Simple, Low-Cost Measures at the National Institute of Child Health’s Pediatric Intensive Care Unit in Lima, Peru, Decrease Health Care-Associated Infections
The National Institute of Child Health (INSN) is a government health facility in Lima, Peru, that serves as a referral center for critically ill children from all regions of the country. It has 21 intensive care beds serving 480 hospital beds, including critical areas for cardiology, heart surgery, burn unit, and neurosurgical and neonatal wards. By 2007, INSN was treating growing numbers of children with increasingly complex conditions. Critically ill patients with sepsis have often benefited from the use of invasive devices and technology, but these technologies have increased their risk of infection and sepsis-associated mortality. A study in five hospitals in Lima demonstrated that HAIs were the most important adverse events in the intensive care units. The rate of CLABSI at INSN’s Pediatric Intensive Care Unit (PICU) was high (rate = more than 10 x 1000), significantly increasing the morbidity, mortality, length of stay, and hospital costs.
The PICU team advocated ensuring decision-making and funding from the leadership of INSN to improve infrastructure, the provision of equipment and materials, and human resources to meet international standards. Twocomplementary but equally important strategies were implemented: (1) systematic application of evidence-based, simple, low-cost procedures to manipulate invasive devices, including hand washing, disinfection with chlorhexidine, the use of maximal protective barriers, and retiring devices when not needed; and (2) teamwork improvement and communication and learning from mistakes. Additional measures included the standardization of targeted procedures through evidence based guidelines, centralization of all the material needed in special carts, monitoring adherence standardized procedures with check lists, and reinforcing verbal and written communication among teams through the use of daily work plans and daily goals during clinical rounds. Supported and encouraged by the INSN leadership, the PICU team shared its experiences and tools with the personnel of other critical areas
Systematic application of evidence-based practices to reduce HAIs is a necessary part of any effort to prevent sepsis and reduce infant mortality. INSN’s experience confirms that the use of simple, low-cost “bundles” can lower the rate of HAIs among hospitalized children, especially critically ill patients. This initiative has helped INSN to identify equally serious problems, such as blood stream infections associated to mechanical ventilation, the insertion of urinary catheters, and other invasive procedures.