Effectiveness of a multidimensional approach for prevention of ventilator-associated pneumonia in 11 adult intensive care units from 10 cities of Turkey: Findings of the International Nosocomial Infection Control Consortium (INICC)

Purpose: To evaluate the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach on the reduction of ventilator-associated pneumonia (VAP) in adult patients hospitalized in 11 intensive care units (ICUs), from 10 hospitals, members of the INICC, in 10 cities of Turkey. Methods: A prospective active before-after surveillance study was conducted to determine the effect of the INICC multidimensional approach in the VAP rate. The study was divided into two phases. In phase 1, active prospective surveillance of VAP was conducted using the definitions of the Centers for Disease Control and Prevention National Health Safety Network, and the INICC methods. In phase 2, we implemented the multidimensional approach for VAP. The INICC multidimensional approach included the following measures: (1) bundle of infection control interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of VAP rates, and (6) performance feedback of infection control practices. We compared the rates of VAP obtained in each phase. A time series analysis was performed to assess the impact of our approach. Results: In phase 1, we recorded 2,376 mechanical ventilator (MV)-days, and in phase 2, after implementing the multidimensional approach, we recorded 28,181 MV-days. The rate of VAP was 31.14 per 1,000 MV-days during phase 1, and 16.82 per 1,000 MV-days during phase 2, amounting to a 46 % VAP rate reduction (RR, 0.54; 95 % CI, 0.42-0.7; P value, 0.0001.) Conclusions: The INICC multidimensional approach was associated with a significant reduction in the VAP rate in these adult ICUs of Turkey. © 2013 Springer-Verlag Berlin Heidelberg

Infección asociada a dispositivos en Unidad de Cuidados Intensivos. Oeste de Qatar

Introduction: Device-associated infection (DAI) in intensive care units have a major impact on morbidity, mortality, and costs.Objective: To describe the incidence and adherence of a DAI and the bundle compliance in an intensive care unit at a community hospital in Western Qatar.Material and Methods: A prospective surveillance was conducted in a 6-beds medical-surgical intensive care unit from Jan 2013 to December 2016. Data about clinical, laboratory, and other diagnostic information were collected to satisfy the criteria for infection. DAI rates, device utilization ratio (UR) and bundle compliance were analyzed, and comparison with 2013 US data was performed.Results: The pooled mean of ventilator-associated pneumonia rates was 2.61 per 1000 ventilator days, and zero for catheter-associated urinary tract and central line bloodstream infections. The ventilator UR was superior (0.32) (p =0.000) than the National Health System Network (NHSN) data (0.24); the use of the central line bundle and the urinary catheter were similar (0.33, 0.54) (p=0.000), respectively. The compliance with bundle elements for ventilator was 99% and 98.2% for 2013 and 2014 respectively, and 100% compliance afterward. The compliance with central line bundle was 100% during the study period, whereas the compliance with urinary catheter bundle had the lowest figure in 2013 (97.9%), 98.3 % in 2015, and 99.6% in 2016, related to bag contact with the floor. Conclusions: The study has shown the low incidence of device-associated infections related to a comprehensive infection control program in the Intensive Care Unit.Keywords: Device-associated infections, bundle, compliance, Intensive Care UnitIntroducción: Las infecciones asociadas a dispositivos en unidades de cuidados intensivos tienen un gran impacto.Objetivo: Describir la incidencia  y adherencia en el cumplimiento de intervenciones preventivas de infecciones asociadas a dispositivos en la Unidad de Cuidados Intensivos  del Hospital Cubano en Qatar.Material y Métodos: Se realizó una vigilancia prospectiva en la UCI de 6 camas entre enero de 2013 y diciembre de 2016. Se recolectaron datos sobre cumplimiento de intervenciones preventivas para inserción y mantenimiento de dispositivos. Se analizaron las tasas de infección, la razón de utilización del dispositivo y el cumplimiento de prácticas.Resultados: La media de Neumonía asociada a la ventilación fue de 2,61 por 1 000 días de ventilación, las tasas de infección, cero para Infección del tracto urinario asociado al catéter y del torrente sanguíneo por dispositivo vascular. La  utilización del ventilador  fue superior (0,32) (p = 0,000) en comparación con los datos de la Red Nacional de Seguridad Sanitaria de los Estados Unidos (0,24), las del catéter venoso central y el catéter urinario fueron similares 0.33, 0.54 (p = 0,000), respectivamente. La adherencia a las intervenciones preventivas para el ventilador fue de 99% y 98,2% durante 2013 y 2014, y  100%  después, las relacionadas con el uso del dispositivos vasculares centrales fue de 100%, mientras con el catéter urinario tuvo la cifra más baja en 2013 (97,9%), 2015 (98,3%) y 2016(99,6%).Conclusiones: Existió baja incidencia de infecciones asociadas a dispositivos relacionadas con la adherencia al programa integral de control de infecciones en la Unidad de Cuidados Intensivos.Palabras claves: Infecciones asociadas al uso de dispositivos, adherencia, intervenciones preventivas,  unidades de cuidados intensivos

