Results of a national system-wide quality improvement initiative for the implementation of evidence-based infection prevention practices in Brazilian hospitals.

Autor: de Miranda Costa MM; Brazilian Health Regulatory Agency, Brasília, Brazil; Graduate Program in Quality Management in Health Services, Federal University of Rio Grande do Norte, Natal, Brazil., Santana HT; Brazilian Health Regulatory Agency, Brasília, Brazil., Saturno Hernandez PJ; National Institute of Public Health, Morelos, Mexico., Carvalho AA; Brazilian Health Regulatory Agency, Brasília, Brazil. Electronic address: Andre.Carvalho@anvisa.gov.br., da Silva Gama ZA; Graduate Program in Quality Management in Health Services, Federal University of Rio Grande do Norte, Natal, Brazil; Department of Collective Health, Federal University of Rio Grande do Norte, Natal, Brazil. Electronic address: zasgama@gmail.com.
Jazyk: angličtina
Zdroj: The Journal of hospital infection [J Hosp Infect] 2020 May; Vol. 105 (1), pp. 24-34. Date of Electronic Publication: 2020 Mar 06.
DOI: 10.1016/j.jhin.2020.03.005
Abstrakt: Background: Quality improvement (QI) methods are recommended to address healthcare-associated infections (HCAIs) in hospitals, but whereas internal initiatives have been widely studied, there is little evidence on the application and effect of a QI approach from an external system-wide perspective.
Aim: To analyse the effect of a national system-wide QI initiative aimed at promoting HCAI prevention via regulatory interventions in Brazil.
Methods: A QI cycle approach designed and assessed with a before-and-after quasi-experimental design was implemented by the Brazilian Health Regulatory Agency (ANVISA), targeting 1869 hospitals. Eleven evidence-based quality indicators related to HCAI prevention and a composite measure were assembled, shared, and assessed; the intervention to improve was then based on participatory multifaceted regulatory actions. Absolute and relative improvements were estimated after the intervention.
Findings: In all, 563 hospitals (30.1% response) totalling 86,837 beds participated in the baseline assessment, and 681 hospitals (36.4% response) totalling 101,231 beds in the second. Ten of the 11 criteria improved (P < 0.05), as well as the composite indicator (P = 0.001) in all the regions of the country, particularly in the group of hospitals participating at baseline. 'Hand hygiene (HH) infrastructure' reached 100% (baseline: 97.9; P = 0.001), 'HH protocol' 96.9% (baseline: 92.9; P = 0.001), 'HH monitoring' 70% (baseline: 60.7; P < 0.001) and 'existence of antimicrobial prescription protocol' 80.7% (baseline: 73.2; P < 0.001), among others. The HCAI rates of the participating hospitals decreased after the intervention (P < 0.05).
Conclusion: The QI cycle approach was useful in guiding system-wide interventions for patient safety. External regulation was feasible and effective in promoting internal HCAI prevention nationwide.
(Copyright © 2020 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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