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Six-year multicenter study on short-term peripheral venous catheters-related bloodstream infection rates in 727 intensive care units of 268 hospitals in 141 cities of 42 countries of Africa, the Americas, Eastern Mediterranean, Europe, South East Asia, and Western Pacific Regions: International Nosocomial Infection Control Consortium (INICC) findings
- Víctor Daniel Rosenthal, Ider Bat-Erdene, Debkishore Gupta, Souad Belkebir, Prasad Rajhans, Farid Zand, Sheila Nainan Myatra, Majeda Afeef, Vito L. Tanzi, S. Muralidharan, Hail M. Al-Abdely, Amani El-Kholy, Safa A. Aziz AlKhawaja, Ali Pekcan Demiroz, Yatin Mehta, Vineya Rai, Nguyen Viet Hung, Amani F. Sayed, Estuardo Salgado-Yepez, Naheed Elahi, María del Rayo Morfin-Otero, Montri Luxsuwong, Braulio Matias De-Carvalho, Audrey Rose D. Tapang, Velmira Angelova Velinova, Ana Marcela Quesada-Mora, Tanja Anguseva, Aamer Ikram, Daisy Aguilar-de-Moros, Wieslawa Duszynska, Nepomuceno Mejia, Florin George Horhat, Vladislav Belskiy, Vesna Mioljevic, Gabriela Di-Silvestre, Katarina Furova, May Osman Gamar-Elanbya, Umesh Gupta, Khalid Abidi, Lul Raka, Xiuqin Guo, Kushlani Jayatilleke, Najla Ben-Jaballah, Harrison Ronald Sandoval-Castillo, Andrew Trotter, Sandra L. Valderrama-Beltrán, Hakan Leblebicioglu, Humberto Guanche-Garcell, Miriam de Lourdes-Dueñas
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue 5 / May 2020
- Published online by Cambridge University Press:
- 18 March 2020, pp. 553-563
- Print publication:
- May 2020
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Background:
Short-term peripheral venous catheter–related bloodstream infection (PVCR-BSI) rates have not been systematically studied in resource-limited countries, and data on their incidence by number of device days are not available.
Methods:Prospective, surveillance study on PVCR-BSI conducted from September 1, 2013, to May 31, 2019, in 727 intensive care units (ICUs), by members of the International Nosocomial Infection Control Consortium (INICC), from 268 hospitals in 141 cities of 42 countries of Africa, the Americas, Eastern Mediterranean, Europe, South East Asia, and Western Pacific regions. For this research, we applied definition and criteria of the CDC NHSN, methodology of the INICC, and software named INICC Surveillance Online System.
Results:We followed 149,609 ICU patients for 731,135 bed days and 743,508 short-term peripheral venous catheter (PVC) days. We identified 1,789 PVCR-BSIs for an overall rate of 2.41 per 1,000 PVC days. Mortality in patients with PVC but without PVCR-BSI was 6.67%, and mortality was 18% in patients with PVC and PVCR-BSI. The length of stay of patients with PVC but without PVCR-BSI was 4.83 days, and the length of stay was 9.85 days in patients with PVC and PVCR-BSI. Among these infections, the microorganism profile showed 58% gram-negative bacteria: Escherichia coli (16%), Klebsiella spp (11%), Pseudomonas aeruginosa (6%), Enterobacter spp (4%), and others (20%) including Serratia marcescens. Staphylococcus aureus were the predominant gram-positive bacteria (12%).
Conclusions:PVCR-BSI rates in INICC ICUs were much higher than rates published from industrialized countries. Infection prevention programs must be implemented to reduce the incidence of PVCR-BSIs in resource-limited countries.
