ABSTRACT
Central line-associated bloodstream infection [CLABSIs] is an importanthealthcare-associated infection in the critical care units. It causes substantial mor-bidity, mortality and incurs high costs. The use of central venous line [CVL] insertionbundle has been shown to decrease the incidence of CLABSIs.Our aim was to study the impact of CVL insertion bundle on incidence of CLABSIand study the causative microbial agents in an intensive care unit in Kuwait.Surveillance for CLABSI was conducted by trained infection control team usingNational Health Safety Network [NHSN] case definitions and device days measure-ment methods. During the intervention period, nursing staff used central line carebundle consisting of [1] hand hygiene by inserter [2] maximal barrier precautionsupon insertion by the physician inserting the catheter and sterile drape from headto toe to the patient [3] use of a 2% chlorohexidine gluconate [CHG] in 70% ethanolscrub for the insertion site [4] optimum catheter site selection. [5] Examination ofthe daily necessity of the central line.During the pre-intervention period, there were 5367 documented catheter-daysand 80 CLABSIs, for an incidence density of 14.9 CLABSIs per 1000 catheter-days. After implementation of the interventions, there were 5052 catheter-days and 56CLABSIs, for an incidence density of 11.08 per 1000 catheter-days. The reduction inthe CLABSI/1000 catheter days was not statistically significant [P = 0.0859].This study demonstrates that implementation of a central venous catheter post-insertion care bundle was associated with a reduction in CLABSI in an intensive carearea setting
ABSTRACT
The Gulf Cooperation Council Center for Infection Control [GCC-IC] has placed the emergence of antimicrobial resistance [AMR] on the top of its agenda for the past four years. The board members have developed the initial draft for the GCC strategic plan for combating AMR in 2014. The strategic plan stems from the WHO mandate to combat AMR at all levels. The need for engaging a large number of stakeholders has prompted the GCC-IC to engage a wider core of professionals in finalizing the plan. A multi-disciplinary group of more than 40 experts were then identified. And a workshop was conducted in Riyadh January 2015 and included, for the first time, representation of relevant ministries and agencies as well as international experts in the field. Participants worked over a period of two and a half days in different groups. International experts shared the global experiences and challenges in addressing human, food, animal, and environmental aspects of controlling AMR. Participants were then divided into 4 groups each to address the human, animal, microbiological and diagnostic, or the environmental aspect of AMR. At the end of the workshop, the strategic plan was revised and endorsed by all participants. The GCC-IC board members then approved it as the strategic plan for AMR. The document produced here is the first GCC strategic plan addressing AMR, which shall be adopted by GCC countries to develop country-based plans and related key performance indicators [KPIs]. It is now the role of each country to identify the body that will be accountable for implementing the plan at the country level
ABSTRACT
Hand washing is widely accepted as the cornerstone of infection control in the intensive care unit [ICU]. Nosocomial infections are frequently viewed as indicating poor compliance with hand washing guidelines. To determine the hand hygiene [HH] compliance rate among healthcare workers [HCWs] and its effect on the nosocomial infection rates in the ICU of our hospital, we conducted an interventional study. The study spanned a period of 7 months [February 2011-August 2011] and consisted of education about HH indications and techniques, workplace reminder posters, focused group sessions, and feedback on the HH compliance and infection rates. The WHO HH observation protocol was used both before and after a hospital-wide HH campaign directed at all staff members, particularly those in the ICU. Compliance was measured by direct observation of the HCWs, using observation record forms in a patient-directed manner, with no more than two patients observed simultaneously. The overall HH compliance rate was calculated by dividing the number of HH actions by the total number of HH opportunities. The nosocomial infection rates for the pre- and post-interventional periods were also compared to establish the effect of the intervention on rate of infections acquired within the unit. The overall rate of HH compliance by all the HCWs increased from 42.9% pre-intervention to 61.4% post-intervention, P < 0.001. Individually, the compliance was highest among the nurses, 49.9 vs. 82.5%, respectively [P < 0.001] and lowest among the doctors, 38.6 vs. 43.2%, respectively [P = 0.24]. The effect of the increase in the HH compliance rate on the nosocomial infection rate was remarkable. There were significant reductions in the following: the rate of overall health care-associated infections/1000 patient-days, which fell from 37.2 pre-intervention to 15.1 post-intervention [P < 0.001]; the rate of bloodstream infections, which fell from 18.6 to 3.4/1000 central-line-days [P < 0.001]; and the rate of lower respiratory tract infections, which fell from 17.6 to 5.2/1000 ventilator-days [P < 0.001]. Similarly, there were significant reductions in the isolation rates of 4 major hospital pathogens [P < 0.001 and P = 0.03]. These findings suggest that although cross-infection in the ICU is a complex process, its frequency can be affected by meticulous adherence to hand hygiene recommendations