![Page 1: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/1.jpg)
Preventionofhealthcareassociatedinfectionandofantimicrobialresistance:anewmanagementapproach
José Artur PaivaMedicalDirector - CentroHospitalarSãoJoãoFaculty of Medicine– University of Porto
Infection and Sepsis I&DGroupSTOPInfeçãoHospitalarMonitoring Committee – FundaçãoCalousteGulbenkian
Porto- Portugal
![Page 2: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/2.jpg)
Deathsattributabletoantimicrobialresistanceeveryyear,by2050
In 2014, in the EU,AMR is
responsible for 25 000 deaths and > EUR 1.5 billion of
healthcare costs and
productivity losses
annually
By2050,itcouldresultinareductionoftheEuropeanGDPby1%to4.5%
![Page 3: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/3.jpg)
Antimicrobial consumption and antimicrobial resistance
![Page 4: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/4.jpg)
EUandWHO“OneHealth”approach
Theagendatodecreaseantibioticuseincludes:n preventinginfectionsandtheirspreadn improvingmonitoringandsurveillancen avoidingunnecessaryuseofantibiotics:usingthemonlywhenneeded,forthe
lesstimepossibleandwiththeleastpossiblespectrumn developingresearchandinnovationtowardsneweffectiveantibioticsn developingnewwaystotackleinfectionwithoutharmingbacteria
Givenitsseverity,AMRisapoliticalhighprioritywithintheEUandalsofortheWHO,thatareusingthe"OneHealth"approach,whichrecognizesthatthehealthofpeople,animalsandtheenvironmentareinextricablylinkedandthatantibioticsareusedinhumanmedicine,veterinaryandagriculture.
CounciloftheEU.CouncilRecommendationof15November2001(2002/77/EC).OfficialJournaloftheEuropeanCommunities.2002(45):13-6.
![Page 5: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/5.jpg)
HAIprevalence Antibioticconsumption
Portugal EU Portugal EU
Homem 12,4% 7,2% 48,3% 39,2%
Mulher 8,8% 5,4% 42,3% 33,2%
PopulaçãoGlobal 10,5% 6,1% 45,3% 35,8%
ECDC Point Prevalence Study PPCIRA/DGS, ECDC 2012
Portugal2011-2012:HighprevalenceofHAIandhighhospitalantibioticconsumption
![Page 6: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/6.jpg)
2012: High ambulatory antibiotic consumption, and
very high quinolone consumption
Insira o seu texto
ESAC Net 2012, ECDC
Global consumption in DDD Quinolone consumption in DDD
![Page 7: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/7.jpg)
Highhospitalconsumptionofcarbapenems,2010-2012
“In2012,consumptionofcarbapenemsvariedbyafactorof14,from0.01(Bulgaria)to0.14DDDper1000inhabitantsandperday(Portugal)“
“Theproportionofconsumptionofcarbapenemsoutofantibacterialsforsystemicuserangedfrom0.8%(Latvia)to9.8%(Portugal)withanEU/EEApopulation-weightedmeanof2.9%.”