Contributors
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. Mendola, Christopher Menzel, Michael J. Meyer, Christian B. Miller, David W. Miller, Peter Millican, Robert N. Minor, Phillip Mitsis, James A. Montmarquet, Michael S. Moore, Tim Moore, Benjamin Morison, Donald R. Morrison, Stephen J. Morse, Paul K. Moser, Alexander P. D. Mourelatos, Ian Mueller, James Bernard Murphy, Mark C. Murphy, Steven Nadler, Jan Narveson, Alan Nelson, Jerome Neu, Samuel Newlands, Kai Nielsen, Ilkka Niiniluoto, Carlos G. Noreña, Calvin G. Normore, David Fate Norton, Nikolaj Nottelmann, Donald Nute, David S. Oderberg, Steve Odin, Michael O’Rourke, Willard G. Oxtoby, Heinz Paetzold, George S. Pappas, Anthony J. Parel, Lydia Patton, R. P. Peerenboom, Francis Jeffry Pelletier, Adriaan T. Peperzak, Derk Pereboom, Jaroslav Peregrin, Glen Pettigrove, Philip Pettit, Edmund L. Pincoffs, Andrew Pinsent, Robert B. Pippin, Alvin Plantinga, Louis P. Pojman, Richard H. Popkin, John F. Post, Carl J. Posy, William J. Prior, Richard Purtill, Michael Quante, Philip L. Quinn, Philip L. Quinn, Elizabeth S. Radcliffe, Diana Raffman, Gerard Raulet, Stephen L. Read, Andrews Reath, Andrew Reisner, Nicholas Rescher, Henry S. Richardson, Robert C. Richardson, Thomas Ricketts, Wayne D. Riggs, Mark Roberts, Robert C. Roberts, Luke Robinson, Alexander Rosenberg, Gary Rosenkranz, Bernice Glatzer Rosenthal, Adina L. Roskies, William L. Rowe, T. M. Rudavsky, Michael Ruse, Bruce Russell, Lilly-Marlene Russow, Dan Ryder, R. M. Sainsbury, Joseph Salerno, Nathan Salmon, Wesley C. Salmon, Constantine Sandis, David H. Sanford, Marco Santambrogio, David Sapire, Ruth A. Saunders, Geoffrey Sayre-McCord, Charles Sayward, James P. Scanlan, Richard Schacht, Tamar Schapiro, Frederick F. Schmitt, Jerome B. Schneewind, Calvin O. Schrag, Alan D. Schrift, George F. Schumm, Jean-Loup Seban, David N. Sedley, Kenneth Seeskin, Krister Segerberg, Charlene Haddock Seigfried, Dennis M. Senchuk, James F. Sennett, William Lad Sessions, Stewart Shapiro, Tommie Shelby, Donald W. Sherburne, Christopher Shields, Roger A. Shiner, Sydney Shoemaker, Robert K. Shope, Kwong-loi Shun, Wilfried Sieg, A. John Simmons, Robert L. Simon, Marcus G. Singer, Georgette Sinkler, Walter Sinnott-Armstrong, Matti T. Sintonen, Lawrence Sklar, Brian Skyrms, Robert C. Sleigh, Michael Anthony Slote, Hans Sluga, Barry Smith, Michael Smith, Robin Smith, Robert Sokolowski, Robert C. Solomon, Marta Soniewicka, Philip Soper, Ernest Sosa, Nicholas Southwood, Paul Vincent Spade, T. L. S. Sprigge, Eric O. Springsted, George J. Stack, Rebecca Stangl, Jason Stanley, Florian Steinberger, Sören Stenlund, Christopher Stephens, James P. Sterba, Josef Stern, Matthias Steup, M. A. Stewart, Leopold Stubenberg, Edith Dudley Sulla, Frederick Suppe, Jere Paul Surber, David George Sussman, Sigrún Svavarsdóttir, Zeno G. Swijtink, Richard Swinburne, Charles C. Taliaferro, Robert B. Talisse, John Tasioulas, Paul Teller, Larry S. Temkin, Mark Textor, H. S. Thayer, Peter Thielke, Alan Thomas, Amie L. Thomasson, Katherine Thomson-Jones, Joshua C. Thurow, Vzalerie Tiberius, Terrence N. Tice, Paul Tidman, Mark C. Timmons, William Tolhurst, James E. Tomberlin, Rosemarie