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Impact of International Nosocomial Infection Control Consortium (INICC) Strategy on Central Line–Associated Bloodstream Infection Rates in the Intensive Care Units of 15 Developing Countries

Published online by Cambridge University Press:  02 January 2015

Victor D. Rosenthal ,
Dennis G. Maki ,
Camila Rodrigues ,
Carlos Álvarez-Moreno ,
Hakan Leblebicioglu ,
Martha Sobreyra-Oropeza ,
Regina Berba ,
Naoufel Madani ,
Eduardo A. Medeiros  and
Luis E. Cuéllar
...Show all authors
Victor D. Rosenthal*
Affiliation:
Medical College of Buenos Aires, Argentina Mumbai, India
Dennis G. Maki
Affiliation:
University of Wisconsin School of Medicine and Public Health, Madison, Mumbai, India
Camila Rodrigues
Affiliation:
P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
Carlos Álvarez-Moreno
Affiliation:
San Ignacio University Hospital, Pontificia Javeriana University, Bogota, Colombia
Hakan Leblebicioglu
Affiliation:
Ondokuz Mayis University Medical School, Samsun, Turkey
Martha Sobreyra-Oropeza
Affiliation:
De la Mujer Hospital, Mexico City, Mexico
Regina Berba
Affiliation:
Philippine General Hospital, Manila, Philippines
Naoufel Madani
Affiliation:
Medical Intensive Care Unit, Ibn Sina, Rabat, Morocco
Eduardo A. Medeiros
Affiliation:
Hospital Sao Paulo, Federal University of Sao Paulo, UNIFESP, Brazil
Luis E. Cuéllar
Affiliation:
Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru
Zan Mitrev
Affiliation:
Filip II Special Cardiosurgery Hospital, Skopje, Macedonia
Lourdes Dueñas
Affiliation:
Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
Humberto Guanche-Garcell
Affiliation:
Joaquín Albarrán Dominguez University Hospital, Havana, Cuba
Trudell Mapp
Affiliation:
San Fernando Hospital, Panama City, Panama
Souha S. Kanj
Affiliation:
American University of Beirut Medical Center, Beirut, Lebanon
Rosalía Fernández-Hidalgo
Affiliation:
Clínica Bíblica Hospital, San José, Costa Rica
*
Corrientes Ave 4580, Floor 12, Apt D, Zip 1195, Buenos Aires, Argentina, (victor_rosenthal@inicc.org)
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Abstract

Background.

The International Nosocomial Infection Control Consortium (INICC) was established in 15 developing countries to reduce infection rates in resource-limited hospitals by focusing on education and feedback of outcome surveillance (infection rates) and process surveillance (adherence to infection control measures). We report a time-sequence analysis of the effectiveness of this approach in reducing rates of central line–associated bloodstream infection (CLABSI) and associated deaths in 86 intensive care units with a minimum of 6-month INICC membership.

Methods.

Pooled CLABSI rates during the first 3 months (baseline) were compared with rates at 6-month intervals during the first 24 months in 53,719 patients (190,905 central line–days). Process surveillance results at baseline were compared with intervention period data.

Results.

During the first 6 months, CLABSI incidence decreased by 33% (from 14.5 to 9.7 CLABSIs per 1,000 central line–days). Over the first 24 months there was a cumulative reduction from baseline of 54% (from 16.0 to 7.4 CLABSIs per 1,000 central line–days; relative risk, 0.46 [95% confidence interval, 0.33–0.63]; P <.001). The number of deaths in patients with CLABSI decreased by 58%. During the intervention period, hand hygiene adherence improved from 50% to 60% (P<.001); the percentage of intensive care units that used maximal sterile barriers at insertion increased from 45% to 85% (P < .001), that adopted Chlorhexidine for antisepsis increased from 7% to 27% (P = .018), and that sought to remove unneeded catheters increased from 37% to 83% (P = .004); and the duration of central line placement decreased from 4.1 to 3.5 days (P < .001).

Conclusions.

Education, performance feedback, and outcome and process surveillance of CLABSI rates significantly improved infection control adherence, reducing the CLABSI incidence by 54% and the number of CLABSI-associated deaths by 58% in INICC hospitals during the first 2 years.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 12 , December 2010 , pp. 1264 - 1272
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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References