Device-associated infection rates in adult intensive care units of Cuban university hospitals: International Nosocomial Infection Control Consortium (INICC) findings

To determine the rate of device-associated healthcare-associated infection (DA-HAI), microbiological profile, length of stay (LOS), extra mortality, and hand hygiene compliance in two intensive care units (ICUs) of two hospital members of the International Infection Control Consortium (INICC) of Havana, Cuba. An open label, prospective cohort, active DA-HAI surveillance study was conducted on adults admitted to two tertiary-care ICUs in Cuba from May 2006 to December 2009, implementing the methodology developed by INICC. Data collection was performed in the participating ICUs, and data were uploaded and analyzed at the INICC headquarters on proprietary software. DA-HAI rates were registered by applying the definitions of the US Centers for Disease Control and Prevention National Healthcare Safety Network (CDC NHSN). We analyzed the mechanical ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLA-BSI), and catheter-associated urinary tract infection (CAUTI) rates, microorganism profile, extra length of stay (ELOS), extra mortality, and hand hygiene compliance. During 14 512 days of hospitalization, 1982 patients acquired 444 DA-HAIs, an overall rate of 22.4% (95% CI 20.6–24.3) or 30.6 (95% CI 27.8–33.5) DA-HAIs per 1000 ICU-days. The CLA-BSI rate was 2.0 (95% CI 1.2–3.1) per 1000 central line-days, the VAP rate was 52.5 (95% CI 47.2–58.3) per 1000 ventilator-days, and the CAUTI rate was 8.1 (95% CI 6.5–10.0) per 1000 catheter-days. LOS of patients was 4.9 days for those without DA-HAI, 23.3 days for those with CLA-BSI, and 23.8 days for those with VAP. CAUTI LOS was not calculated due to the lack of data. Extra mortality was 47% (relative risk (RR) 2.42; p = 0.0693) for VAP and 17% (RR 1.52; p = 0.5552) for CLA-BSI. The only patient with CAUTI died, but there was too little mortality data regarding this infection type to consider this significant. Escherichia coli was the most commonly isolated microorganism. The overall hand hygiene compliance was 48.6% (95% CI 42.8–54.3). DA-HAI rates, LOS, and mortality were found to be high, and hand hygiene low. It is of primary importance that infection control programs that include outcome and process surveillance are implemented in Cuba

International Nosocomial Infection Control Consortium (INICC) report, data summary of 36 countries, for 2004-2009

10.1016/j.ajic.2011.05.020American Journal of Infection Control405396-407AJIC

Surgical site infections, international nosocomial infection control consortium (INICC) report, data summary of 30 countries, 2005-2010

10.1086/670626Infection Control and Hospital Epidemiology346597-604ICEP

Nosocomial Infection Control Consortium (INICC)

We aimed to evaluate the impact of a multidimensional infection control strategy for the reduction of the incidence of catheter-associated urinary tract infection (CAUTI) in patients hospitalized in adult intensive care units (AICUs) of hospitals which are members of the International Nosocomial Infection Control Consortium (INICC), from 40 cities of 15 developing countries: Argentina, Brazil, China, Colombia, Costa Rica, Cuba, India, Lebanon, Macedonia, Mexico, Morocco, Panama, Peru, Philippines, and Turkey.We conducted a prospective before-after surveillance study of CAUTI rates on 56,429 patients hospitalized in 57 AICUs, during 360,667 bed-days. The study was divided into the baseline period (Phase 1) and the intervention period (Phase 2). In Phase 1, active surveillance was performed. In Phase 2, we implemented a multidimensional infection control approach that included: (1) a bundle of preventive measures, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of CAUTI rates, and (6) feedback of performance. The rates of CAUTI obtained in Phase 1 were compared with the rates obtained in Phase 2, after interventions were implemented.We recorded 253,122 urinary catheter (UC)-days: 30,390 in Phase 1 and 222,732 in Phase 2. In Phase 1, before the intervention, the CAUTI rate was 7.86 per 1,000 UC-days, and in Phase 2, after intervention, the rate of CAUTI decreased to 4.95 per 1,000 UC-days [relative risk (RR) 0.63 (95 % confidence interval [CI] 0.55-0.72)], showing a 37 % rate reduction.Our study showed that the implementation of a multidimensional infection control strategy is associated with a significant reduction in the CAUTI rate in AICUs from developing countries