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Findings of the International Nosocomial Infection Control Consortium (INICC), Part III Effectiveness of a Multidimensional Infection Control Approach to Reduce Central Line—Associated Bloodstream Infections in the Neonatal Intensive Care Units of 4 Developing Countries

  • Victor Daniel Rosenthal (a1), Lourdes Dueñas (a2), Martha Sobreyra-Oropeza (a3), Khaldi Ammar (a4), Josephine Anne Navoa-Ng (a5), Ana Conceptión Bran de Casares (a2), Lilian de Jesús Machuca (a2), Nejla Ben-Jaballah (a4), Asma Hamdi (a4), Victoria D. Villanueva (a5) and María Corazon V. Tolentino (a5)...

Abstract

Objective.

To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach to reduce central line-associated bloodstream infection (CLABSI) rates.

Setting.

Four neonatal intensive care units (NICUs) of INICC member hospitals from El Salvador, Mexico, Philippines, and Tunisia.

Patients.

A total of 2,241 patients hospitalized in 4 NICUs for 40,045 bed-days.

Methods.

We conducted a before-after prospective surveillance study. During Phase 1 we performed active surveillance, and during phase 2 the INICC multidimensional infection control approach was implemented, including the following practices: (1) central line care bundle, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of CLABSI rates, and (6) performance feedback of infection control practices. We compared CLABSI rates obtained during the 2 phases. We calculated crude stratified rates, and, using random-effects Poisson regression to allow for clustering by ICU, we calculated the incidence rate ratio (IRR) for each follow-up time period compared with the 3-month baseline.

Results.

During phase 1 we recorded 2,105 CL-days, and during phase 2 we recorded 17,117 CL-days. After implementation of the multidimensional approach, the CLABSI rate decreased by 55%, from 21.4 per 1,000 CL-days during phase 1 to 9.7 per 1,000 CL-days during phase 2 (rate ratio, 0.45 [95% confidence interval, 0.33–0.63]). The IRR was 0.53 during the 4–12-month period and 0.07 during the final period of the study (more than 45 months).

Conclusions.

Implementation of a multidimensional infection control approach was associated with a significant reduction in CLABSI rates in NICUs.

Copyright

Corresponding author

Corrientes Avenue No. 4580, Floor 12, Apt. D, Buenos Aires 1195, Argentina (victor_rosenthal@inicc.org, http://www.inicc.org)

