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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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