FOUR SEASONS PROJECT –
CONTINUOUS TRAINING AND LESSONS LEARNED IN A BRAZILIAN HOSPITAL
Cláudia Cândido da Luz. RN Nurse. Coordinator of the Infusional Therapy Team (TTI) Hospital Israelita Albert Einstein. Jorge Luis Saraiva dos Santos. RN Nurse. Member of the Infusional Therapy Team (TTI) Hospital Israelita Albert Einstein. Claudia Regina Laselva. RN Nurse. MsC. Director of Hospital Israelita Albert Einstein. Alexandra do Rosario Toniolo. RN Nurse. MsC. Specialist in hospital infection control of Hospital Israelita Albert Einstein. Ellen Cristina Bergamasco. RN Nurse. MSC. PhD. Professor in Faculdade Israelita de Ciências da Saúde Albert Einstein.
One of the biggest challenges for the prevention of infections related to health care is keeping the multidisciplinary care team continuously trained. Many studies have reported difficulties in keeping staff engaged in infection control measures, including measures to prevent Central LineAssociated Bloodstream Infection (CLABSI). The U.S. Centers for Disease Control and Prevention (CDC) suggests that instituted training programs should be continuous and systematic; although the guidance is clear, it is increasingly difficult to put it into practice. In hospital services, training is related to new protocols, new products, admission training for new employees, training related to adverse events, or periodic training; in general they are led by a specific area that works with the development of professionals. Hospitals with large number of beds and, consequently healthcare professionals, have specific sectors for development of employees and typically organize training by teams, making it difficult to look at the specific care with central catheter and CLABSI-prevention measures. At the Hospital Israelita Albert Einstein, located in the city of São Paulo (Brazil), 682 beds are available. The training is organized by a corporate team that inserts into its annual timeline activities related to the prevention of bloodstream infection. The historical rate of Central Line-Associated Bloodstream Infection (CLABSI) was approximately 1.4 percent per month until 2011. In 2012, the hospital created the Infusional Therapy
Team (TTI). It consists of nurses, who are responsible for the insertion and maintenance of peripherally inserted central catheters. The nurses also responsible for improving the success rates in peripheral punctures, reducing the incidence of chemical phlebitis, reducing pain related to peripheral puncture, ensuring early removal central venous catheters, and acting to reduce bloodstream infection rates related to intravascular devices. In addition to the professional development of the TTI members, the institution proposed the creation of care protocols and monitoring of patients with implanted catheters. During their activities, TTI realized the need for specific training on the care of implanted catheters, which would happen continuously and systematically. TTI found that training should be extended to the entire multidisciplinary team assisting patients, which included approximately 4,000 professionals, including: physicians, nurses, physiotherapists, and psychologists and, among others. This is how the 4 Seasons Project was created. The construction of the 4 Seasons Project was based on the premise that continuous training can improve patient safety by providing quality care andreducing CLABSI. The project was named 4 Seasons because the training occurred quarterly with the seasons (Spring, Summer, Fall and Winter). CONTINUED ON NEXT PAGE MAY 2021 | 20
