2024-09-22 04:30:00
Two hospitals in Neuquen and Rio Negro They took part in a national study aimed at improving the care of patients in critical care. They tested a collaborative model to better administer antibiotics to critically ill patients. Results published in journal BMJ Quality and Safety.
In total, more than 25 researchers began implementing the model based on World Health Organization recommendations. The trial was conducted in hospitals in the provinces of Buenos Aires, Jujuy and the city of Buenos Aires. The meeting was also attended by professionals from the Doctors Hospital of Castro Rendong, Neuquen Province, and the Francisco Lopez Lima Hospital, General Rio Negroca City.
The first authors of the study are Facundo Jorro-Baron, director of the Buenos Aires Institute of Clinical and Health Effectiveness (IECS) and Pedro de Eli Safety and Quality Researcher at Salde Children’s General Hospital.
The goal is to use as little antibiotics as possible, that is, only use what the patient needs. “Antibiotic resistance is a global problem and hospital deaths also occur due to the presence of multi-drug-resistant bacteria. “The purpose of the protocols we are involved in is not to work on treating patients per se, but rather on cyclical improvements in the process of care,” Comment to Diary of Rio Negro Dr. Fernando Perré is a critical care specialist and study co-author.
Professionals and patients from Neuquen Provincial Hospital Dr. Castro Rendon participated in the study.
This process lasts approximately nine months and consists of four cycles in total. It includes training, pre-intervention, first improvement cycle and post-intervention. “You have to identify these problems, even if they are small, and try to improve the process to get better results,” he said.
As part of the study, the incidence of pneumonia associated with mechanical ventilation; catheter-associated urinary tract infections or catheter-associated infections with multidrug-resistant bacteria and their treatment were measured. In the case of Neuquen Provincial Hospital, the average age of patients receiving this service is 45 to 55 years old.
What changes have been made
Since the use of antibiotics has become fairly widely regulated in hospitals, a priority is to continue to focus on the indications for antibiotic use. “The guidelines for the management of critically ill patients in our department have been updated. Once we have updated them, we implement them and see if our guidelines are fully adhered to. We have a 95% compliance rate,” Perré emphasized.
The process for sending bacteriology samples has also been improved. Prior to the study, many samples were received. Priority routes were mapped so that those coming from critical care could be planted quickly.
“We completed the process and achieved close to 80% adhesion,” the professional emphasized. Therefore, samples are processed as quickly as possible once they are incorporated into the improvement protocol. “Because the purpose is to start empiric antibiotic therapy and then quickly detect the bacteria,” he explained. For what purpose? Avoid unnecessary use of antibiotics as this can lead to antibiotic resistance.
The idea is that instead of delaying 48 to 72 hours to analyze the sample, within 24 hours at least a preliminary report can be written in the system. That is: what bacteria have been discovered so far. This is the third round of the investigation.
Improve infection prevention and control capabilities
The fourth cycle, and perhaps the most important, is already in critical care services, which have a culture of rapid adjustment of medications. Perré said almost 95 percent of people complied. “So, after improving all these processes, we achieved very good results,” he noted. Taking all phases into account, the study took a total of 52 weeks.
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The most common illness treated in this intensive care unit is pneumonia associated with mechanical ventilation. Perre said the service does not have multidrug-resistant bacteria per se but comes from inpatient floors or other facilities.
When multidrug-resistant bacteria are detected, care measures are intensified. “It’s very important to eliminate them to prevent transmission because if it’s endogenous, it’s harder to eradicate,” he said. As an example, he mentioned bacteria KPC, MLB, y Acinetobacter.
In itself, Romina Villegasfrom the intensive care unit Hospital doctor. Francisco Lopez Lima in RocaRio Negro, it is said Diary of Rio Negro: “The experience has been tremendous by participating in this study. It paves the way for us to improve quality and patient safety. Although we are not experiencing a major antimicrobial resistance problem, antibiotics are being used during the COVID-19 pandemic emergency.” usage increased. During the course of our investigation, we developed guidance and new forms of treatment monitoring that will help us further reduce antimicrobial resistance levels.
The Argentine Society of Intensive Care and the Argentine Society of Infectious Diseases also collaborated on the national study. To achieve this goal, they secured commitments from critical care service staff and residents, microbiology services, and pharmacy services at the different participating hospital centers.
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