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

2013 ◽  
Vol 34 (03) ◽  
pp. 229-237 ◽  
Author(s):  
Victor Daniel Rosenthal ◽  
Lourdes Dueñas ◽  
Martha Sobreyra-Oropeza ◽  
Khaldi Ammar ◽  
Josephine Anne Navoa-Ng ◽  
...  
Keyword(s):  
Intensive Care ◽  
Nosocomial Infection ◽  
Infection Control ◽  
Rate Ratio ◽  
Neonatal Intensive Care ◽  
Phase 1 ◽  
Central Line ◽  
Neonatal Intensive Care Units ◽  
Phase 2 ◽  
Control Approach

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.

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

2013 ◽  
Vol 34 (3) ◽  
pp. 229-237 ◽  
Author(s):  
Victor Daniel Rosenthal ◽  
Lourdes Dueñas ◽  
Martha Sobreyra-Oropeza ◽  
Khaldi Ammar ◽  
Josephine Anne Navoa-Ng ◽  
...  
Keyword(s):  
Intensive Care ◽  
Nosocomial Infection ◽  
Infection Control ◽  
Rate Ratio ◽  
Neonatal Intensive Care ◽  
Phase 1 ◽  
Central Line ◽  
Neonatal Intensive Care Units ◽  
Phase 2 ◽  
Control Approach

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.

Findings of the International Nosocomial Infection Control Consortium (INICC), Part II: Impact of a Multidimensional Strategy to Reduce Ventilator-Associated Pneumonia in Neonatal Intensive Care Units in 10 Developing Countries

2012 ◽  
Vol 33 (7) ◽  
pp. 704-710 ◽  
Author(s):  
Victor D. Rosenthal ◽  
Maria E. Rodríguez-Calderón ◽  
Marena Rodríguez-Ferrer ◽  
Tanu Singhal ◽  
Mandakini Pawar ◽  
...  
Keyword(s):  
Developing Countries ◽  
Intensive Care ◽  
Infection Control ◽  
Neonatal Intensive Care ◽  
Phase 1 ◽  
Control Program ◽  
Neonatal Intensive Care Units ◽  
Ventilator Associated Pneumonia ◽  
Phase 2 ◽  
Infection Control Program

Design.Before-after prospective surveillance study to assess the efficacy of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control program to reduce the rate of occurrence of ventilator-associated pneumonia (VAP).Setting.Neonatal intensive care units (NICUs) of INICC member hospitals from 15 cities in the following 10 developing countries: Argentina, Colombia, El Salvador, India, Mexico, Morocco, Peru, Philippines, Tunisia, and Turkey.Patients.NICU inpatients.Methods.VAP rates were determined during a first period of active surveillance without the implementation of the multidimensional approach (phase 1) to be then compared with VAP rates after implementation of the INICC multidimensional infection control program (phase 2), which included the following practices: a bundle of infection control interventions, education, outcome surveillance, process surveillance, feedback on VAP rates, and performance feedback on infection control practices. This study was conducted by infection control professionals who applied National Health Safety Network (NHSN) definitions for healthcare-associated infections and INICC surveillance methodology.Results.During phase 1, we recorded 3,153 mechanical ventilation (MV)–days, and during phase 2, after the implementation of the bundle of interventions, we recorded 15,981 MV-days. The VAP rate was 17.8 cases per 1,000 MV-days during phase 1 and 12.0 cases per 1,000 MV-days during phase 2 (relative risk, 0.67 [95% confidence interval, 0.50–0.91]; P = .001 ), indicating a 33% reduction in VAP rate.Conclusions.Our results demonstrate that an implementation of the INICC multidimensional infection control program was associated with a significant reduction in VAP rate in NICUs in developing countries.

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

2012 ◽  
Vol 33 (7) ◽  
pp. 696-703 ◽  
Author(s):  
Victor D. Rosenthal ◽  
Bala Ramachandran ◽  
Lourdes Dueñas ◽  
Carlos Álvarez-Moreno ◽  
J. A. Navoa-Ng ◽  
...  
Keyword(s):  
Developing Countries ◽  
Urinary Tract Infection ◽  
Intensive Care ◽  
Urinary Tract ◽  
Tract Infection ◽  
Infection Control ◽  
Phase 1 ◽  
Pediatric Intensive Care ◽  
Phase 2 ◽  
Control Approach

Design.A before-after prospective surveillance study to assess the impact of a multidimensional infection control approach for the reduction of catheter-associated urinary tract infection (CAUTI) rates.Setting.Pediatric intensive care units (PICUs) of hospital members of the International Nosocomial Infection Control Consortium (INICC) from 10 cities of the following 6 developing countries: Colombia, El Salvador, India, Mexico, Philippines, and Turkey.Patients.PICU inpatients.Methods.We performed a prospective active surveillance to determine rates of CAUTI among 3,877 patients hospitalized in 10 PICUs for a total of 27,345 bed-days. The study was divided into a baseline period (phase 1) and an intervention period (phase 2). In phase 1, surveillance was performed without the implementation of the multidimensional approach. In phase 2, we implemented a multidimensional infection control approach that included outcome surveillance, process surveillance, feedback on CAUTI rates, feedback on performance, education, and a bundle of preventive measures. The rates of CAUTI obtained in phase 1 were compared with the rates obtained in phase 2, after interventions were implemented.Results.During the study period, we recorded 8,513 urinary catheter (UC) days, including 1,513 UC-days in phase 1 and 7,000 UC-days in phase 2. In phase 1, the CAUTI rate was 5.9 cases per 1,000 UC-days, and in phase 2, after implementing the multidimensional infection control approach for CAUTI prevention, the rate of CAUTI decreased to 2.6 cases per 1,000 UC-days (relative risk, 0.43 [95% confidence interval, 0.21–1.0]), indicating a rate reduction of 57%.Conclusions.Our findings demonstrated that implementing a multidimensional infection control approach is associated with a significant reduction in the CAUTI rate of PICUs in developing countries.