References

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1. Marschall, J, Mermel, LA, Classen, D, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29(suppl 1):S22S30.
2. 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(26):27252732.
3. Digiovine, B, Chenoweth, C, Watts, C, Higgins, M. The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J Respir Crit Care Med 1999; 160(3):976981.
4. Warren, DK, Quadir, WW, Hollenbeak, CS, Elward, AM, Cox, MJ, Fraser, VJ. Attributable cost of catheter-associated bloodstream infections among intensive care patients in a nonteaching hospital. Crit Care Med 2006;34(8):20842089.
5. Powers, RJ, Wirtschafter, DW. Decreasing central line associated bloodstream infection in neonatal intensive care. Clin Perinatol 2010;37(1):247272.
6. Barnett, AG, Beyersmann, J, Allignol, A, Rosenthal, VD, Graves, N, Wolkewitz, M. The time-dependent bias and its effect on extra length of stay due to nosocomial infection. Value Health 2011; 14(2):381386.
7. 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(1):3135.
8. Rosenthal, VD, Guzman, S, Migone, O, Crnich, CJ. 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(8):475480.
9. Rosenthal, VD, Guzman, S, Migone, O, Safdar, N. The attributable cost and length of hospital stay because of nosocomial pneumonia in intensive care units in 3 hospitals in Argentina: a prospective, matched analysis. Am J Infect Control 2005;33(3): 157161.
10. Rosenthal, VD, Udwadia, FE, Muñoz, HJ, et al. Time-dependent analysis of extra length of stay and mortality due to ventilator-associated pneumonia in intensive-care units of ten limited-resources countries: findings of the International Nosocomial Infection Control Consortium (INICC). Epidemiol Infect 2011; 139(11):17571763.
11. Rosenthal, VD, Dwivedy, A, Calderon, ME, et al. Time-dependent analysis of length of stay and mortality due to urinary tract infections in ten developing countries: INICC findings. J Infect 2011;62(2):136141.
12. Barnett, AG, Graves, N, Rosenthal, VD, Salomao, R, Rangel-Frausto, MS. Excess length of stay due to central line-associated bloodstream infection in intensive care units in Argentina, Brazil, and Mexico. Infect Control Hosp Epidemiol 2010;31(11): 11061114.
13. 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(4): 244247.
14. 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(10):S171.e7-S171.el2.
15. 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(5): 291295.
16. Tarricone, R, Torbica, A, Franzetti, F, Rosenthal, VD. Hospital costs of central line-associated bloodstream infections and cost-effectiveness of closed vs. open infusion containers: the case of intensive care units in Italy. Cost Eff Resour Alloc 2010;8:8.
17. 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(4):349356.
18. Rosenthal, VD, Guzman, S, Crnich, C. Device-associated nosocomial infection rates in intensive care units of Argentina. Infect Control Hosp Epidemiol 2004;25(3):251255.
19. Rosenthal, VD, Lynch, P, Jarvis, WR, et al. Socioeconomic impact on device-associated infections in limited-resource neonatal intensive care units: findings of the INICC. Infection 2011;39(5): 439450.
20. Townsend, TR, Wenzel, RP. Nosocomial bloodstream infections in a newborn intensive care unit: a case-matched control study of morbidity, mortality and risk. Am J Epidemiol 1981;114(1): 7380.
21. Pessoa-Silva, CL, Miyasaki, CH, de Almeida, MF, Kopelman, BI, Raggio, RL, Wey, SB. Neonatal late-onset bloodstream infection: attributable mortality, excess of length of stay and risk factors. Eur J Epidemiol 2001;17(8):715720.
22. Stoli, BJ, Hansen, N, Fanaroff, AA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002;110(2 pt 1):285291.
23. Stoll, BJ, Hansen, NI, Adams-Chapman, I, et al. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA 2004;292(19): 23572365.
24. Shah, DK, Doyle, LW, Anderson, PJ, et al. Adverse neurodevelopment in preterm infants with postnatal sepsis or necrotizing enterocolitis is mediated by white matter abnormalities on magnetic resonance imaging at term. J Pediatr 2008;153(2):170175, 175.el.
25. Lahra, MM, Beeby, PJ, Jeffery, HE. Intrauterine inflammation, neonatal sepsis, and chronic lung disease: a 13-year hospital cohort study. Pediatrics 2009;123(5):13141319.
26. Hermans, D, Talbotec, C, Lacaille, F, Goulet, O, Ricour, C, Colomb, V. Early central catheter infections may contribute to hepatic fibrosis in children receiving long-term parenteral nutrition. J Pediatr Gastroenterol Nutr 2007;44(4):459463.
27. 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(9218):18641868.
28. Apisarnthanarak, A, Thongphubeth, K, Yuekyen, C, Warren, DK, Fraser, VJ. Effectiveness of a catheter-associated bloodstream infection bundle in a Thai tertiary care center: a 3-year study. Am J Infect Control 2010;38(6):449455.
29. Rosenthal, VD, Ramachandran, B, Dueñas, L. Findings of the International Nosocomial Infection Control Consortium (INICC), part I: effectiveness of a multidimensional infection control approach on catheter-associated urinary tract infection rates in pediatric intensive care units of 6 developing countries. Infect Control Hosp Epidemiol 2012;33(7):696703.
30. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36(5):309332.
