Bruno Adler Maccagnan Pinheiro Besen, Camila Dietrich, Carla Cristina Gomes Pinheiro, Débora Patrício Silva, Renata Rodrigues de Mattos, Clayse Carla da Silva Spadoni, Luiz Fernando Lima Reis, Pedro Aniceto Nunes Neto, Luis Eduardo Miranda Paciência, Eliana Bernadete Caser, Caio Cesar Ferreira Fernandes, Vanildes de Fátima Fernandes, Bianca Ramos Ferronato, Hugo Corrêa de Andrade Urbano, Cintia Magalhães Carvalho Grion, Elisangela Maria de Lima Medeiros, Antônio Carlos da Silva, Nicole Alberti Golin, Valéria Paes Lima, Emerson Boschi, André Sant'Ana Machado, Rafael Botelho Foernges, Lúcio Couto de Oliveira Junior, Everton Macêdo Silva, Francielle Constantino Pereira, Thiago Costa Lisboa, Antônio Paulo Nassar, Adriano José Pereira, Viviane Cordeiro Veiga, Beatriz Arns, Giovanna Marsola, Flávia Ribeiro Machado, Alexandre Biasi Cavalcanti, Luciano César Pontes Azevedo, Bruno Martins Tomazini
{"title":"Institutional Risk Factors Associated With Healthcare-Associated Infections in Brazilian ICUs: A Nested Cohort Within the IMPACTO-MR Platform.","authors":"Bruno Adler Maccagnan Pinheiro Besen, Camila Dietrich, Carla Cristina Gomes Pinheiro, Débora Patrício Silva, Renata Rodrigues de Mattos, Clayse Carla da Silva Spadoni, Luiz Fernando Lima Reis, Pedro Aniceto Nunes Neto, Luis Eduardo Miranda Paciência, Eliana Bernadete Caser, Caio Cesar Ferreira Fernandes, Vanildes de Fátima Fernandes, Bianca Ramos Ferronato, Hugo Corrêa de Andrade Urbano, Cintia Magalhães Carvalho Grion, Elisangela Maria de Lima Medeiros, Antônio Carlos da Silva, Nicole Alberti Golin, Valéria Paes Lima, Emerson Boschi, André Sant'Ana Machado, Rafael Botelho Foernges, Lúcio Couto de Oliveira Junior, Everton Macêdo Silva, Francielle Constantino Pereira, Thiago Costa Lisboa, Antônio Paulo Nassar, Adriano José Pereira, Viviane Cordeiro Veiga, Beatriz Arns, Giovanna Marsola, Flávia Ribeiro Machado, Alexandre Biasi Cavalcanti, Luciano César Pontes Azevedo, Bruno Martins Tomazini","doi":"10.1097/CCM.0000000000006881","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Healthcare-associated infections are common and potentially preventable, especially in low- and middle-income countries (LMICs), due to substandard staffing, structure, and process-of-care. We evaluated institutional risk factors associated with ventilator-associated pneumonia (VAP) and central line-associated bloodstream infection (CLABSI) rates.</p><p><strong>Design: </strong>Multicenter cohort study.</p><p><strong>Setting: </strong>Fifty Brazilian ICUs.</p><p><strong>Patients: </strong>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).</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>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.</p><p><strong>Conclusions: </strong>Processes-of-care and ICU structure measures are associated with the burden of VAP and CLABSI in LMICs.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0000,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Care Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/CCM.0000000000006881","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives: Healthcare-associated infections are common and potentially preventable, especially in low- and middle-income countries (LMICs), due to substandard staffing, structure, and process-of-care. We evaluated institutional risk factors associated with ventilator-associated pneumonia (VAP) and central line-associated bloodstream infection (CLABSI) rates.
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.
期刊介绍：
Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the ICU and CCU, including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient.
Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
