Impact of a multidimensional infection control approach on central line-associated bloodstream infections rates in adult intensive care units of 8 cities of Turkey: findings of the International Nosocomial Infection Control Consortium (INICC)

Abstract

BackgroundCentral line-associated bloodstream infections (CLABs) have long been associated with excess lengths of stay, increased hospital costs and mortality attributable to them. Different studies from developed countries have shown that practice bundles reduce the incidence of CLAB in intensive care units. However, the impact of the bundle strategy has not been systematically analyzed in the adult intensive care unit (ICU) setting in developing countries, such as Turkey. The aim of this study is to analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach to reduce the rates of CLAB in 13 ICUs of 13 INICC member hospitals from 8 cities of Turkey.MethodsWe conducted active, prospective surveillance before-after study to determine CLAB rates in a cohort of 4,017 adults hospitalized in ICUs. We applied the definitions of the CDC/NHSN and INICC surveillance methods. The study was divided into baseline and intervention periods. During baseline, active outcome surveillance of CLAB rates was performed. During intervention, the INICC multidimensional approach for CLAB reduction was implemented and included the following measures: 1- bundle of infection control interventions, 2- education, 3- outcome surveillance, 4- process surveillance, 5- feedback of CLAB rates, and 6- performance feedback on infection control practices. CLAB rates obtained in baseline were compared with CLAB rates obtained during intervention.ResultsDuring baseline, 3,129 central line (CL) days were recorded, and during intervention, we recorded 23,463 CL-days. We used random effects Poisson regression to account for clustering of CLAB rates within hospital across time periods. The baseline CLAB rate was 22.7 per 1000 CL days, which was decreased during the intervention period to 12.0 CLABs per 1000 CL days (IRR 0.613; 95% CI 0.43 – 0.87; P 0.007). This amounted to a 39% reduction in the incidence rate of CLAB.ConclusionsThe implementation of multidimensional infection control approach was associated with a significant reduction in the CLAB rates in adult ICUs of Turkey, and thus should be widely implemented.

Attitudes Toward Nosocomial Infections Associated Mortality at Intensive Care Units, and Evaluation of the Risk Factors

“…Similar to the present study, most of the studies found VAP as the most frequent NIs (4,7,12,13,20) and other studies reported analogous rates of NIs in Argentina and Latin American countries (5, 7). Although some studies detected that UTI was the most prevalent NIs (11,21), it is considerable that researches distinguished higher prevalence of NIs in university hospitals (20,22).…”

“…NIs are associated with considerable morbidity, extra cost, and are responsible for more mortality (9)(10)(11)(12)(13). On the basis of data from death certificates, these infections are the 10th leading cause of death in the United States (5,14).…”

“…On the basis of data from death certificates, these infections are the 10th leading cause of death in the United States (5,14). Importantly, bloodstream infections (BSIs) are major causes of morbidity and mortality (10,13,15).…”

Clinical impact and cost-effectiveness of split-septum and single-use prefilled flushing device vs 3-way stopcock on central line–associated bloodstream infection rates in India: a randomized clinical trial conducted by the International Nosocomial Infection Control Consortium (INICC)

“…5 Within the scope of other studies addressing the burden of CLABSIs in India, the CLABSI rate in our 3WSC group was similar to the rate of 7.92 CLABSIs per 1000 CL-days found in a 2007 study. 3 In previous studies performed by INICC member hospitals, it was shown that the implementation of a 6-component multidimensional approach for CLABSI resulted in significant reductions in CLABSI rates in Argentina (45.9 vs 11.1 CLABSIs per 1000 CL-days), 13 in Mexico (46.3 vs 19.5 CLABSIs per 1000 CL-days), 12 in Turkey (22.7 vs 12.0 CLABSIs per 1000 CL-days), 9 in India (6.4 vs 3.9 CLABSIs per 1000 CL-days), 8 11 However, in none of the previous studies conducted by INICC the CLABSI rate was lower than 5.2 CLABSIs per 1000 CL-days, as was achieved in the SS þ SUF group. [8][9][10][11][12][13][14] This finding is consistent with the fact that according to the INICC, between 88% and 94% of hospitals in the developing world use 3WSC devices instead of SS þ SUF devices.…”

“…6,7 However, to date only 2 studies addressing this issue have been published, which showed higher CLABSI rates in pediatric ICUs in lower-middle-income countries compared with upper-middle-income countries, 6 and significantly higher CLABSI rates in neonatal ICU patients from low-income countries than in lower-middle or upper-middle-income countries. 7 In the developing countries, including India, 8 it has been demonstrated that CLABSI rates can be reduced by more than 50% [8][9][10][11][12][13][14] by adopting a multidimensional approach with the simultaneous implementation of 6 elements: (1) a bundle of interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback on CLABSI rates and consequences, and (6) performance feedback.…”