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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

Published online by Cambridge University Press:  02 January 2015

Victor Daniel Rosenthal*
Affiliation:
International Nosocomial Infection Control Consortium, Buenos Aires, Argentina
Lourdes Dueñas
Affiliation:
Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
Martha Sobreyra-Oropeza
Affiliation:
Hospital de la Mujer, Mexico City, Mexico
Khaldi Ammar
Affiliation:
Hôpital d'Enfants, Tunis, Tunisia
Josephine Anne Navoa-Ng
Affiliation:
St. Luke's Medical Center, Quezon City, Philippines
Ana Conceptión Bran de Casares
Affiliation:
Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
Lilian de Jesús Machuca
Affiliation:
Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
Nejla Ben-Jaballah
Affiliation:
Hôpital d'Enfants, Tunis, Tunisia
Asma Hamdi
Affiliation:
Hôpital d'Enfants, Tunis, Tunisia
Victoria D. Villanueva
Affiliation:
St. Luke's Medical Center, Quezon City, Philippines
María Corazon V. Tolentino
Affiliation:
St. Luke's Medical Center, Quezon City, Philippines
*
Corrientes Avenue No. 4580, Floor 12, Apt. D, Buenos Aires 1195, Argentina (victor_rosenthal@inicc.org, http://www.inicc.org)

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.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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