2010
Carbapenems
ESAC Net 2012, ECDC
![Page 8: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/8.jpg)
8
HighindexofantimicrobialresistanceFromPPS2011-2012,ECDC
ESKAPE
![Page 9: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/9.jpg)
MortalityassociatedwithHCAIversusthatassociatedwithroadtrafficaccidents
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
2010 2011 2012 2013
Roadtrafficaccidents Infections
ANSR e PPCIRA/DGS
Estimated costs of 300 million euros
per year associated with HCAI
![Page 10: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/10.jpg)
WeaknessesandthreatsofICfightinPortugal:early2013report
n Understaffing and underpowerment of the centralandperipheral ICstructures
n Low level of integration and synergy of the several processes;noholistic vision;toomany process leaders
n Low strategic sustainability;Absence of focus inthe mostrelevant issues;low involvement of the citizen
n Problems of datasharing among state institutions and of datafeedbacktothe providers;low reliability of indicators
n Difficulties inimplementing acollaborative model, increasingcapacity building and maximizing participation andtransparency
n Reimbursement system not reflecting the indicators and targetsand not boosting motivation
PaivaJAetal.PPCIRAlaunchingreport,feb.2013.DGH
![Page 11: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/11.jpg)
NATIONALPROGRAMONPREVENTIONOFINFECTIONANDOFANTIMICROBIALRESISTANCE(PPCIRA)
NATIONALPROGRAMON
INFECTIONCONTROL
NATIONALPROGRAMONPREVENTIONOFANTIMICROBIALRESISTANCE
+
8Fev.2013
1999 2008
PPCIRA:ANationalPriorityProgram
![Page 12: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/12.jpg)
ReduceHCAI Reduceantibioticconsumption
Reducetheemergenceofantibioticresistance
Evictionofantibioticuseintheabsenceofbacterial
infection
ReducetransmissionofMDRmicrorganisms
Reductionofantibioticdurationandspectrum
ReducetheincidenceofMDRmicrorganisms
EPIDEMIOLOGICALSURVEILLANCE
TacklingAMRbyreducingantibioticconsumption
![Page 13: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/13.jpg)
TacklingAMRbyreducingantibioticconsumption,bylaunching:
(a) a Joint Alliance in the spirit of One Health to commit different stakeholders that agreed on a ten-point memorandum;
(b) an Antibiotic Awareness Campaign for the citizen;
(c) a national Antimicrobial Stewardship (AMS) programme.
![Page 14: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/14.jpg)
(b)TheCitizen’sAntibioticAwarenessCampaign
n Itwasanationalcampaign,involvingprimarycarecenters,hospitals,schoolsandbigeventsarenasin2011-2012.
n Globalslogan“Moreantibiotics,lesshealth”.n Verysimplekeymessages,namely“donotself-medicatewith
antibiotics”,“unusedantibioticsshouldbereturnedtothepharmacy”and“donottreatcoldswithantibiotics”.
n 5millionflyersand10000posters;200billboardsandpublictransportsignswereplacardedinthe3mainportuguese cities;adailyTVspotwaspresentedfor30days.
n Attheendofthecampaign,atotalof226insertions/newswereissuedinthemedia,includingTV,radio,pressandinternet.
n Thecampaignwasrepeated,atasmallerscale,twoyearslater,inthewinter2013-14.
![Page 15: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/15.jpg)
(c)TheAntimicrobialStewardshipProgrammen Anation-wideprogramme,locallycustomized,usingrestrictivebut
mainlypersuasive/enablementtechniques,ledbyalocalexpertteamn Focused onsurgicalantibioticprophylaxis,ononehand,andon
quinolones andcarbapenems therapies,ontheotherhand.n Targetswereclearlydefined:10%reductionforquinolonesand5%for
carbapenems,withconcomitantnon-riseofglobalantibioticuse.n Nationalguidelineswere issuedfortheuseofantibioticsinsurgical
prophylaxisandondurationofantibiotictherapy(focusingontonotmorethan7days,exceptforasmallgroupofinfectiousdiseases).
n AtwodayeducationalcoursewasperformedbytheHeadoftheNationalProgramme ineachofthesevenhealthregions,discussingandteachingreasonsforquinolones andcarbapenems useandstrategiesforlimitingitsusetocasesinwhichtheyarereallynecessary.
n Asagoal,allprescriptionsofthesetwoclassesofantibioticsshouldbechecked,discussedwiththebedsidemedicalteamandeventuallyvalidatedbytheAMSteaminthefirst96hoursafterprescription.
![Page 16: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/16.jpg)
AMS:Howtouseit?
