impact of the International Nosocomial Infection Control Consortium [INICC] multicenter, multidimensional hand hygiene approach in two cities of India

The fundamental tool for preventing and controlling healthcare-acquired infections is hand hygiene [HH]. Nonetheless, adherence to HH guidelines is often low. Our goal was to assess the effect of the International Nosocomial Infection Control Consortium [INICC] Multidimensional Hand Hygiene Approach [IMHHA] in three intensive care units of three INICC member hospitals in two cities of India and to analyze the predictors of compliance with HH. From August 2004 to July 2011, we carried out an observational, prospective, interventional study to evaluate the implementation of the IMHHA, which included the following elements: [1] administrative support, [2] supplies availability, [3] education and training, [4] reminders in the workplace, [5] process surveillance and [6] performance feedback. The practices of health care workers were monitored during randomly selected 30-min periods. We observed 3612 opportunities for HH. Overall adherence to HH increased from 36.9% to 82% [95% CI 79.3-84.5; P = 0.0001]. Multivariate analysis indicated that certain variables were significantly associated with poor HH adherence: nurses vs. physicians [70.5% vs. 74%; 95% CI 0.62-0.96; P = 0.018], ancillary staff vs. physicians [43.6% vs. 74.0%; 95% CI 0.48-0.72; P < 0.001], ancillary staff vs. nurses [43.6% vs. 70.5%; 95% CI 0.51-0.75; P < 0.001] and private vs. academic hospitals [74.2% vs. 66.3%; 95% CI 0.83-0.97; P < 0.001]. It is worth noticing that in India, the HH compliance of physicians is higher than in nurses. Adherence to HH was significantly increased by implementing the IMHHA. Programs targeted at improving HH are warranted to identify predictors of poor compliance

Device-associated infection rates and bacterial resistance in six academic teaching hospitals of Iran: Findings from the International Nocosomial Infection Control Consortium [INICC]

Device-associated health care-acquired infections [DA-HAIs] pose a threat to patient safety, particularly in the intensive care unit [ICU]. However, few data regarding DA-HAI rates and their associated bacterial resistance in ICUs from Iran are available. A DA-HAI surveillance study was conducted in six adult and pediatric ICUs in academic teaching hospitals in Tehran using CDC/NHSN definitions. We collected prospective data regarding device use, DA-HAI rates, and lengths of stay from 2584 patients, 16,796 bed-days from one adult ICU, and bacterial profiles and bacterial resistance from six ICUs. Among the DA-HAIs, there were 5.84 central line-associated bloodstream infections [CLABs] per 1000 central line-days, 7.88 ventilator-associated pneumonias [VAPs] per 1000 mechanical ventilator-days and 8.99 catheter-associated urinary tract infections [CAUTIs] per 1000 urinary catheter-days. The device utilization ratios were 0.44 for central lines, 0.42 for mechanical ventilators and 1.0 for urinary catheters. The device utilization ratios of mechanical ventilators and urinary catheters were higher than those reported in the ICUs of the INICC and the CDC's NHSN reports, but central line use was lower. The DA-HAI rates in this study were higher than the CDC's NHSN report. However, compared with the INICC report, the VAP rate in our study was lower, while the CLAB rate was similar and the CAUTI rate was higher. Nearly 83% of the samples showed a mixed-type infection. The most frequent pathogens were Acinetobacter baumannii,Staphylococcus aureus and Pseudomonas aeruginosa, followed by Klebsiella pneumoniae andEnterococcus spp. In the S. aureus isolates, 100% were resistant to oxacillin. Overall resistances of A. baumannii and K. pneumonia to imipenem were 70.5% and 76.7%, respectively. A multiple drug resistance phenotype was detected in 68.15% of the isolates. The DA-HAI rates in Iran were shown to be higher than the CDC-NHSN rates and similar to the INICC rates. Resistance to oxacillin and imipenem was higher as well. Comparing device use, DA-HAI rates, and bacterial resistance for the primary isolated bacteria indicated a direct association between urinary catheter use and the rates of CAUTI

Surgical site infection rates in four Mexican cities: findings of the international nosocomial infection control consortium [INICC]

From January 2005 to December 2010, we conducted a prospective cohort surveillance study on surgical site infections [SSIs] in five hospitals, all of which were members of the International Nosocomial Infection Control Consortium [INICC] in four cities in Mexico. Data were recorded from hospitalized patients using the methods and definitions of the Centers for Disease Control and Prevention's National Healthcare Safety Network [CDC-NHSN] for SSIs. Surgical procedures [SPs] were classified into 11 types according to the ICD-9 criteria. We documented 312 SSIs, associated with 5063 SPs [5.5%; CI, 5.5-6.9]. SSI rates per type of SP in these Mexican hospitals compared with the INICC and CDC-NHSN reports, respectively, include: 18.4% for ventricular shunt [vs. 12.9% vs. 5.6%]; 10% for spleen surgery [vs. 5.6% vs. 2.3%]; 7.3% for cardiac surgery [vs. 5.6% vs. 1.3%]; 6.4% for open reduction of fracture [vs. 4.2% vs. 1.7%]; 5.2% for exploratory abdominal surgery [vs. 4.1% vs. 2.0%], and 5.1% for hip prosthesis [vs. 2.6% vs. 1.3%]. Compared with the CDC-NHSN, our SSIs rates were higher in 73% and similar in 27% of the analyzed types of SPs, whereas compared with INICC, rates were similar in 55% and higher in 45% of SPs. There are no data on SSI rates by surgical procedure in Mexico. Therefore, this paper represents an important advance in the knowledge of epidemiology of SSIs in Mexico that will allow us to introduce targeted interventions. This study also demonstrates that the INICC is a valuable international benchmarking tool, in addition to the CDC-NSHN, the participating hospitals of which enjoy factual advantages

