{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T23:55:08Z","timestamp":1793836508654,"version":"4.6.1"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2023,10,1]],"date-time":"2023-10-01T00:00:00Z","timestamp":1696118400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Programa de Apoio ao Desenvolvimento Institucional do Sistema \u00danico de Sa\u00fade"},{"name":"Programa de Apoio ao Desenvolvimento Institucional do Sistema \u00danico de Sa\u00fade"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,12,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Lean healthcare visual management has been successfully integrated into infection control programs, leading to lower healthcare-associated infection (HAI) rates and greater provider compliance with evidence-based prevention practices; however, its implementation during quality improvement (QI) initiatives in limited-resource settings has not yet been well exploited. We aimed to describe a low-cost strategy involving Kamishibai cards to sustain bundles\u2019 adherence to prevent HAIs in a middle-income country. This descriptive case study evaluated the implementation of a lean healthcare visual management tool\u2014Kamishibai board (K-board)\u2014during a nationwide QI collaborative preventing three critical HAIs in 189 adult and pediatric\/neonatal intensive care units (ICUs) from September 2021 to January 2023. Considering a limited-resource setting, our team adapted a K-board using simple, cheap, and easy-to-handle materials for routine monitoring of QI procedures, including safety bundles\u2019 compliance. After test prototypes, the final K-board version was implemented. The chart materials and assembly cost BRL 80.00 (USD 15.48). Before launching, expert working group meetings were held to shape the contents, refine technical issues, and prepare the ICU teams for implementation. After starting, plan-do-study-act cycles were conducted according to the Breakthrough Series model. Participating ICU teams, including leaders and front-line health workers, performed bedside audits following a weekly chronogram. Two indicators were calculated: the percentage of ICUs in which K-boards were being implemented and whether bundles\u2019 compliance was addressed in the K-board. Audit data were recorded in \u2018SimpleQI\u2019. After 17\u2009months of this initiative, 177 (93.7%) participating ICUs had included this visual management tool in their daily care routines. When more than 94 (&amp;gt;50%) ICUs posted K-board data, the mean compliance for the bundles for each HAI was sustained above 85%. A lean healthcare visual management tool can be adapted to local settings, including healthcare facilities with limited resources. K-board seems to be a feasible method for auditing evidence-based practices in medical care, including safety bundles to simultaneously prevent three types of HAIs.<\/jats:p>","DOI":"10.1093\/intqhc\/mzad100","type":"journal-article","created":{"date-parts":[[2023,12,29]],"date-time":"2023-12-29T19:26:44Z","timestamp":1703878004000},"source":"Crossref","is-referenced-by-count":2,"title":["Adapting lean management to prevent healthcare-associated infections: a low-cost strategy involving Kamishibai cards to sustain bundles\u2019 compliance"],"prefix":"10.1093","volume":"35","author":[{"given":"Marco Antonio","family":"Saavedra Bravo","sequence":"first","affiliation":[{"name":"Hospital S\u00edrio-Liban\u00eas , Rua Dona Adma Jafet, 91 - Bela Vista, Sao Paulo, SP 01308-050, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guilherme Cesar Silva Dias","family":"Santos","sequence":"additional","affiliation":[{"name":"BP - A Benefic\u00eancia Portuguesa de S\u00e3o Paulo , Rua Maestro Cardim, 769 - Bela Vista, Sao Paulo, SP 01323-001, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ademir Jose","family":"Petenate","sequence":"additional","affiliation":[{"name":"Universidade Estadual de Campinas - UNICAMP , Cidade Universit\u00e1ria Zeferino Vaz - Bar\u00e3o Geraldo, Campinas, SP, 13083-970, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick Jacobsen","family":"Westphal","sequence":"additional","affiliation":[{"name":"Hospital Moinhos de Vento , Rua Ramiro Barcelos, 910 - Moinhos de Vento, Porto Alegre, RS 90035-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciana Gouvea de Albuquerque","family":"Souza","sequence":"additional","affiliation":[{"name":"Hospital Alem\u00e3o Oswaldo Cruz , Rua Treze de Maio, 1815 - Bela Vista, Sao Paulo, SP 