Institutional Risk Factors Associated With Healthcare-Associated Infections in Brazilian ICUs: A Nested Cohort Within the IMPACTO-MR Platform.
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Besen Bruno Adler Maccagnan Pinheiro, Dietrich Camila, Pinheiro Carla Cristina Gomes, Silva Débora Patrício, de Mattos Renata Rodrigues, Spadoni Clayse Carla da Silva, Reis Luiz Fernando Lima, Nunes Neto Pedro Aniceto, Paciência Luis Eduardo Miranda, Caser Eliana Bernadete, Ferreira Fernandes Caio Cesar, Fernandes Vanildes de Fátima, Ferronato Bianca Ramos, Urbano Hugo Corrêa de Andrade, Grion Cintia Magalhães Carvalho, Medeiros Elisangela Maria de Lima, Silva Antônio Carlos da, Golin Nicole Alberti, Lima Valéria Paes, Boschi Emerson, Machado André Sant'Ana, Foernges Rafael Botelho, de Oliveira Junior Lúcio Couto, Silva Everton Macêdo, Pereira Francielle Constantino, Lisboa Thiago Costa, Nassar Antônio Paulo, Pereira Adriano José, Veiga Viviane Cordeiro, Arns Beatriz, Marsola Giovanna, Machado Flávia Ribeiro, Cavalcanti Alexandre Biasi, Azevedo Luciano César Pontes, Tomazini Bruno Martins, Impact of Infections by Antimicrobial-Resistant Microorganisms in Patients Admitted to Adult ICUs in Brazil: Platform of Projects to Support the National Action Plan for the Prevention and Control of Antimicrobial Resistance (IMPACTO-MR) investigators and Brazilian Research in Intensive Care Network (BRICNet)
Аннотация
DESIGN: Multicenter cohort study.
SETTING: Fifty Brazilian ICUs.
PATIENTS: All patients admitted from September 2019 to December 2021 to the participating ICUs, exposed to at least 2 days of invasive mechanical ventilation (MV) or central venous catheter (CVC).
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Individual patient data were prospectively collected, and cross-sectional hospital-level data were collected at baseline. VAP and CLABSI were reported in accordance with Brazilian regulatory agency guidance. Negative binomial or Poisson multiple regression were used to model risk factors, adjusted for individual-level covariates. Of 75,164 ICU admissions, there were 19,108 at-risk (≥ 48 hr of MV) patients with a total of 244,059 MV-days for a VAP incidence rate of 6.03 (95% CI, 5.73-6.35) per 1,000 MV-days. There were 26,560 patients with a total of 375,078 CVC-days for a CLABSI incidence rate of 1.63 per 1,000 CVC-days (95% CI, 1.51-1.77 per 1,000 CVC-days). The median rate ratios of hospital random-effects were 4.39 (95% CI, 2.72-6.06) for VAP and 3.53 (95% CI, 2.30-4.76) for CLABSI. Hospital-level fixed effects explained 39.9% (95% CI, 33.6-46.1%) of the between-hospital variability for VAP and 44.7% (95% CI, 35.0-54.5%) for CLABSI. Prevention protocols, flexible family visitation policies, and hand hygiene training were associated with reduced rates of VAP and CLABSI. Nursing staffing ratios, single-use gowns, and alcohol availability were associated with a lower CLABSI rate. Sedation titration by nurses, weaning by respiratory therapists, and dentist availability were associated with a lower rate of VAP.
CONCLUSIONS: Processes-of-care and ICU structure measures are associated with the burden of VAP and CLABSI in LMICs.