Reduction of Healthcare-Associated Infections Through the Profile Program

Pediatric cancer outcomes are influenced by biological and non-biological factors. While biological factors are static, non-biological factors can be modified through quality interventions. The PrOFILE program (Pediatric Oncology Facility Integrated Local Evaluation) of St. Jude Children’s Research Hospital aims to identify opportunities for improvement and implement actions that contribute to increased survival in childhood cancer. Based on this program, the Hospital Infection Control Service (SCIH) of a pediatric oncology referral hospital located in São Paulo (Brazil) established a goal of reducing Healthcare-Associated Infections (HAIs) by 30% between August 2024 and July 2025. In the Preparation phase, the SCIH analyzed 2023 indicators and data from the first half of 2024, selecting pillars for intervention. In the Evaluation phase, a multidisciplinary team used the Ishikawa Diagram to identify potential causes of observed outcomes. Four pillars were defined for action: hand hygiene, prevention of surgical site infection (SSI), prevention of central line–associated primary bloodstream infection (CLABSI), and stewardship. In the Interpretation and Action phase, the Impact–Effort Matrix guided selection of priority actions. Interventions included improvements in hand hygiene infrastructure and supplies, audits in operating rooms and sterilization centers, catheter teams, document review, and strengthened communication between pharmacy and prescribers. Between August 2024 and July 2025, HAIs decreased by 24%. Hand hygiene adherence remained at an average of 65%. CLABSI incidence density remained equal to that observed in the first study phase, and no SSI occurred in the first quarter of 2025. Reduction in antimicrobial consumption has not yet shown significant results. The target was not achieved, largely due to a 12% increase in viral respiratory infections. Implementation of PrOFILE confirmed that HAI reduction relies on a triad of success: simple quality tools, an engaged team, and support from senior management. However, the project also demonstrated that cultural changes are gradual and require long-term commitment to be established.