DeWaeleJetal,ICM2016
Think global,act localPatrick Geddes
Geddes believed in working with the environment, versus working against it
![Page 17: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/17.jpg)
AMSteam
Clinical Pathology
Service A
Service E
Service D
Service C
Service B
Medical Direction- Definition of aims, goals and targets- Empowerment- Macro changes
![Page 18: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/18.jpg)
Mainqualitygapsinantibioticstrategy
Presentation
History,physicalexamand
microbiologicalsamples
Antibiotic
Clinical evolutionand furtherculture andsusceptibilityresults andbiomarkers
48-72hours
Stop
Shorten
Narrow
RescueAntibioticchange
Incorrectempiricaltreatment:- 40% ofpatientswithBSI,- 50% ofthosewithHCABSI,- 70% ofthosewithfungemia
Wrong selection of patients that need antibiotic therapy
longtimetodirectedantibiotictherapy
![Page 19: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/19.jpg)
ConsumptionofantibioticsinPortugalindefineddailydoses(DDD)per1000habitantsperdayYear Global
communityconsumptionofantibiotics#
Communityconsumptionofquinolones
Globalhospital
consumptionofantibiotics
Hospitalconsumption
ofcabapenems
Hospitalconsumption
ofquinolones
2011 23,72 2,91 1,73 0,139 0,222012 23,04 2,61 1,67 0,142 0,182013 19,04 2,18 1,64 0,146 0,182014 20,32 2,12 1,55 0,139 0,172015 21,30 2,05 1,57 0,133 0,152016 ? ? ? ? ?
#From2013on,thedatareferstosellingfiguresandnot,asuntilthen,tostockingfigures30%
By the end of 2015:n 78% ofPortuguesehospitalshadimplementedAMSteamandprocessn Theprocessextendedtoprimarycarecenters:11% ofthemhadAMSn Theeducationalcourseonadequateantibioticusewasreplicatedinsideeach
ofthehealthregions,bysteeringlocalgroups
10% 9% 4% 32%
![Page 20: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/20.jpg)
ReduceHCAI Reduceantibioticconsumption
Reducetheemergenceofantibioticresistance
Evictionofantibioticuseintheabsenceofbacterial
infection
ReducetransmissionofMDRmicrorganisms
Reductionofantibioticdurationandspectrum
ReducetheincidenceofMDRmicrorganisms
EPIDEMIOLOGICALSURVEILLANCE
NATIONALANTIMICROBIALSTEWARDSHIPPROGRAMSTANDARD
PRECAUTIONSNATIONALCAMPAIGN
JOINTALLIANCE
ANTIBIOTICAWARENESSCAMPAIGN
![Page 21: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/21.jpg)
Until 2014, no significative reduction in HCAI
PPCIRA/DGS (HELICS & INCS)
Staph aureus
hospital acq bacteremia(per 1 000
patient days)
MRSA hospital acquired
bacteremia(per 1 000
patient days)
ICU Catheter related
infection(per 1 000
cateter days)
Ventilator associated pneumonia(per 1 000 intubation
days)
Catheter related
sepsis in neonatal ICU
(per 1 000 cateter days)
2008 2,1 11,2 10,082009 2,2 10,6 11,342010 1,4 8,7 11,292011 1,5 8,6 13,402012 0,27 0,17 1,0 8,7 11,462013 0,27 0,16 1,3 7,4 9,132014 0,27 0,15 1,9 7,1
![Page 22: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/22.jpg)
n The Gulbenkian Foundation invited the Institute for Healthcare Improvement (IHI) to become a program partner, due to its expertise in running large-scale collaborative improvement projects and its persistent focus on execution, measurement and results.
n In liaison with the National PPCIRA
n Aim: to reduce HAI by 50%, for a group of 12 selected Portugal NHS centers (19 hospitals) over a period of three years.
n Represented 25% to 30% of all inpatient episodes in Portuguese NHS hospitals
n The work commenced in late 2015, under the name of STOP Infeçao Hospitalar
Oursharednorth:toreduceHAIby50%
TheSTOPInfeçãoHospitalarProject
AGulbenkianFoundationProject
![Page 23: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/23.jpg)
Fourworkstreamsandfourhospitalsites
TheStopinfeção hospitalar isfocusedonfourmaintypesofHAI:
n Catheter-AssociatedUrinaryTractInfection(CAUTI);
n Centralline-associated bloodstreaminfection(CLA BSI);
n SurgicalSiteInfection(SSI),namelyHipandKnee replacement,Colon-recto andGallbladder;
n Ventilator-associatedpneumonia(VAP).
