The impact of the coronavirus disease 2019 (COVID-19) pandemic on a national project preventing healthcare-associated infections in intensive care units.

Beginning in 2018, a quality improvement collaborative initiative in Brazil successfully reduced the baseline incidence density of healthcare-associated infections in intensive care settings after 2 years. We describe the adaptations of the quality improvement interventions as the COVID-19 pandemic emerged and how the pandemic affected the project outcomes.

A National Implementation Project to Prevent Healthcare-Associated Infections in Intensive Care Units: A Collaborative Initiative Using the Breakthrough Series Model.

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

Neutrophil apoptosis: a marker of disease severity in sepsis and sepsis-induced acute respiratory distress syndrome.

INTRODUCTION: Apoptosis of neutrophils (polymorphonuclear neutrophils [PMNs]) may limit inflammatory injury in sepsis and acute respiratory distress syndrome (ARDS), but the relationship between the severity of sepsis and extent of PMN apoptosis and the effect of superimposed ARDS is unknown. The objective of this study was to correlate neutrophil apoptosis with the severity of sepsis and sepsis-induced ARDS. METHODS: A prospective cohort study was conducted in intensive care units of three tertiary hospitals in Porto Alegre, southern Brazil. Fifty-seven patients with sepsis (uncomplicated sepsis, septic shock, and sepsis-induced ARDS) and 64 controls were enrolled. Venous peripheral blood was collected from patients with sepsis within 24 hours of diagnosis. All surgical groups, including controls, had their blood drawn 24 hours after surgery. Control patients on mechanical ventilation had blood collected within 24 hours of initiation of mechanical ventilation. Healthy controls were blood donors. Neutrophils were isolated, and incubated ex vivo, and apoptosis was determined by light microscopy on cytospun preparations. The differences among groups were assessed by analysis of variance with Tukeys. RESULTS: In medical patients, the mean percentage of neutrophil apoptosis (+/- standard error of the mean [SEM]) was lower in sepsis-induced ARDS (28% +/- 3.3%; n = 9) when compared with uncomplicated sepsis (57% +/- 3.2%; n = 8; p < 0.001), mechanical ventilation without infection, sepsis, or ARDS (53% +/- 3.0%; n = 11; p < 0.001) and healthy controls (69% +/- 1.1%; n = 33; p < 0.001) but did not differ from septic shock (38% +/- 3.7%; n = 12; p = 0.13). In surgical patients with sepsis, the percentage of neutrophil apoptosis was lower for all groups when compared with surgical controls (52% +/- 3.6%; n = 11; p < 0.001). CONCLUSION: In medical patients with sepsis, neutrophil apoptosis is inversely proportional to the severity of sepsis and thus may be a marker of the severity of sepsis in this population.