Estudo de Implementação de Melhoria de Qualidade Para Redução do Uso de Antimicrobianos em Unidades de Terapia Intensiva

Status: Recruiting
Location: See all (10) locations...
Intervention Type: Other
Study Type: Interventional
Study Phase: Not Applicable
SUMMARY

The goal of this clinical trial is to learn if an educational intervention with audit and feedback on physicians and health care professionals who participate in antimicrobial treatment decisions can reduce the use of antimicrobials in adult patients admitted to a sample of Brazilian intensive care units (ICUs). The educational intervention is based on a literature review of current recommendations for a more rational use of antimicrobials and microbiological tests in daily ICU practice. The main questions it aims to answer are: * Does the educational intervention reduce the antimicrobial consumption in the intensive care units? * Does this educational intervention aiming to reduce antimicrobial utilization in accordance with the latest guidelines have any safety signals regarding ICU mortality rates or ICU length-of-stay? Researchers will compare (1) ICUs sequentially randomized to this quality improvement educational intervention aimed at improving antimicrobial utilization to (2) the same ICUs at months where the educational intervention has not been delivered yet. Each participant ICU will transition to the quality improvement intervention approximately each month, starting at July, 2025. This quality improvement intervention is based on current recommendations for antimicrobial stewardship from regulatory agencies and medical societies, including cognitive aids for physicians to improve decision-making regarding the commencement of antimicrobials, their duration and antimicrobial time-outs. The investigators hypothesize that intensivists (ICU doctors) need to embrace antimicrobial stewardship as a core competence of their daily activities.

Eligibility
Participation Requirements
Sex: All
Minimum Age: 18
Healthy Volunteers: f
View:

• ICU leadership acceptance to participant in the quality improvement intervention;

• Hospital infection control leadership acceptance to participant in the quality improvement intervention;

• ICU participation in the IMPACTO-MR platform with high quality data;

• ICU potential for quality improvement based on a subjective assessment of the ICU and hospital infection leaderships

• All patients admitted to the intensive care unit

Locations
Other Locations
Brazil
Santa Casa de Misericórdia de Barretos
RECRUITING
Barretos
Hospital Maternidade São José
RECRUITING
Colatina
Hospital Municipal de Maringá
RECRUITING
Maringá
Hospital Onofre Lopes
RECRUITING
Natal
Santa Casa de Misericórdia de Passos
RECRUITING
Passos
Hospital de Pronto Socorro
RECRUITING
Porto Alegre
Hospital da Restauração
RECRUITING
Recife
Hospital Pelópidas Silveira
RECRUITING
Recife
Hospital Naval Marcílio Dias
NOT_YET_RECRUITING
Rio De Janeiro
Hospital Santa Cruz
RECRUITING
Santa Cruz Do Sul
Contact Information
Primary
Camila Dietrich
camila.dietrich@hsl.org.br
+55 51 9723-2844
Backup
Bruno M Tomazini
Time Frame
Start Date: 2025-06-01
Estimated Completion Date: 2026-07
Participants
Target number of participants: 9000
Treatments
No_intervention: ICU Standard-of-care
The control group will be before the quality improvement intervention. Each ICU will be their own control and also the control group for ICUs that have already transitioned to the quality improvement arm.~During this period, before transitioning to the educational QI intervention, ICUs will continue their routine standard-of-care, including any ongoing continuous quality improvement that takes part of the usual ICU management activities. Local ICUs have been disencouraged, though, to start any quality improvement initiatives aiming to improve antimicrobial consumption before their transition to the intervention phase.
Experimental: Educational Quality Improvement Intervention
Participant ICUs who have transitioned to the quality improvement intervention will be part of this arm after their first visit. The intervention will consist of cognitive aids regarding antimicrobial initiation and duration for ICU physicians and healthcare professionals involved with antimicrobial decision-making. There will also be a monthly cross-sectional evaluation of the fidelity of the intervention, with immediate feedback at each assessment to the participating ICU.
Related Therapeutic Areas
Sponsors
Collaborators: Hospital do Coracao, Beneficência Portuguesa de São Paulo, Hospital Israelita Albert Einstein
Leads: Hospital Sirio-Libanes

This content was sourced from clinicaltrials.gov