1.Jarvis, WR. Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost, and prevention. Infect Control Hosp Epidemiol 1996;17:552–557.Google Scholar
2.Laupland, KB, Zygun, DA, Doig, CJ, Bagshaw, SM, Svenson, LW, Fick, GH. One-year mortality of bloodstream infection-associated sepsis and septic shock among patients presenting to a regional critical care system. Intensive Care Med 2005;31:213–219.Google Scholar
3.Eggimann, P, Harbarth, S, Constantin, MN, Touveneau, S, Chevrolet, JC, Pittet, D. Impact of a prevention strategy targeted at vascular-access care on incidence of infections acquired in intensive care. Lancet 2000;355:1864–1868.CrossRefGoogle ScholarPubMed
4.Pronovost, P, Needham, D, Berenholtz, S, et al.An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355:2725–2732.Google Scholar
5.Rosenthal, VD, Maki, DG, Salomao, R, et al.Device-associated nosocomial infections in 55 intensive care units of 8 developing countries. Ann Intern Med 2006;145:582–591.CrossRefGoogle ScholarPubMed
6.Rosenthal, VD, Maki, DG, Mehta, A, et al.International Nosocomial Infection Control Consortium report, data summary for 2002-2007, issued January 2008. Am J Infect Control 2008;36:627–637.CrossRefGoogle ScholarPubMed
7.Rosenthal, VD, Maki, DG, lamulitrat, S, et al.International Nosocomial Infection Control Consortium (INICC) report, data summary for 20032008, issued June 2009. Am J Infect Control 2010;38(2):95–104.e2.Google Scholar
8.Rosenthal, VD, Maki, DG, Graves, N. The International Nosocomial Infection Control Consortium (INICC): goals and objectives, description of surveillance methods, and operational activities. Am J Infect Control 2008;36:e1–e12.CrossRefGoogle ScholarPubMed
9.Edwards, IR, Peterson, KD, Andrus, ML, Dudeck, MA, Pollock, DA, Horan, TC. National Healthcare Safety Network (NHSN) report, data summary for 2006 through 2007, issued November 2008. Am J Infect Control 2008;36:609–626.CrossRefGoogle ScholarPubMed
10.Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of healthcare-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–332.CrossRefGoogle ScholarPubMed
11.Madani, N, Rosenthal, VD, Dendane, T, Abidi, K, Zeggwagh, AA, Abouqal, R. Healthcare-associated infections rates, length of stay, and bacterial resistance in an intensive care unit of Morocco: findings of the International Nosocomial Infection Control Consortium (INICC). Int Arch Med 2009;2:29.CrossRefGoogle Scholar
12.Leblebicioglu, H, Rosenthal, VD, Arikan, OA, et al.Device-associated hospital-acquired infection rates in Turkish intensive care units: findings of the International Nosocomial Infection Control Consortium (INICC). J Hosp Infect 2007;65:251–257.Google Scholar
13.Mehta, A, Rosenthal, VD, Mehta, Y, et al.Device-associated nosocomial infection rates in intensive care units of seven Indian cities: findings of the International Nosocomial Infection Control Consortium (INICC). J Hosp Infect 2007;67:168–174.CrossRefGoogle ScholarPubMed
14.Salomao, R, Rosenthal, VD, Grinberg, G, et al.Device-associated infection rates in intensive care units of Brazilian hospitals: findings of the International Nosocomial Infection Control Consortium. Rev Panam Salud Publica 2008;24:195–202.Google Scholar
15.Cuellar, LE, Fernandez-Maldonado, E, Rosenthal, VD, et al.Device-associated infection rates and mortality in intensive care units of Peruvian hospitals: findings of the International Nosocomial Infection Control Consortium. Rev Panam Salud Publica 2008;24:16–24.Google Scholar
16.Rosenthal, VD, Guzman, S, Crnich, C. Device-associated nosocomial infection rates in intensive care units of Argentina. Infect Control Hosp Epidemiol 2004;25:251–255.Google Scholar
17.Ramirez Barba, EJ, Rosenthal, VD, Higuera, F, et al.Device-associated nosocomial infection rates in intensive care units in four Mexican public hospitals. Am J Infect Control 2006;34:244–247.CrossRefGoogle ScholarPubMed
18.Rosenthal, VD. Device-associated nosocomial infections in limited-resources countries: findings of the International Nosocomial Infection Control Consortium (INICC). Am J Infect Control 2008;36:S171 e7–12.Google Scholar
19.Rosenthal, VD, Guzman, S, Orellano, PW. Nosocomial infections in medical-surgical intensive care units in Argentina: attributable mortality and length of stay. Am J Infect Control 2003;31:291–295.CrossRefGoogle ScholarPubMed
