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 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 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.

Molecular Epidemiology of an Outbreak ofSerratia marcescensin a Neonatal Intensive Care Unit

2001 ◽  
Vol 22 (10) ◽  
pp. 630-634 ◽  
Author(s):  
Paolo Villari ◽  
Margherita Crispino ◽  
Alessandra Salvadori ◽  
Alda Scarcella
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Infection Control ◽  
Neonatal Intensive Care Unit ◽  
Genomic Dna ◽  
Neonatal Intensive Care ◽  
Control Program ◽  
Control Measures ◽  
Infection Control Program ◽  
Multiresistant Bacteria

AbstractObjective:To investigate and control a biphasic outbreak ofSerratia marcescensin a neonatal intensive care unit (NICU).Design:Epidemiological and laboratory investigation of the outbreak.Setting:The NICU of the 1,470-bed teaching hospital of the University “Federico II,” Naples, Italy.Patients:The outbreak involved 56 cases of colonization by Smarcescensover a 15-month period, with two epidemic peaks of 6 and 3 months, respectively. Fourteen (25%) of the 56 colonized infants developed clinical infections, 50% of which were major (sepsis, meningitis, or pneumonia).Methods:Epidemiological and microbiological investigations, analysis of macrorestriction pattern of genomic DNA through pulsed-field gel electrophoresis (PFGE) of clinical and environmental isolates, and institution of infection control measures.Results:Analysis of macrorestriction patterns of genomic DNA by PFGE demonstrated that the vast majority of Smarcescensisolates, including three environmental strains isolated from two handwashing disinfectants and the hands of a nurse, were of the same clonal type. The successful control of the outbreak was achieved through cohorting of noncolonized infants, isolation of Smarcescens-infectedand -colonized infants, and an intense educational program that emphasized the need for adherence to glove use and handwashing policies. The NICU remained open to new admissions.Conclusions:Outbreaks caused by Smarcescensare very difficult to eradicate. An infection control program that includes molecular typing of microorganisms and the proper dissemination among staff members of the typing results is likely to be very effective in reducing NICU-acquired infections and in controlling outbreaks caused by Smarcescens,as well as other multiresistant bacteria.

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