Thepilot-sites/departmentsinclude:• General Wards (CAUTI and
CLA BSI), • Intensive care units (CLA BSI
and VAP), • Orthopedic (SSI related to hip
and knee replacement) • General Surgery
(SSI related to colon-rectum and gallbladder)
Multidisciplinaryfrontlineteamsarebeingsupportedtodesign,testandimplementimprovedwork
processesdesignedtodeliversaferandmorereliablecaretothepatients.
![Page 24: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/24.jpg)
KeyelementsoftheSTOPprogramn anevidencebasedchangepackage
(e.g.bundlesforinsertionandmaintenanceofurinarycatheterandcentrallinecatheters,VAPpreventionandSSIprevention);
n arobustmeasurementanddatacollectionsystem(process,outcomeandbalancingmeasures);
n astrategyforbuildingcapacity(creationofasustainableinfra-structureforhealthcareimprovement,putinplacefirstatthe19participatinghospitalsandlaterspreadtootherhospitalsthroughoutthecountry);
n anevaluationplantomeasurethesuccessoftheQIinitiativeandtoidentifyareasforimprovementalongwithadisseminationplantopublishandsharepracticesandresultsachieved.
n Leadershipcommitment - apre-requisiteforparticipation
![Page 25: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/25.jpg)
SchematicRepresentationoftheBreakthroughSeriesCollaborativeSTOPInfeçãoHospitalar!
![Page 26: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/26.jpg)
Themodelforimprovementn A large number of teams from hospitals or
clinics seeking improvement in a focused area come together under a working environment where all members learn and all members teach.
n Teams are taught improvement methodology including The Model for Improvement.
n Interventions include participation at learning sessions, educational interventions and discussion of activities and progress at coaching conversations by telephone, webexcalls and face-to-face meetings.
• to build a learning community and system that is capable of future ongoing sustainable improvement
• to build improvement capability and improve organization cultures over time.
![Page 27: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/27.jpg)
DynamicMeasurementisakeyactivity
n Measurement and monitoring of the targetof change is akey activityn Statistical process control maps variations over time,combining
statistical significance tests with chronological analysis of graphs ofsummary data
n Annotating timingof interventions and showing targetand controllimits
n Measuring process complianceand outcome improvement
n Constant feedbacktoprovidersat service level
n Themonthlycollectionandanalysisofdataallowsrealtimelearningandimprovement Accelerate
Real-WorldEvidence
DeriveEvidencefromEachCareExperience
ElectronicHealthRecordembeddedinitiatives
![Page 28: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/28.jpg)
QualityBetter Worse
Action taken on all
occurrences
QualityImprovementthroughbreakthroughcollaborative
Alearningorganization,alearningcomunity
• ALLTEACH,ALLLEARN• Transparency• DistributedLeadership
Bestpracticesareharvestedandsharedthroughthecollaborativelearningsystem,boththroughthe
websiteandwebex callsandface-to-facemeetings
![Page 29: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/29.jpg)
High-ImpactLeadershipBehaviorsWhatleadersdotomakeadifference
Swensen,Pugh,McMullan,Kabcenell.High-ImpactLeadership:ImproveCare,ImprovetheHealthofPopulations&ReduceCosts.InstituteforHealthcareImprovement;2013.Available:www.ihi.org.