Tong, Lawrence Torcello, Kelly Trogdon, J. D. Trout, Robert E. Tully, Raimo Tuomela, John Turri, Martin M. Tweedale, Thomas Uebel, Jennifer Uleman, James Van Cleve, Harry van der Linden, Peter van Inwagen, Bryan W. Van Norden, René van Woudenberg, Donald Phillip Verene, Samantha Vice, Thomas Vinci, Donald Wayne Viney, Barbara Von Eckardt, Peter B. M. Vranas, Steven J. Wagner, William J. Wainwright, Paul E. Walker, Robert E. Wall, Craig Walton, Douglas Walton, Eric Watkins, Richard A. Watson, Michael V. Wedin, Rudolph H. Weingartner, Paul Weirich, Paul J. Weithman, Carl Wellman, Howard Wettstein, Samuel C. Wheeler, Stephen A. White, Jennifer Whiting, Edward R. Wierenga, Michael Williams, Fred Wilson, W. Kent Wilson, Kenneth P. Winkler, John F. Wippel, Jan Woleński, Allan B. Wolter, Nicholas P. Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
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- The Cambridge Dictionary of Philosophy
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- 05 August 2015
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- 27 April 2015, pp ix-xxx
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Surgical Site Infections, International Nosocomial Infection Control Consortium (INICC) Report, Data Summary of 30 Countries, 2005–2010
- Victor D. Rosenthal, Rosana Richtmann, Sanjeev Singh, Anucha Apisarnthanarak, Andrzej Kübler, Nguyen Viet-Hung, Fernando M. Ramírez-Wong, Jorge H. Portillo-Gallo, Jessica Toscani, Achilleas Gikas, Lourdes Dueñas, Amani El-Kholy, Sameeh Ghazal, Dale Fisher, Zan Mitrev, May Osman Gamar-Elanbya, Souha S. Kanj, Yolanda Arreza-Galapia, Hakan Leblebicioglu, Soňa Hlinková, Badaruddin A. Memon, Humberto Guanche-Garcell, Vaidotas Gurskis, Carlos Álvarez-Moreno, Amina Barkat, Nepomuceno Mejía, Magda Rojas-Bonilla, Goran Ristic, Lul Raka, Cheong Yuet-Meng, on behalf of the International Nosocomial Infection Control Consortium
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 34 / Issue 6 / June 2013
- Published online by Cambridge University Press:
- 02 January 2015, pp. 597-604
- Print publication:
- June 2013
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Objective.
To report the results of a surveillance study on surgical site infections (SSIs) conducted by the International Nosocomial Infection Control Consortium (INICC).
Design.Cohort prospective multinational multicenter surveillance study.
Setting.Eighty-two hospitals of 66 cities in 30 countries (Argentina, Brazil, Colombia, Cuba, Dominican Republic, Egypt, Greece, India, Kosovo, Lebanon, Lithuania, Macedonia, Malaysia, Mexico, Morocco, Pakistan, Panama, Peru, Philippines, Poland, Salvador, Saudi Arabia, Serbia, Singapore, Slovakia, Sudan, Thailand, Turkey, Uruguay, and Vietnam) from 4 continents (America, Asia, Africa, and Europe).
Patients.Patients undergoing surgical procedures (SPs) from January 2005 to December 2010.
Methods.Data were gathered and recorded from patients hospitalized in INICC member hospitals by using the methods and definitions of the Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) for SSI. SPs were classified into 31 types according to International Classification of Diseases, Ninth Revision, criteria.
