Integrated Multimodal Strategy to Reduce Healthcare-Associated Infections in a Trauma ICU: Impact of a Quality Improvement Project

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Abstract
Background: Healthcare-associated infections (HAIs) remain a significant challenge in intensive care units (ICUs), especially in trauma settings where invasive interventions are frequent. This study aimed to assess the impact of a structured quality improvement project (QIP) on nosocomial infection rates and patient outcomes in a polytrauma ICU. Methods: We conducted a retrospective observational study at the “Pius Brînzeu” County Emergency Clinical Hospital, Timișoara. A total of 78 ICU trauma patients were included: 35 in the Pre-QIP group and 43 in the Post-QIP group. The QIP integrated evidence-based interventions, including hand hygiene reinforcement, individualized protective equipment, improved nurse staffing, and antimicrobial stewardship. Outcomes analyzed included nosocomial infection rate, ICU length of stay, antibiotic use, mechanical ventilation days, and mortality. Multivariable logistic, linear, and Poisson regression models were applied to control for confounding variables. Results: The Post-QIP group showed a significantly lower number of infections per patient (0.60 ± 0.95 vs. 1.41 ± 1.97, p = 0.03) and a trend toward lower mortality (0.19 vs. 0.34, p = 0.18). While ICU stay, antibiotic use, and ventilation days decreased post-QIP, these changes were not statistically significant. ISS and Charlson scores were consistent predictors of worse outcomes. Conclusions: Implementation of a targeted, multidisciplinary QIP was associated with improved infection control and patient outcomes. These results support the feasibility and value of structured infection prevention strategies in resource-constrained ICU settings.
Funding Information
  • “Victor Babes” University of Medicine and Pharmacy Timisoara

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