Desfechos clínicos e implicações econômicas das infecções relacionadas à saúde em unidades de terapia intensiva: do leito à gestão

Abstract

Healthcare-Associated Infections (HAIS) represent one of the main challenges in hospitals, especially in Intensive Care Units (ICU), where the clinical severity of patients and invasive procedures increase the risk of complications. In addition to adverse clinical outcomes, HAIs impose a significant financial burden on health systems due to the use of broad-spectrum antimicrobials, intensive therapies, and prolonged hospital stays. In this context, it is essential to understand the economic impact of HAIs through clinical and care indicators that can support management and guide public health policies. This thesis aimed to analyze the clinical and economic impact of HAIs in Intensive Care Units to support improvements in care managementTo this end, complementary methodological strategies were developed: an integrative literature review on the costs associated with HAIs in ICU; an observational retrospective study based on 590 patients hospitalized with hospital-acquired pneumonia in Ceará; and a field study at the Hospital Regional Norte (HRN), where the epidemiological profile and clinical outcomes of ICU patients with HAIs were characterized, along with the measurement of hospital costs associated with these infections. Based on these data, an analysis of the correlation between clinical outcomes and costs was conducted, allowing for a deeper understanding of the magnitude of the problem at the institutional level. Finally, a critical analysis of health management challenges in the prevention and control of HAIs was carried out, emphasizing strategies for improving care quality and patient safety. The results showed that hospitalization costs for patients with HAIs can be up to four times higher, mainly due to longer hospital stays and the use of last-line antimicrobials. The observational study indicated elevated costs in pneumonia hospitalizations, particularly among the elderly. The field study at HRN revealed higher mortality rates, prolonged hospitalization, and significantly higher costs among patients with HAIs, with ventilator-associated pneumonia, urinary tract infections, and primary bloodstream infections being the most frequent. Moreover, multivariate analysis identified factors such as advanced age, sepsis, and the need for mechanical ventilation as independent predictors of mortality, substantially increasing hospital costs. These findings reinforce the importance of continuous epidemiological surveillance, adherence to HAI prevention protocols, and the integrated work of multiprofessional teams, highlighting the strategic role of hospital pharmacy in resource management. The use of clinical-economic indicators proved effective in measuring the impact of HAI, showing their potential to guide cost-effective interventions and managerial decisions. It is concluded that HAI are not only a clinical but also an economic and managerial problem. The integrated analysis of outcomes and costs provides a comprehensive approach that contributes to improving care quality and the sustainability of the health system. This study provides evidence to support managers and health professionals in implementing preventive strategies, monitoring, and rationalizing the use of resources, aiming to reduce the incidence and impact of HAI in the hospital setting.