Hospital-Acquired Infection: A Safety Issue That Keeps Us Awake at Night

Improving the safety of patient care is a significant challenge for the Portuguese healthcare system, as it is for many health services around the world. While it may be impossible to build a completely fail-safe system, the creation of a healthcare system that is aware and systematically reflects, learns, and acts to reduce unintended patient harm is a reasonable and achievable aim.

Many countries, like Portugal, have taken initiatives over the past years to address quality and safety issues in healthcare. In the aftermath of the U.S. report, To Err Is Human (Kohn et al., 2000), patient safety has gained momentum among healthcare policymakers as well as healthcare professionals and managers. Although the safety problems should not be underestimated, it should also be recognized that healthcare systems have been addressing issues like hospital infections, falls, and bedsores over a long period of time. There is, however, little consistency in data, and measurements may be quantified differently in different contexts without adequate understanding or explanation of the same.

As one of the most common sources of preventable harm, hospital-acquired infections (HAI) represent a major threat to patient safety. However, there is a robust body of evidence detailing interventions that can substantially reduce the incidence of HAI; indeed, recent analyses indicate that at least 50% are preventable.

HAI are a matter of great concern to patient safety, and they affect both the quality of care received and costs incurred during treatment. According to the point of prevalence survey of healthcare-associated infections and antimicrobial use (2011-2012), developed by the European Center for Disease Control (ECDC), Portugal's infection rate—10.5%—i s significantly higher than those of most other European countries and almost double that of the European average of 5.7%. Antimicrobial use (45.3% in Portugal; 38.5% in Europe) is also relatively high.

Portugal has made efforts to reduce the rate of hospital infections over the past years. Infection control activities in Portugal date from the late 1980s, and in 1996 a national infection control program was set up. An ongoing infection surveillance program in intensive care units (ICUs), bloodstream, surgical sites, and neonatal infections has been running since 2002, and in 2008, a national program for the prevention of antimicrobial resistance was established. Because the results of these programs were less than satisfactory, in 2013, the two programs were merged into a single national priority program (Program for the Prevention and Control of Infection and Antimicrobial Resistance), which was integrated into the National Strategy for Quality in Healthcare. Subsequently, activities have focused on two main areas: the reduction of infection rates and the promotion of the rational use of antimicrobial drugs. Although it is too early to know whether the observed improvements will be sustained in the long-term, the initial results are promising.

In 2013, The Gulbenkian Foundation, a private non-profit organization with cultural, educational, social, and scientific interests, and a mission to improve the lives of the most vulnerable, commissioned a group of international experts to analyze the Portuguese healthcare system. This analysis involved looking forward 25 years, in an effort to "create a new vision for health and healthcare in Portugal," describing what this would mean in practice and setting out how it might be achieved and sustained (Crisp, 2015). The recommendations of this report identified three major areas for improvement to be implemented by the Gulbenkian Foundation with the support of the health ministry. The high rate of HAIs was one of the identified areas, and an immediate and short-term challenge was to reduce HAIs by 50%, for a group of 12 NHS centers—a total of 19 hospitals—over a period of 3 years. This initiative, Stop Infegao Hospitalar! (SIH), commenced in late 2015.

 
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