Results.We gathered data from 7,523 SSIs associated with 260,973 SPs. SSI rates were significantly higher for most SPs in INICC hospitals compared with CDC-NHSN data, including the rates of SSI after hip prosthesis (2.6% vs 1.3%; relative risk [RR], 2.06 [95% confidence interval (CI), 1.8–2.4]; P<.001), coronary bypass with chest and donor incision (4.5% vs 2.9%; RR, 1.52 [95% CI, 1.4–1.6]; P<.001); abdominal hysterectomy (2.7% vs 1.6%; RR, 1.66 [95% CI, 1.4–2.0]; P<.001); exploratory abdominal surgery (4.1 % vs 2.0%; RR, 2.05 [95% CI, 1.6–2.6]; P<.001); ventricular shunt, 12.9% vs 5.6% (RR, 2.3 [95% CI, 1.9–2.6]; P<.001), and others.
Conclusions.SSI rates were higher for most SPs in INICC hospitals compared with CDC-NHSN data.
Impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene Approach over 13 Years in 51 Cities of 19 Limited-Resource Countries from Latin America, Asia, the Middle East, and Europe
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- Victor D. Rosenthal, Mandakini Pawar, Hakan Leblebicioglu, Josephine Anne Navoa-Ng, Wilmer Villamil-Gómez, Alberto Armas-Ruiz, Luis E. Cuéllar, Eduardo A. Medeiros, Zan Mitrev, Achilleas Gikas, Yun Yang, Altaf Ahmed, Souha S. Kanj, Lourdes Dueñas, Vaidotas Gurskis, Trudell Mapp, Humberto Guanche-Garcell, Rosalía Fernández-Hidalgo, Andrzej Kübler
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 34 / Issue 4 / April 2013
- Published online by Cambridge University Press:
- 02 January 2015, pp. 415-423
- Print publication:
- April 2013
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Objective.
To assess the feasibility and effectiveness of the International Nosocomial Infection Control Consortium (INICC) multi-dimensional hand hygiene approach in 19 limited-resource countries and to analyze predictors of poor hand hygiene compliance.
Design.An observational, prospective, cohort, interventional, before-and-after study from April 1999 through December 2011. The study was divided into 2 periods: a 3-month baseline period and a 7-year follow-up period.
Setting.Ninety-nine intensive care unit (ICU) members of the INICC in Argentina, Brazil, China, Colombia, Costa Rica, Cuba, El Salvador, Greece, India, Lebanon, Lithuania, Macedonia, Mexico, Pakistan, Panama, Peru, Philippines, Poland, and Turkey.
Participants.Healthcare workers at 99 ICU members of the INICC.
Methods.A multidimensional hand hygiene approach was used, including (1) administrative support, (2) supplies availability, (3) education and training, (4) reminders in the workplace, (5) process surveillance, and (6) performance feedback. Observations were made for hand hygiene compliance in each ICU, during randomly selected 30-minute periods.
Results.A total of 149,727 opportunities for hand hygiene were observed. Overall hand hygiene compliance increased from 48.3% to 71.4% (P < .01). Univariate analysis indicated that several variables were significantly associated with poor hand hygiene compliance, including males versus females (63% vs 70%; P<.001), physicians versus nurses (62% vs 72%; P<.001), and adult versus neonatal ICUs (67% vs 81%; P<.001), among others.
Conclusions.Adherence to hand hygiene increased by 48% with the INICC approach. Specific programs directed to improve hand hygiene for variables found to be predictors of poor hand hygiene compliance should be implemented.