20.Pawar, M, Mehta, Y, Purohit, A, Trehan, N, Rosenthal, VD. Resistance in gram-negative bacilli in a cardiac intensive care unit in India: risk factors and outcome. Ann Card Anaesth 2008;11:20–26.Google Scholar
21.Lynch, P, Rosenthal, VD, Borg, MA, Eremin, SR. Infection control in developing countries. In: Jarvis, WR, ed. Bennett and Brachman's Hospital Infections. Philadelphia: Lipppincott Williams & Wilkins; 2007:255.Google Scholar
22.Rosenthal, VD. Central line-associated bloodstream infections in limited-resource countries: a review of the literature. Clin Infect Dis 2009;49:1899–1907.CrossRefGoogle ScholarPubMed
23.Moreno, CA, Rosenthal, VD, Olarte, N, et al.Device-associated infection rate and mortality in intensive care units of 9 Colombian hospitals: findings of the International Nosocomial Infection Control Consortium. Infect Control Hosp Epidemiol 2006;27:349–356.CrossRefGoogle ScholarPubMed
24.Rezende, EM, Couto, BR, Starling, CE, Modena, CM. Prevalence of nosocomial infections in general hospitals in Belo Horizonte. Infect Control Hosp Epidemiol 1998;19:872–876.Google Scholar
25.Hughes, IM. Study on the Efficacy of Nosocomial Infection Control (SENIC) project: results and implications for the future. Chemotherapy 1988;34:553–561.Google Scholar
26.Rosenthal, VD, Guzman, S, Pezzotto, SM, Crnich, CJ. Effect of an infection control program using education and performance feedback on rates of intravascular device-associated bloodstream infections in intensive care units in Argentina. Am J Infect Control 2003;31:405–409.Google Scholar
27.Rosenthal, VD, Guzman, S, Safdar, N. Effect of education and performance feedback on rates of catheter-associated urinary tract infection in intensive care units in Argentina. Infect Control Hosp Epidemiol 2004;25:47–50.CrossRefGoogle ScholarPubMed
28.Rosenthal, VD, Guzman, S, Crnich, C. Impact of an infection control program on rates of ventilator-associated pneumonia in intensive care units in 2 Argentinean hospitals. Am J Infect Control 2006;34:58–63.CrossRefGoogle ScholarPubMed
29.Maki, DG, Weise, CE, Sarafin, HW. A semiquantitative culture method for identifying intravenous catheter-related infection. N Engl J Med 1977;296:1305–1309.CrossRefGoogle ScholarPubMed
30.Higuera, F, Rangel-Frausto, MS, Rosenthal, VD, et al.Attributable cost and length of stay for patients with central venous catheter-associated bloodstream infection in Mexico City intensive care units: a prospective, matched analysis. Infect Control Hosp Epidemiol 2007;28:31–35.CrossRefGoogle ScholarPubMed
31.Rosenthal, VD, Guzman, S, Migone, O, Crnich, CI. The attributable cost, length of hospital stay, and mortality of central line-associated bloodstream infection in intensive care departments in Argentina: a prospective, matched analysis. Am J Infect Control 2003;31:475–480.Google Scholar
32.Crnich, CI, Maki, DG. The role of intravascular devices in sepsis. Curr Infect Dis Rep 2001;3:496–506.Google Scholar
33.Mattie, AS, Webster, BL. Centers for Medicare and Medicaid Services' “never events”: an analysis and recommendations to hospitals. Health Care Manag (Frederick) 2008;27(4):338–349.Google Scholar
34.Hugonnet, S, Harbarth, S, Sax, H, Duncan, RA, Pittet, D. Nursing resources: a major determinant of nosocomial infection? Curr Opin Infect Dis 2004;17:329–333.CrossRefGoogle Scholar
35.Rosenthal, VD, Maki, DG. Prospective study of the impact of open and closed infusion systems on rates of central venous catheter-associated bacteremia. Am J Infect Control 2004;32:135–141.Google Scholar
36.Deming, W. Out of the Crisis. Boston: MIT Press; 1986.Google Scholar
37.Pande, P, Neuman, R, Cavanagh, R. The Six Sigma Way: How GE, Motorola, and Other Top Companies are Honing Their Performance. New York: McGraw-Hill Professional; 2001.Google Scholar
38.Bennett, J, Scheckler, W, Maki, D, Brachman, P. Surveillance of nosocomial infections. In: Proceedings of the 1st International Conference on Nosocomial Infections, Centers for Disease Control. Chicago: American Hospital Association; 1971.Google Scholar
39.Gastmeier, P, Sohr, D, Schwab, F, et al.Ten years of KISS: the most important requirements for success. J Hosp Infect 2008;70(suppl 1):11–16.Google Scholar
40.Geubbels, EL, Nagelkerke, NI, Mintjes-De Groot, AJ, Vandenbroucke-Grauls, CM, Grobbee, DE, De Boer, AS. Reduced risk of surgical site infections through surveillance in a network. Int J Qual Health Care 2006;18:127–133.Google Scholar