INTEGRAR: Multimodal intervention to promote antimicrobial stewardship and reduce device-associated infections in intensive care units of hospitals in Paraguay, 2021-2023

Overview

The effective implementation of antimicrobial stewardship programs (ASP) that are well integrated with infection prevention and control (IPC) programs have proven to prevent the emergence and transmission of multidrug-resistant organisms (MDROs) in health care settings, particularly in intensive care units (ICUs). In Paraguay, similarly to other countries in Latin America, the development of ASP at the local level has been challenging, and has reached varying degrees of implementation across the country. In order to address this gap, the Ministry of Public Health and Social Welfare, through the Communicable Disease Surveillance Directorate (DIVET), requested the support of the Pan American Health Organization (PAHO) to pilot a multimodal intervention for the prevention and control of device-associated infections (catheter-associated bloodstream infections, catheter-associated urinary tract infections and ventilator-associated pneumonia) and optimization of antimicrobial use in adult and pediatric ICUs in Paraguayan hospitals. The project, denominated “INTEGRAR”, began in November 2021 and its pilot phase was completed in March 2023, informing the development of a national roll-out proposal. Five public hospitals and one social security hospital (non-profit center providing treatment to syndicated patients) participated in the project, namely Itaugua National Hospital; Trauma Hospital "Dr. Manuel Giagni"; Institute of Tropical Medicine; National Cardiology Institute - San Jorge; Regional Hospital of Encarnacion; Central Hospital - Social Security Institute. All hospitals had IPC programs implemented prior to this project. The proposal was aligned with Paraguay’s National Action Plan on antimicrobial resistance (AMR) (2019-23), specifically the strategic lines of action of aiming to reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures and optimizing the use of antimicrobials in human health.