31. Rosenthal, VD, Guzman, S, Safdar, N. Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina. Am J Infect Control 2005; 33(7):392397.
32. Berenholtz, SM, Pronovost, PJ, Lipsett, PA, et al. Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med 2004;32(10):20142020.
33. Raad, II, Hohn, DC, Gilbreath, BJ, et al. Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion. Infect Control Hosp Epidemiol 1994;15(4 pt 1):231238.
34. O'Grady, NP, Alexander, M, Burns, LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011;52(9):e162e193.
35. Pratt, RJ, Pellowe, CM, Wilson, JA, et al. epic2: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect 2007;65(suppl 1): S1S64.
36. Casey, AL, Worthington, T, Lambert, PA, Quinn, D, Faroqui, MH, Elliott, TS. A randomized, prospective clinical trial to assess the potential infection risk associated with the PosiFlow needleless connector. J Hosp Infect 2003;54(4):288293.
37. Luebke, MA, Arduino, MJ, Duda, DL, et al. Comparison of the microbial barrier properties of a needleless and a conventional needle-based intravenous access system. Am J Infect Control 1998;26(4):437441.
38. Parenti, CM, Lederle, FA, Impola, CL, Peterson, LR. Reduction of unnecessary intravenous catheter use: internal medicine house staff participate in a successful quality improvement project. Arch Intern Med 1994;154(16):18291832.
39. Lederle, FA, Parenti, CM, Berskow, LC, Ellingson, KJ. The idle intravenous catheter. Ann Intern Med 1992;116(9):737738.
40. O'Grady, NP, Alexander, M, Burns, LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control 2011;39(4 suppl 1):S1S34.
41. Royer, T. Implementing a better bundle to achieve and sustain a zero central line-associated bloodstream infection rate. J Infus Nurs 2010;33(6):398406.
42. 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(9):e1e12.
43. Sax, H, Allegranzi, B, Chraiti, MN, Boyce, J, Larson, E, Pittet, D. The World Health Organization hand hygiene observation method. Am J Infect Control 2009;37(10):827834.
44. Maki, DG, Weise, CE, Sarafin, HW. A semiquantitative culture method for identifying intravenous-catheter-related infection. N Engl J Med 1977;296(23):13051309.
45. Emori, TG, Culver, DH, Horan, TC, et al. National nosocomial infections surveillance system (NNIS): description of surveillance methods. Am J Infect Control 1991;19(1):1935.
46. World Bank classification of economies. World Bank website. http://web.worldbank.org/WBSITE/EXTERNAL/DATA STATISTICS/0,,contentMDK:20421402~pagePK:64133150~piPK:64133175~theSitePK:239419,00.html. Published 2007. Accessed October 5, 2008.
47. Tseng, YC, Chiu, YC, Wang, JH, Lin, HC, Su, BH, Chiu, HH. Nosocomial bloodstream infection in a neonatal intensive care unit of a medical center: a three-year review. J Microbiol Immunol Infect 2002;35(3):168172.
48. Landre-Peigne, C, Ka, AS, Peigne, V, Bougere, J, Seye, MN, Imbert, P. Efficacy of an infection control programme in reducing nosocomial bloodstream infections in a Senegalese neonatal unit. J Hosp Infect 2011;79(2):161165.
49. Mahieu, LM, De Dooy, JJ, Lenaerts, AE, leven, MM, De Muynck, AO. Catheter manipulations and the risk of catheter-associated bloodstream infection in neonatal intensive care unit patients. J Hosp Infect 2001;48(1):2026.
50. Pronovost, PJ, Marsteller, JA, Goeschel, CA. Preventing bloodstream infections: a measurable national success story in quality improvement. Health Aff (Millwood) 2011;30(4):628634.
51. Schulman, J, Stricof, R, Stevens, TP, et al. Statewide NICU central-line-associated bloodstream infection rates decline after bundles and checklists. Pediatrics 2011;127(3):436444.
52. Haley, RW, Quade, D, Freeman, HE, Bennett, JV. The SENIC Project: study on the efficacy of nosocomial infection control (SENIC Project): summary of study design. Am J Epidemiol 1980;111(5):472485.
53. Hughes, JM. Study on the efficacy of nosocomial infection control (SENIC Project): results and implications for the future. Chemotherapy 1988;34(6):553561.
54. Rosenthal, VD, Maki, DG, Rodrigues, C, et al. 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. Infect Control Hosp Epidemiol 2010;31(12):12641272.
55. Edwards, JR, Peterson, KD, Mu, Y, et al. National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control 2009;37(10): 783805.
56. Rosenthal, VD, Jarvis, WR, Jamulitrat, S, et al. Socioeconomic impact on device-associated infections in pediatric intensive care units of 16 limited-resource countries: International Nosocomial Infection Control Consortium findings. Pediatr Crit Care Med 2012;13(4):399406.

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Findings of the International Nosocomial Infection Control Consortium (INICC), Part III Effectiveness of a Multidimensional Infection Control Approach to Reduce Central Line—Associated Bloodstream Infections in the Neonatal Intensive Care Units of 4 Developing Countries

  • Victor Daniel Rosenthal (a1), Lourdes Dueñas (a2), Martha Sobreyra-Oropeza (a3), Khaldi Ammar (a4), Josephine Anne Navoa-Ng (a5), Ana Conceptión Bran de Casares (a2), Lilian de Jesús Machuca (a2), Nejla Ben-Jaballah (a4), Asma Hamdi (a4), Victoria D. Villanueva (a5) and María Corazon V. Tolentino (a5)...

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