01323-020, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta Gon\u00e7alves","family":"Marques","sequence":"additional","affiliation":[{"name":"Hospital Israelita Albert Einstein , Avenida Paulista, 2300 - Bela Vista, Sao Paulo, SP 01310-300, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica Deji Moura","family":"Morosov","sequence":"additional","affiliation":[{"name":"Hcor , Rua Desembargador Eliseu Guilherme, 147 - Para\u00edso, Sao Paulo, SP 04004-030, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea Keiko Fujinami","family":"Gushken","sequence":"additional","affiliation":[{"name":"Hcor , Rua Desembargador Eliseu Guilherme, 147 - Para\u00edso, Sao Paulo, SP 04004-030, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavia Fernanda","family":"Franco","sequence":"additional","affiliation":[{"name":"Hospital Israelita Albert Einstein , Avenida Paulista, 2300 - Bela Vista, Sao Paulo, SP 01310-300, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wladimir Garcia","family":"Silva","sequence":"additional","affiliation":[{"name":"Hospital Alem\u00e3o Oswaldo Cruz , Rua Treze de Maio, 1815 - Bela Vista, Sao Paulo, SP 01323-020, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafaela Moraes","family":"de Moura","sequence":"additional","affiliation":[{"name":"Hospital Moinhos de Vento , Rua Ramiro Barcelos, 910 - Moinhos de Vento, Porto Alegre, RS 90035-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreia Lopes","family":"de Lima","sequence":"additional","affiliation":[{"name":"BP - A Benefic\u00eancia Portuguesa de S\u00e3o Paulo , Rua Maestro Cardim, 769 - Bela Vista, Sao Paulo, SP 01323-001, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renata Gonsalez","family":"dos Santos","sequence":"additional","affiliation":[{"name":"Hospital S\u00edrio-Liban\u00eas , Rua Dona Adma Jafet, 91 - Bela Vista, Sao Paulo, SP 01308-050, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karina de Carvalho","family":"Andrade","sequence":"additional","affiliation":[{"name":"Hospital S\u00edrio-Liban\u00eas , Rua Dona Adma Jafet, 91 - Bela Vista, Sao Paulo, SP 01308-050, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreza Pivato Susin","family":"Hamada","sequence":"additional","affiliation":[{"name":"Hospital S\u00edrio-Liban\u00eas , Rua Dona Adma Jafet, 91 - Bela Vista, Sao Paulo, SP 01308-050, Brazil"},{"name":"BP - A Benefic\u00eancia Portuguesa de S\u00e3o Paulo , Rua Maestro Cardim, 769 - Bela Vista, Sao Paulo, SP 01323-001, Brazil"},{"name":"Hospital Moinhos de Vento , Rua Ramiro Barcelos, 910 - Moinhos de Vento, Porto Alegre, RS 90035-000, Brazil"},{"name":"Hospital Alem\u00e3o Oswaldo Cruz , Rua Treze de Maio, 1815 - Bela Vista, Sao Paulo, SP 01323-020, Brazil"},{"name":"Hospital Israelita Albert Einstein , Avenida Paulista, 2300 - Bela Vista, Sao Paulo, SP 01310-300, Brazil"},{"name":"Hcor , Rua Desembargador Eliseu Guilherme, 147 - Para\u00edso, Sao Paulo, SP 04004-030, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristiane Maria Reis","family":"Cristalda","sequence":"additional","affiliation":[{"name":"Minist\u00e9rio da Sa\u00fade , Esplanada dos Minist\u00e9rios - Bloco G, Bras\u00edlia, DF 70058-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciana Yumi","family":"Ue","sequence":"additional","affiliation":[{"name":"Minist\u00e9rio da Sa\u00fade , Esplanada dos Minist\u00e9rios - Bloco G, Bras\u00edlia, DF 70058-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia Garcia","family":"de Barros","sequence":"additional","affiliation":[{"name":"Hospital Israelita Albert Einstein , Avenida Paulista, 2300 - Bela Vista, Sao Paulo, SP 01310-300, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8589-0089","authenticated-orcid":false,"given":"Sebastian","family":"Vernal","sequence":"additional","affiliation":[{"name":"Hospital S\u00edrio-Liban\u00eas , Rua Dona Adma Jafet, 91 - Bela Vista, Sao Paulo, SP 01308-050, Brazil"},{"name":"BP - A Benefic\u00eancia Portuguesa de S\u00e3o Paulo , Rua Maestro Cardim, 769 - Bela Vista, Sao Paulo, SP 01323-001, Brazil"},{"name":"Hospital Moinhos de Vento , Rua Ramiro Barcelos, 910 - Moinhos de Vento, Porto Alegre, RS 90035-000, Brazil"},{"name":"Hospital Alem\u00e3o Oswaldo Cruz , Rua Treze de Maio, 1815 - Bela Vista, Sao Paulo, SP 01323-020, Brazil"},{"name":"Hospital Israelita Albert Einstein , Avenida Paulista, 2300 - Bela Vista, Sao Paulo, SP 01310-300, Brazil"},{"name":"Hcor , Rua Desembargador Eliseu Guilherme, 147 - Para\u00edso, Sao Paulo, SP 04004-030, 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