scholarly journals 582. Impact of Central Line Bundle for Prevention of Umbilical Vein Catheter-Related Bloodstream Infections in a Neonatal Intensive Care Unit

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S275-S275
Author(s):  
İlker devrim ◽  
Ferit Kulalı ◽  
İlknur Çağlar ◽  
Yeliz Oruc ◽  
Nevbahar Demiray ◽  
...  
Keyword(s):  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Umbilical Vein ◽  
Bloodstream Infections ◽  
Central Line ◽  
Neonatal Intensive Care Units ◽  
Vein Catheter ◽  
Single Use ◽  
Umbilical Vein Catheter ◽  
Central Line Bundle

Abstract Background Umbilical vein catheters (UVC) are one of the most common types of vascular access device in the neonatal intensive care units. Central line-associated bloodstream infections were reported to be in the first place of healthcare-associated infections in preterm infants. In this study, we aimed to evaluate the effectiveness of the bundle applications in the prevention of umbilical vein catheter-associated bloodstream infections in neonates including premature infants. Methods This 40 months cross-sectional study included two periods, including pre-bundle period (from August 1, 2015 to March 31, 2017) and bundle period (April 1, 2017 to November 30, 2018). The umbilical vein catheter-related bloodstream infections, catheter line days, number of the patients were recorded and compared between the prebundle and bundle periods. Bundle steps were defined as education-training-assignment, evaluation of daily catheter indications, hand hygiene and aseptic technique while insertion, maximal sterile barrier precautions, closure of the catheter area with transparent semi-permeable membrane, using needless connectors in stead of 3-way stop-cocks, and single-use prefilled saline syringes for flushing. Results During the whole study period total umbilical vein catheter days were 2,228 days. During the prebundle period there was 10 and in the bundle period there was 2 umbilical vein catheter-related bloodstream infections (Table 1). While umbilical vein-associated bloodstream infection rate was 8.9 per 1,000 catheter days in the pre-bundle period, and significantly decreased to 1.79 in the bundle period (P < 0.05). After the introduction of bundle applications, it was observed that the rate of infection decreased by 68% (P < 0.05) Conclusion Our study showed that implementation of central line bundle including needless connectors and single-use prefilled syringes for umbilical vein-related bloodstream infections was effective for the prevention of catheter-related bloodstream infections in neonatal intensive care units. Disclosures All authors: No reported disclosures.

Impact of International Nosocomial Infection Control Consortium’s multidimensional approach on central line–associated bloodstream infection rates in Bahrain

2019 ◽  
Vol 21 (4) ◽  
pp. 481-489
Author(s):  
Safaa Alkhawaja ◽  
Nermeen Kamal Saeed ◽  
Victor Daniel Rosenthal ◽  
Sana Abdul-Aziz ◽  
Ameena Alsayegh ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nosocomial Infection ◽  
Infection Control ◽  
Bloodstream Infection ◽  
Infection Rate ◽  
Bloodstream Infections ◽  
Central Line ◽  
Multidimensional Approach ◽  
Infection Rates

Background: Central line–associated bloodstream infections are serious life-threatening infections in the intensive care unit setting. Methods: To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Approach (IMA) and INICC Surveillance Online System (ISOS) on central line–associated bloodstream infection rates in Bahrain from January 2013 to December 2016, we conducted a prospective, before-after surveillance, cohort, observational study in one intensive care unit in Bahrain. During baseline, we performed outcome and process surveillance of central line–associated bloodstream infection on 2320 intensive care unit patients, applying Centers for Disease Control and Prevention’s National Healthcare Safety Network definitions. During intervention, we implemented IMA through ISOS, including (1) a bundle of infection prevention interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback on central line–associated bloodstream infection rates and consequences, and (6) performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using a logistic regression model to estimate the effect of the intervention on the central line–associated bloodstream infection rate. Results: During baseline, 672 central line days and 7 central line–associated bloodstream infections were recorded, accounting for 10.4 central line–associated bloodstream infections per 1000 central line days. During intervention, 13,020 central line days and 48 central line–associated bloodstream infections were recorded. After the second year, there was a sustained 89% cumulative central line–associated bloodstream infection rate reduction to 1.2 central line–associated bloodstream infections per 1000 central line days (incidence density rate, 0.11; 95% confidence interval 0.1–0.3; p, 0.001). The average extra length of stay of patients with central line–associated bloodstream infection was 23.3 days, and due to the reduction of central line–associated bloodstream infections, 367 days of hospitalization were saved, amounting to a reduction in hospitalization costs of US$1,100,553. Conclusion: Implementing IMA was associated with a significant reduction in the central line–associated bloodstream infection rate in Bahrain.

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