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, Lourdes Dueñas, Martha Sobreyra-Oropeza, Khaldi Ammar, Josephine Anne Navoa-Ng, Ana Conceptión Bran de Casares, Lilian de Jesús Machuca, Nejla Ben-Jaballah, Asma Hamdi, Victoria D. Villanueva, María Corazon V. Tolentino
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 34 / Issue 3 / March 2013
- Published online by Cambridge University Press:
- 02 January 2015, pp. 229-237
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- March 2013
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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
- Victor D. Rosenthal, Maria E. Rodríguez-Calderón, Marena Rodríguez-Ferrer, Tanu Singhal, Mandakini Pawar, Martha Sobreyra-Oropeza, Amina Barkat, Teodora Atencio-Espinoza, Regina Berba, J. A. Navoa-Ng, Lourdes Dueñas, Nejla Ben-Jaballah, Davut Ozdemir, Gulden Ersoz, Canan Aygun
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 33 / Issue 7 / July 2012
- Published online by Cambridge University Press:
- 02 January 2015, pp. 704-710
- Print publication:
- July 2012
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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
- Victor D. Rosenthal, Bala Ramachandran, Lourdes Dueñas, Carlos Álvarez-Moreno, J. A. Navoa-Ng, Alberto Armas-Ruiz, Gulden Ersoz, Lorena Matta-Cortés, Mandakini Pawar, Ata Nevzat-Yalcin, Marena Rodriguez-Ferrer, Ana Concepción Bran de Casares, Claudia Linares, Victoria D. Villanueva, Roberto Campuzano, Ali Kaya, Luis Fernando Rendon-Campo, Amit Gupta, Ozge Turhan, Nayide Barahona-Guzmán, Lilian de Jesús-Machuca, María Corazon V. Tolentino, Jorge Mena-Brito, Necdet Kuyucu, Yamileth Astudillo, Narinder Saini, Nurgul Gunay, Guillermo Sarmiento-Villa, Eylul Gumus, Alfredo Lagares-Guzmán, Oguz Dursun
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 33 / Issue 7 / July 2012
- Published online by Cambridge University Press:
- 02 January 2015, pp. 696-703
- Print publication:
- July 2012
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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.
Impact of Switching from an Open to a Closed Infusion System on Rates of Central Line–Associated Bloodstream Infection: A Meta-analysis of Time-Sequence Cohort Studies in 4 Countries
- Dennis G. Maki, Victor D. Rosenthal, Reinaldo Salomao, Fabio Franzetti, Manuel Sigfrido Rangel-Frausto
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 32 / Issue 1 / January 2011
- Published online by Cambridge University Press:
- 02 January 2015, pp. 50-58
- Print publication:
- January 2011
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Background.
We report a meta-analysis of 4 identical time-series cohort studies of the impact of switching from use of open infusion containers (glass bottle, burette, or semirigid plastic bottle) to closed infusion containers (fully collapsible plastic containers) on central line-associated bloodstream infection (CLABSI) rates and all-cause intensive care unit (ICU) mortality in 15 adult ICUs in Argentina, Brazil, Italy, and Mexico.
Methods.All ICUs used open infusion containers for 6–12 months, followed by switching to closed containers. Patient characteristics, adherence to infection control practices, CLABSI rates, and ICU mortality during the 2 periods were compared by χ2 test for each country, and the results were combined using meta-analysis.
Results.Similar numbers of patients participated in 2 periods (2,237 and 2,136). Patients in each period had comparable Average Severity of Illness Scores, risk factors for CLABSI, hand hygiene adherence, central line care, and mean duration of central line placement. CLABSI incidence dropped markedly in all 4 countries after switching from an open to a closed infusion container (pooled results, from 10.1 to 3.3 CLABSIs per 1,000 central line-days; relative risk [RR], 0.33 [95% confidence interval {CI}, 0.24-0.46]; P<.001). All-cause ICU mortality also decreased significantiy, from 22.0 to 16.9 deaths per 100 patients (RR, 0.77 [95% CI, 0.68-0.87]; P<.001).
Conclusions.Switching from an open to a closed infusion container resulted in a striking reduction in the overall CLABSI incidence and all-cause ICU mortality. Data suggest that open infusion containers are associated with a greatiy increased risk of infusion-related bloodstream infection and increased ICU mortality that have been unrecognized. Furthermore, data suggest CLABSIs are associated with significant attributable mortality.
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
- Victor D. Rosenthal, Dennis G. Maki, Camila Rodrigues, Carlos Álvarez-Moreno, Hakan Leblebicioglu, Martha Sobreyra-Oropeza, Regina Berba, Naoufel Madani, Eduardo A. Medeiros, Luis E. Cuéllar, Zan Mitrev, Lourdes Dueñas, Humberto Guanche-Garcell, Trudell Mapp, Souha S. Kanj, Rosalía Fernández-Hidalgo, International Nosocomial Infection Control Consortium Investigators
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 31 / Issue 12 / December 2010
- Published online by Cambridge University Press:
- 02 January 2015, pp. 1264-1272
- Print publication:
- December 2010
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Background.
