performed assessing monthly rates of overall healthcare-associated infections (HCAI), VAP, laboratory-confirmed central line associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI), from January 2007 through June 2019. Moreover, multivariate ITS was adjusted for seasonality in Poisson regression models. An intervention based on a bundle for VAP prevention was introduced in August 2010. FINDINGS: The intervention was followed by sustained reduction in overall HCAI, VAP and CLABSI in both ICU. Continuous post-intervention trends towards reduction were detected for overall HCAI and VAP. CONCLUSION: Interventions aimed at preventing one specific site of infection may have sustained impact on other HCAI, which can be documented using time series analyses. Elsevier 2020-09-16 /pmc/articles/PMC9392082/ /pubmed/32949494 http://dx.doi.org/10.1016/j.bjid.2020.08.004 Text en © 2020 Sociedade Brasileira de Infectologia. Published by Elsevier España, S.L.U. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
Fortaleza, Carlos Magno Castelo Branco
Filho, Sebastião Pires Ferreira
Silva, Marina de Oliveira
Queiroz, Sandra Mara
Cavalcante, Ricardo de Souza
Sustained reduction of healthcare-associated infections after the introduction of a bundle for prevention of ventilator-associated pneumonia in medical-surgical intensive care units
title Sustained reduction of healthcare-associated infections after the introduction of a bundle for prevention of ventilator-associated pneumonia in medical-surgical intensive care units
title_full Sustained reduction of healthcare-associated infections after the introduction of a bundle for prevention of ventilator-associated pneumonia in medical-surgical intensive care units
title_fullStr Sustained reduction of healthcare-associated infections after the introduction of a bundle for prevention of ventilator-associated pneumonia in medical-surgical intensive care units
title_full_unstemmed Sustained reduction of healthcare-associated infections after the introduction of a bundle for prevention of ventilator-associated pneumonia in medical-surgical intensive care units
title_short Sustained reduction of healthcare-associated infections after the introduction of a bundle for prevention of ventilator-associated pneumonia in medical-surgical intensive care units
title_sort sustained reduction of healthcare-associated infections after the introduction of a bundle for prevention of ventilator-associated pneumonia in medical-surgical intensive care units
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9392082/
https://www.ncbi.nlm.nih.gov/pubmed/32949494
http://dx.doi.org/10.1016/j.bjid.2020.08.004
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