![Page 30: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/30.jpg)
MANAGEMENT
QUALITY IMPROVEMENT
CREATING A MOVEMENT
Results
Time
From holding to handing power
Holding power
Handing power
Sharing power
![Page 31: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/31.jpg)
What’s the Matter?
What matters to you?
WehaveaproblemwithHCAIandantibioticuse
WearetryingtoreduceHCAIandempiricalantibiotictherapy
AMSandSTOPteamsareintheservicedoingit
Wearetreatingonlythosethatclearlyhavebacterialinfectionandonlyaftercollectingmicroexams:AMSandSTOPteamsarehelping
TheMentalShiftattheServicelevel
![Page 32: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/32.jpg)
ResultsafterSTOPInfeçãoHospitalar,inseptember2017
![Page 33: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/33.jpg)
Catheter Related Infection Prevention –compliance with insertion budle
![Page 34: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/34.jpg)
Catheter Related Infection Prevention –compliance with maintenance budle
![Page 35: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/35.jpg)
Reduction of 61%
Catheter related infection –All 19 hospitals
![Page 36: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/36.jpg)
Compliance with the VAP prevention bundle
![Page 37: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/37.jpg)
Reduction of 51%
VAP – All 19 hospitals
![Page 38: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/38.jpg)
SSI in hip and knee replacement–compliance with SSI prevention bundle
![Page 39: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/39.jpg)
Reduction of 78%
SSI in hip and knee replacement–All 19 hospitals
![Page 40: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/40.jpg)
SSI in general surgery–compliance with the bundle
![Page 41: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/41.jpg)
Reduction of 65%
SSI in general surgery– All 19 hospitals
![Page 42: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/42.jpg)
CAUTI prevention-compliance with insertion bundle
![Page 43: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/43.jpg)
CAUTI prevention-compliance with maintenance bundle
![Page 44: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/44.jpg)
Reduction of 35%
CAUTI – All 19 hospitals
![Page 45: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/45.jpg)
Scaleandspreadn TheQIinitiativeSTOPHAIwillsystematicallyworktospreadthe
knowledgeregardingsafetyinterventionsthathavealreadybeentestedandimplementedonprototypeunitsineachparticipatinghospital– “scalableunits”- andthathaveachievedbothreliabilityinprocessesandchangeinoutcomes.
n Overtime,theambitionofSTOPHAIisthatitsresultswillinfluencedepartment/hospital/healthpoliciesandotherhealthcareinstitutionsthroughoutPortugal,whowilllearnfromtheinitiativeandbe“contaminated”byitsunderling methodology,practicesand“philosophy”.
SousaP,PaivaJA.ReducingHospital-AcquiredInfectioninPortugueseHospitals:ACollaborativeApproachtowardQualityImprovement.InHealthSystemsImprovementAcrosstheGlobe:SuccessStoriesfrom60Countries.Editedby JeffreyBraithwaite, etal.2017.CRCPress2017
![Page 46: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/46.jpg)
PPCIRAQuality IndexLaw March 2016
![Page 47: Prevention of health care associated infection and of antimicrobial resistance: a new ... · 2017-11-17 · Prevention of health care associated infection and of antimicrobial resistance:](https://reader035.vdocuments.net/reader035/viewer/2022070802/5f02b5647e708231d4059d9a/html5/thumbnails/47.jpg)
n Constantdynamicofqualityimprovement,followedbyqualitycontrol
n Qualityimprovementinitiativesn Changepackage(bundlesandestablishmentofcleartargets)n Iterative,incrementalPDSAcycles,usingeducationaland
behavioralinterventionsn Capacitybuildingn Datacollectionsystemn Dynamicandfeedbackedmeasurementn Highimpactleadershipcommitmentn Progressiveculturalchange
Infectionandantibioticresistanceprevention:Qualityimprovementcyclescanhelp
PPCIRA+STOPInfeçãoHospitalar
It´shappeninginPortugalwithsuccess