Institutional Risk Factors Associated With Healthcare-Associated Infections in Brazilian ICUs: A Nested Cohort Within...

Area of Science:

• Infection Control and Hospital Epidemiology
• Intensive Care Medicine
• Global Health

Background:

• Healthcare-associated infections (HAIs), including ventilator-associated pneumonia (VAP) and central line-associated bloodstream infections (CLABSI), pose significant risks, particularly in low- and middle-income countries (LMICs).
• Substandard staffing, infrastructure, and care processes contribute to the high burden of HAIs in these settings.
• Identifying institutional risk factors is crucial for developing targeted prevention strategies.

Purpose of the Study:

• To evaluate institutional risk factors associated with ventilator-associated pneumonia (VAP) and central line-associated bloodstream infection (CLABSI) rates in Brazilian intensive care units (ICUs).
• To determine the impact of specific processes of care and ICU structural elements on VAP and CLABSI incidence.

Main Methods:

• A multicenter cohort study was conducted across 50 Brazilian ICUs from September 2019 to December 2021.
• Data included individual patient information and cross-sectional hospital-level data. Patients exposed to invasive mechanical ventilation (MV) or central venous catheter (CVC) for at least 48 hours were included.
• Negative binomial or Poisson regression models were used to analyze risk factors, adjusted for individual-level covariates.

Main Results:

• The study analyzed 75,164 ICU admissions, identifying VAP incidence at 6.03 per 1,000 MV-days and CLABSI incidence at 1.63 per 1,000 CVC-days.
• Significant between-hospital variability was observed, with hospital-level factors explaining substantial portions of this variation for both VAP (39.9%) and CLABSI (44.7%).
• Prevention protocols, flexible visitation, hand hygiene training, nursing staffing, single-use gowns, alcohol availability, nurse-led sedation titration, respiratory therapist-led weaning, and dentist availability were associated with reduced infection rates.

Conclusions:

• Processes of care and ICU structural measures are significantly associated with the burden of VAP and CLABSI in LMICs.
• Targeted interventions focusing on these modifiable factors can effectively reduce HAI rates in resource-limited settings.
• The findings underscore the importance of a systems-based approach to infection prevention in ICUs.