Ten Years in Brazil Yields Complex Surgeries + Huge Decrease in Infection

Dr. Ulisses Croti and his team at Hospital da Criança e Maternidade, São José do Rio Preto, Brazil


The partnership between Children’s HeartLink and Hospital da Criança e Maternidade in São José do Rio Preto, Brazil, is now embarking on its tenth year, and the hospital is poised to become a Children’s HeartLink Center of Excellence. Our 10-year collaboration led not only to a significant decrease in infections after surgery, but also to an increase in the number of children treated and the complexity of their surgeries, as well as a reduction in deaths.

Last year Hospital da Criança e Maternidade served over 3,300 children with heart disease and performed over 300 heart surgeries.

Through our partnership, medical volunteers from Mayo Clinic and Children’s Minnesota traveled to Hospital da Criança e Maternidade every year to train and mentor their peers. Among the specialists on these teams: surgeons, cardiologists, respiratory therapists, intensivists, anesthesiologists, perfusionists, and scrub and ICU nurses.

“The partnership with Hospital da Crianca e Maternidade shows how advantageous it can be for improving cardiac care around the world. This team grows, and their reputation grows. They’re opening the second operating room for heart surgeries. They’ve started a training program for perfusionists, who operate a heart-lung machine, to pump blood while the surgeon operates on the heart. Hospital da Crianca e Maternidade hosts people from all over the country for various training. They’re frequently in the news because they are doing such important and groundbreaking work in Brazil,” says Children’s HeartLink Country Director Andreas Tsakistos.

The hospital also created a new nurse educator position to provide ongoing training and education for nurses. In addition, in September 2018 the hospital began a postgraduate nursing course in pediatric cardiology and cardiac surgery that runs for 18 months and is truly one of its kind in Brazil.

Huge decrease in infection 

Yet a few years ago, infections after surgery were a big concern in its cardiac unit.

In a paper published in World Journal for Pediatric and Congenital Heart Surgery, the medical team from Hospital da Criança e Maternidade cites the guidance of professional volunteers from Children’s HeartLink and subsequent implementation of recommended changes, as critical to improving their heart program. The partnership reduced patient deaths. Bacterial sepsis (a life-threatening infection) was reduced from 19% in 2011 to 3% in 2017. Other infections, including ventilator-associated pneumonia, a lung infection that develops in a person who is on a ventilator, dropped from 22% in 2011 to 4% in 2017.

“It makes me feel so good to see those improved infection rates they have. I don’t personally take credit for it,” says Patsy Stinchfield, MS, CPNP, CIC, an infectious disease Pediatric Nurse Practitioner and the senior director of Infection Prevention and Control, the Wound Care Team and The Children’s Immunization Project at Children’s Minnesota. She traveled to Rio Preto as a medical volunteer three times, in 2012, 2014 and 2018. Read more about her trips here.

“The team was wholeheartedly on board with what I recommended, and they built it into their practice. Here’s what stands out about my trips with Children’s HeartLink: the eagerness of the team to improve, to be better doctors, nurses, respiratory therapists, infection preventionists and even environmental services staff. They almost wanted to make changes on the spot.”

Key to these improvements: embracing a patient safety culture with improved communication within the multidisciplinary team, and the implementation of nurse empowerment practices, where nurses are encouraged to voice their concerns.

In February 2019, Dr. Ulisses Croti and his team within the space of 24 hours performed two heart transplants on 10-month-old babies, the youngest patients receiving new hearts in the 17 years of existence of the service of cardiology and pediatric cardiovascular surgery at the hospital.

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