Brazilian Health Regulatory Agency, Brasília, Brazil; Graduate Program in Quality Management in Health Services, Federal University of Rio Grande do Norte, Natal, Brazil.
Brazilian Health Regulatory Agency, Brasília, Brazil.
J Hosp Infect. 2020 May;105(1):24-34. doi: 10.1016/j.jhin.2020.03.005. Epub 2020 Mar 6.
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.
To analyse the effect of a national system-wide QI initiative aimed at promoting HCAI prevention via regulatory interventions in Brazil.
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.
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).
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.
质量改进（QI）方法被推荐用于解决医院内的医疗保健相关感染（HCAI）问题，但尽管内部举措已得到广泛研究，但从外部系统角度来看，关于 QI 方法的应用和效果的证据很少。
分析巴西一项旨在通过监管干预促进 HCAI 预防的全国性系统范围 QI 计划的效果。
巴西卫生监管机构（ANVISA）采用了一种质量改进周期方法，该方法是在前后准实验设计下设计和评估的，针对 1869 家医院实施。共制定和评估了 11 个与 HCAI 预防相关的基于证据的质量指标和一个综合指标；然后基于参与式多方面监管行动来确定需要改进的措施。干预后估计了绝对和相对改进。
共有 563 家医院（30.1%的回应率）总计 86837 张床位参加了基线评估，681 家医院（36.4%的回应率）总计 101231 张床位参加了第二次评估。11 项标准中的 10 项（P < 0.05）以及综合指标（P=0.001）在该国所有地区均有所改善，尤其是在参与基线的医院组中。“手卫生（HH）基础设施”达到了 100%（基线：97.9；P=0.001），“HH 方案”达到了 96.9%（基线：92.9；P=0.001），“HH 监测”达到了 70%（基线：60.7；P < 0.001），“存在抗菌药物处方方案”达到了 80.7%（基线：73.2；P < 0.001）等。参与医院的 HCAI 发生率在干预后下降（P < 0.05）。
质量改进周期方法有助于指导患者安全的系统范围干预。外部监管在全国范围内促进内部 HCAI 预防是可行且有效的。