Impact of an international nosocomial infection control consortium multidimensional approach on catheter-associated urinary tract infections in adult intensive care units in the Philippines: international nosocomial infection control consortium [INICC] findings

To assess the impact of a multidimensional infection control approach on the reduction of catheter-associated urinary tract infection [CAUTI] rates in adult intensive care units [AICUs] in two hospitals in the Philippines that are members of the International Nosocomial Infection Control Consortium. This was a before-after prospective active surveillance study to determine the rates of CAUTI in 3183 patients hospitalized in 4 ICUS over 14,426 bed-days. The study was divided into baseline and intervention periods. During baseline, surveillance was performed using the definitions of the US Centers for Disease Control and Prevention and the National Healthcare Safety Network [CDC/NHSN]. During intervention, we implemented a multidimensional approach that included: [1] a bundle of infection control interventions, [2] education, [3] surveillance of CAUTI rates, [4] feedback on CAUTI rates, [5] process surveillance and [6] performance feedback. We used random effects Poisson regression to account for the clustering of CAUTI rates across time. We recorded 8720 urinary catheter [UC]-days: 819 at baseline and 7901 during intervention. The rate of CAUTI was 11.0 per 1000 UC-days at baseline and was decreased by 76% to 2.66 per 1000 UC-days during intervention [rate ratio [RR], 0.24; 95% confidence interval [CI], 0.11-0.53; P-value, 0.0001]. Our multidimensional approach was associated with a significant reduction in the CAUTI rates in the ICU setting of a limited-resource country

Effectiveness of a multidimensional approach for the prevention of ventilator-associated pneumonia in an adult intensive care unit in Cuba: findings of the international nosocomial infection control consortium [INICC]

This study sought to assess the effect of the multidimensional approach developed by the International Nosocomial Infection Control Consortium [INICC] on the reduction of ventilator-associated pneumonia [VAP] rates in patients hospitalized in an adult intensive care unit [AICU] in an INICC member hospital in Havana, Cuba. We conducted a prospective surveillance pre-post study in AICU patients. The study was divided into two periods: baseline and intervention. During the baseline period, we conducted active prospective surveillance of VAP using the Centers for Disease Control and Prevention [CDC] National Health Safety Network [NHSN] definition and INICC methods. During the intervention period, we implemented the INICC multidimensional approach for VAP, in addition to performing active surveillance. This multidimensional approach included the following measures: a bundle of infection control interventions, education, outcome surveillance, process surveillance, feedback of VAP rates and performance feedback of infection control practices. The baseline rates of VAP were compared to the rates obtained after intervention, and we analyzed the impact of our interventions by Poisson regression. During the baseline period, we recorded 114 mechanical ventilator [MV] days, whereas we recorded 2350 MV days during the intervention period. The baseline rate of VAP was 52.63 per 1000 MV days and 15.32 per 1000 MV days during the intervention. At the end of the study period, we achieved a 70% reduction in the rate of VAP [RR, 0.3; 95% CI, 0.12-0.7; P value, 0.003.]. The implementation the INICC multidimensional approach for VAP was associated with a significant reduction in the VAP rate in the participating AICU of Cuba

Device-associated infection rates in adult and pediatric intensive care units of hospitals in Egypt. International nosocomial infection control consortium [INICC] findings

To determine the rate of device-associated healthcare-associated infections [DA-HAIs] at a respiratory intensive care unit [RICU] and in the pediatric intensive care units [PICUs] of member hospitals of the International Nosocomial Infection Control Consortium [INICC] in Egypt. A prospective cohort DA-HAI surveillance study was conducted from December 2008 to July 2010 by applying the methodology of the INICC and the definitions of the NHSN-CDC. In the RICU, 473 patients were hospitalized for 2930 d and acquired 155 DA-HAIs, with an overall rate of 32.8%. There were 52.9 DA-HAIs per 1000 ICU-days. In the PICUs, 143 patients were hospitalized for 1535 d and acquired 35 DA-HAIs, with an overall rate of 24.5%. There were 22.8 DA-HAIs per 1000 ICU-days. The central line-associated blood stream infection [CLABSI] rate was 22.5 per 1000 line-days in the RICU and 18.8 in the PICUs; the ventilator-associated pneumonia [VAP] rate was 73.4 per 1000 ventilator-days in the RICU and 31.8 in the PICUs; and the catheter-associated urinary tract infection [CAUTI] rate was 34.2 per 1000 catheter-days in the RICU. DA-HAIs in the ICUs in Egypt pose greater threats to patient safety than in industrialized countries, and infection control programs, including surveillance and guidelines, must become a priority