The International Nosocomial Infection Control Consortium (INICC) was established in 15 developing countries to reduce infection rates in resource-limited hospitals by focusing on education and feedback of outcome surveillance (infection rates) and process surveillance (adherence to infection control measures). We report a time-sequence analysis of the effectiveness of this approach in reducing rates of central line–associated bloodstream infection (CLABSI) and associated deaths in 86 intensive care units with a minimum of 6-month INICC membership.
Methods.Pooled CLABSI rates during the first 3 months (baseline) were compared with rates at 6-month intervals during the first 24 months in 53,719 patients (190,905 central line–days). Process surveillance results at baseline were compared with intervention period data.
Results.During the first 6 months, CLABSI incidence decreased by 33% (from 14.5 to 9.7 CLABSIs per 1,000 central line–days). Over the first 24 months there was a cumulative reduction from baseline of 54% (from 16.0 to 7.4 CLABSIs per 1,000 central line–days; relative risk, 0.46 [95% confidence interval, 0.33–0.63]; P <.001). The number of deaths in patients with CLABSI decreased by 58%. During the intervention period, hand hygiene adherence improved from 50% to 60% (P<.001); the percentage of intensive care units that used maximal sterile barriers at insertion increased from 45% to 85% (P < .001), that adopted Chlorhexidine for antisepsis increased from 7% to 27% (P = .018), and that sought to remove unneeded catheters increased from 37% to 83% (P = .004); and the duration of central line placement decreased from 4.1 to 3.5 days (P < .001).
Conclusions.Education, performance feedback, and outcome and process surveillance of CLABSI rates significantly improved infection control adherence, reducing the CLABSI incidence by 54% and the number of CLABSI-associated deaths by 58% in INICC hospitals during the first 2 years.
Well-Being in Canadian Seniors: Findings from the Canadian Study of Health and Aging*
- Philippa J. Clarke, Victor W. Marshall, Carol D. Ryff, Carolyn J. Rosenthal
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- Journal:
- Canadian Journal on Aging / La Revue canadienne du vieillissement / Volume 19 / Issue 2 / Été/Summer 2000
- Published online by Cambridge University Press:
- 29 November 2010, pp. 139-159
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While aging is associated with increased health problems and disability, most seniors subjectively rate their health positively, and view aging as a positive period of life evaluation, increased wisdom and maturity. The somewhat paradoxical nature of these findings suggests that later life well-being is multidimensional and variable. Drawing on data from a nationally representative survey, this paper describes the subjective well-being of a sample of Canadian seniors, using the Ryff multidimensional measure of well-being, and investigates the effects of various demographic, health and socio-economic conditions on reported levels of well-being. Seniors’ well-being is robust in terms of the dimension of autonomy, which is resilient to the physical and social circumstances of later life. But, as seniors age, they experience declines in their sense of purpose in life and opportunities for personal growth, in part, due to socio-economic factors. Good health and functional status are important for seniors’ sense of mastery over their surrounding world.
Excess Length of Stay Due to Central Line–Associated Bloodstream Infection in Intensive Care Units in Argentina, Brazil, and Mexico
- Adrian G. Barnett, Nicholas Graves, Victor D. Rosenthal, Reinaldo Salomao, Manuel Sigfrido Rangel-Frausto
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 31 / Issue 11 / November 2010
- Published online by Cambridge University Press:
- 02 January 2015, pp. 1106-1114
- Print publication:
- November 2010
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Objective.
To estimate the excess length of stay in an intensive care unit (ICU) due to a central line-associated bloodstream infection (CLABSI), using a multistate model that accounts for the timing of infection.
