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Title: 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
Authors: Rosenthal, Victor D.
Maki, Dennis G.
Rodrigues, Camila
Alvarez-Moreno, Carlos
Leblebicioglu, Hakan
Sobreyra-Oropeza, Martha
Berba, Regina
Madani, Naoufel
Medeiros, Eduardo A. [UNIFESP]
Cuellar, Luis E.
Mitrev, Zan
Duenas, Lourdes
Guanche-Garcell, Humberto
Mapp, Trudell
Kanj, Souha S.
Fernandez-Hidalgo, Rosalia
Int Nosocomial Infect Control
Med Coll Buenos Aires
Univ Wisconsin
Hinduja Natl Hosp & Med Res Ctr
Pontificia Javeriana Univ
Ondokuz Mayis Univ
De la Mujer Hosp
Philippine Gen Hosp
Ibn Sina
Universidade Federal de São Paulo (UNIFESP)
Filip II Special Cardiosurg Hosp
Hosp Nacl Ninos Benjamin Bloom
Joaquin Albarran Dominguez Univ Hosp
San Fernando Hosp
Amer Univ Beirut
Clin Bibl Hosp
Issue Date: 1-Dec-2010
Publisher: Univ Chicago Press
Citation: Infection Control and Hospital Epidemiology. Chicago: Univ Chicago Press, v. 31, n. 12, p. 1264-1272, 2010.
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.
ISSN: 0899-823X
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