Explore the vast range of titles available.

BackgroundThere is limited evidence from antimicrobial stewardship programmes in less-resourced settings. This study aimed to improve the quality of antibacterial prescriptions by mitigating overuse and promoting the use of narrow-spectrum agents in intensive care units (ICUs) in a middle-income country.MethodsWe established a quality improvement collaborative (QIC) model involving nine Argentine ICUs over 11 months with a 16-week baseline period (BP) and a 32-week implementation period (IP). Our intervention package included audits and feedback on antibacterial use, facility-specific treatment guidelines, antibacterial timeouts, pharmacy-based interventions and education. The intervention was delivered in two learning sessions with three action periods along with coaching support and basic quality improvement training.ResultsWe included 912 patients, 357 in BP and 555 in IP. The latter had higher APACHE II (17 (95% CI: 12 to 21) vs 15 (95% CI: 11 to 20), p=0.036), SOFA scores (6 (95% CI: 4 to 9) vs 5 (95% CI: 3 to 8), p=0.006), renal failure (41.6% vs 33.1%, p=0.009), sepsis (36.1% vs 31.6%, p<0.001) and septic shock (40.0% vs 33.8%, p<0.001). The days of antibacterial therapy (DOT) were similar between the groups (change in the slope from BP to IP 28.1 (95% CI: −17.4 to 73.5), p=0.2405). There were no differences in the antibacterial defined daily dose (DDD) between the groups (change in the slope from BP to IP 43.9, (95% CI: −12.3 to 100.0), p=0.1413).The rate of antibacterial de-escalation based on microbiological culture was higher during the IP (62.0% vs 45.3%, p<0.001).The infection prevention control (IPC) assessment framework was increased in eight ICUs.ConclusionImplementing an antimicrobial stewardship program in ICUs in a middle-income country via a QIC demonstrated success in improving antibacterial de-escalation based on microbiological culture results, but not on DOT or DDD. In addition, eight out of nine ICUs improved their IPC Assessment Framework Score.

BackgroundPrimary care has been essential in ensuring the continuity of health services for patients with COVID-19 and other conditions. We aimed to increase the adoption of evidence-based interventions to identify clinical deterioration in adult patients with confirmed or suspected respiratory COVID-19 at the primary care level.MethodsWe implemented specific interventions in nine Primary Healthcare Centres (PHCC) through a quality improvement collaborative (QIC) with an interrupted time-series design. Interventions included triage for acute respiratory symptoms, the National Early Warning Score 2 (NEWS2) scale, portable oximeters for selected patients and the provincial telehealth system. Additional components involved leadership commitment, teamwork tools, reminders, audits, feedback and direct observation. A mixed-method evaluation was conducted, with two learning sessions and three action periods to test and implement selected change ideas.ResultsSix PHHCs completed the study. Over 48 weeks, data from 877 patients were gathered, 356 in the baseline period (BP) and 477 in the implementation period (IP). Eight hundred and sixty-two medical consultations were reported, 367 for BP and 495 for IP. More COVID-19-confirmed diagnoses were observed in the IP group (1.9% vs 15%, p<0.001).The bundle was implemented in 0% and 28.4% of patients in the BP and IP groups, respectively. On evaluating the individual components of the bundle, we discovered enhancements in the utilisation of triage, application of NEWS2 and utilisation of oximeters when appropriate. A decrease in the number of follow-up calls was observed at the end of the implementation.Patients rated the quality of care as positive in 66% of the cases in the BP and 76% in the IP group (p=0.023).ConclusionWe successfully implemented a triage algorithm based on the NEWS2 score to identify respiratory deterioration in adult patients in primary care through a QIC. This intervention was perceived as an improvement in the quality of care by the patients.