A National Collaborative Project to Decrease Healthcare-Associated Infections in Intensive Care Units: Results from...

The collaborative "Stop Hospital Infection 2.0", implemented in Portugal between 2023 and 2025, aimed to reduce the incidence of catheter-associated urinary tract infection (CAUTI), ventilator-associated pneumonia (VAP) and central-line associated bloodstream infection (CLABSI) by 50.0% in 21 hospitals.

The project followed the Breakthrough Series methodology. Each team was to audit the national preventive bundles, using a Kamishibai card, and drive changes using plan-do-study-act cycles. Before the project, teams reported their 6-month baseline incidence levels. The main outcome was the incidence of infection. The secondary outcome was the proportion of teams that achieved a ≥50.0% reduction in incidence. The number of infections, deaths and bed-days potentially prevented, and costs saved during the project were estimated, along with the potential gains in the future.

Incidence rate for teams reporting at least 36 months decreased 47.6% in CAUTI (4.8 to 2.5 infections/1000 device-days), 66.1% in CLABSI (1.5 to 0.5 infections/1000 device-days) and 50.0% in VAP (9.9 to 5.0 infections/1000 intubation-days). The proportion of teams achieving a reduction of at least 50% in infection incidence was 60.0%, 100% and 57.1%, respectively. Teams reporting ≥24 months may have prevented 465 HAI, 108 deaths, 4526 bed-days and saved 8,375,841 euros. In the future, the teams who reported for at least 36 months may avoid 150 cases, 36 deaths, 1538 bed-days and 2,693,546 euros, yearly.

A national collaborative focused on evidence-based bundles may be effective in decreasing the incidence of CAUTI, CLABSI and VAP in adult intensive care units.