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Quality Improvement Intervention for a Safe Antimicrobial Use Reduction in Critically Ill Patients
Sponsor: Hospital Sirio-Libanes
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.
Official title: Estudo de Implementação de Melhoria de Qualidade Para Redução do Uso de Antimicrobianos em Unidades de Terapia Intensiva
Key Details
Gender
All
Age Range
18 Years - Any
Study Type
INTERVENTIONAL
Enrollment
9000
Start Date
2025-06-01
Completion Date
2026-07
Last Updated
2025-12-03
Healthy Volunteers
No
Interventions
Educational Quality Improvement Intervention
The intervention will be delivered at the cluster level. It will include an initiation visit, when educational sessions and an operations manual will be delivered to the ICU. These will consist of cognitive aids for antimicrobial initiation and duration decision-making, based on recent recommendations from guidelines, societies and regulatory authorities. In this visit, an assessment of barriers and facilitators for implementation of the behavioral change will be done, so that local adaptations can be done by the clinicians championing the implementation. Additionally, monthly, one-day audits will be done, which will be used to provide feedback to the ICU during the intervention phase regarding the suggested recommendations for antimicrobial decision-making.
Locations (9)
Hospital Maternidade São José
Colatina, Espírito Santo, Brazil
Santa Casa de Misericórdia de Passos
Passos, Minas Gerais, Brazil
Hospital Municipal de Maringá
Maringá, Paraná, Brazil
Hospital Pelópidas Silveira
Recife, Pernambuco, Brazil
Hospital Naval Marcílio Dias
Rio de Janeiro, Rio de Janeiro, Brazil
Hospital Onofre Lopes
Natal, Rio Grande do Norte, Brazil
Hospital de Pronto Socorro
Porto Alegre, Rio Grande do Sul, Brazil
Hospital Santa Cruz
Santa Cruz do Sul, Rio Grande do Sul, Brazil
Santa Casa de Misericórdia de Barretos
Barretos, São Paulo, Brazil