RecruitingNot ApplicableNCT07093450

Quality Improvement Intervention for a Safe Antimicrobial Use Reduction in Critically Ill Patients

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

Sponsor

Hospital Sirio-Libanes

Enrollment

9,000 participants

Start Date

Jun 1, 2025

Study Type

INTERVENTIONAL

Conditions

Antimicrobial Stewardship Infection Critically Ill Intensive Care Unit Patients

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

Min Age: 18 Years

Inclusion Criteria5

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

Exclusion Criteria2

\- Absence of local IRB approval
Patients younger than 18 years-old will be excluded from individual-level analysis

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Interventions

OTHEREducational 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.