Design.A cohort of 3,560 patients followed up for 36,806 days in ICUs.
Setting.Eleven ICUs in 3 Latin American countries: Argentina, Brazil, and Mexico.
Patients.All patients admitted to the ICU during a defined time period with a central line in place for more than 24 hours.
Results.The average excess length of stay due to a CLABSI increased in 10 of 11 ICUs and varied from -1.23 days to 4.69 days. A reduction in length of stay in Mexico was probably caused by an increased risk of death due to CLABSI, leading to shorter times to death. Adjusting for patient age and Average Severity of Illness Score tended to increase the estimated excess length of stays due to CLABSI.
Conclusions.CLABSIs are associated with an excess length of ICU stay. The average excess length of stay varies between ICUs, most likely because of the case-mix of admissions and differences in the ways that hospitals deal with infections.
Device-Associated Infection Rate and Mortality in Intensive Care Units of 9 Colombian Hospitals: Findings of the International Nosocomial Infection Control Consortium
- Carlos Álvarez Moreno, Victor D. Rosenthal, Narda Olarte, Wilmer Villamil Gomez, Otto Sussmann, Julio Garzon Agudelo, Catherine Rojas, Laline Osorio, Claudia Linares, Alberto Valderrama, Patricia Garrido Mercado, Patrick Hernán Arrieta Bernate, Guillermo Ruiz Vergara, Alberto Marrugo Pertuz, Beatriz Eugenia Mojica, María del Pilar Torres Navarrete, Ana Sofia Alonso Romero, Daibeth Henríquez
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 27 / Issue 4 / April 2006
- Published online by Cambridge University Press:
- 21 June 2016, pp. 349-356
- Print publication:
- April 2006
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Objective.
To perform active targeted prospective surveillance to measure device-associated infection (DAI) rates, attributable mortality due to DAI, and the microbiological and antibiotic resistance profiles of infecting pathogens at 10 intensive care units (ICUs) in 9 hospitals in Colombia, all of which are members of the International Infection Control Consortium.
Methods.We conducted prospective surveillance of healthcare-associated infection in 9 hospitals by using the definitions of the US Centers for Disease Control and Prevention National Nosocomial Surveillance System (NNIS). DAI rates were calculated as the number of infections per 100 ICU patients and per 1,000 device-days.
Results.During the 3-year study, 2,172 patients hospitalized in an ICU for an aggregate duration of 14,603 days acquired 266 DAIs, for an overall DAI rate of 12.2%, or 18.2 DAIs per 1,000 patient-days. Central venous catheter (CVC)–related bloodstream infection (BSI) (47.4% of DAIs; 11.3 cases per 1,000 catheter-days) was the most common DAI, followed by ventilator-associated pneumonia (VAP) (32.3% of DAIs; 10.0 cases per 1,000 ventilator-days) and catheter-associated urinary tract infection (CAUTI) (20.3% of DAIs; 4.3 cases per 1,000 catheter-days). Overall, 65.4% of all Staphylococcus aureus infections were caused by methicillin-resistant strains; 40.0% of Enterobacteriaceae isolates were resistant to ceftriaxone and 28.3% were resistant to ceftazidime; and 40.0% of Pseudomonas aeruginosa isolates were resistant to fluoroquinolones, 50.0% were resistant to ceftazidime, 33.3% were resistant to piperacillin-tazobactam, and 19.0% were resistant to imipenem. The crude unadjusted attributable mortality was 16.9% among patients with VAP (relative risk [RR], 1.93; 95% confidence interval [CI], 1.24-3.00; P = .002); 18.5 among those with CVC-associated BSI (RR, 2.02; 95% CI, 1.42-2.87; P<.001); and 10.5% among those with CAUTI (RR, 1.58; 95% CI, 0.78-3.18; P = .19).
Conclusion.The rates of DAI in the Colombian ICUs were lower than those published in some reports from other Latin American countries and were higher than those reported in US ICUs by the NNIS. These data show the need for more-effective infection control interventions in Colombia.