Risk factors for mortality in ICU patients in 10 middle eastern countries: The role of healthcare-associated infections.

PURPOSE: The International Nosocomial Infection Control Consortium (INICC) found a high mortality rate in ICUs of the Middle East (ME). Our goal was to identify mortality risk factor (RF) in ICUs of the ME. MATERIALS: From 08/01/2003 to 02/12/2022, we conducted a prospective cohort study in 236 ICUs of 77 hospitals in 44 cities in 10 countries of ME. We analyzed 16 independent variables using multiple logistic regression. RESULTS: 66,440 patients, hospitalized during 652,167 patient-days, and 13,974 died. We identified following mortality RF: Age (adjusted odds ratio (aOR):1.02;p < 0.0001) rising risk 2% yearly; length of stay (LOS) (aOR:1.02;p < 0.0001) rising the risk 2% per day; central line (CL)-days (aOR:1.01;p < 0.0001) rising risk 1% per day; mechanicalventilator (MV) utilization-ratio (aOR:14.51;p < 0.0001); CL-associated bloodstream infection (CLABSI) acquisition (aOR):1.49;p < 0.0001); ventilator-associated pneumonia (VAP) acquisition (aOR:1.50;p < 0.0001); female gender (OR:1.14;p < 0.0001); hospitalization at a public-hospital (OR:1.31;p < 0.0001); and medical-hospitalization (aOR:1.64;p < 0.0001). High-income countries showed lowest risk (aOR:0.59;p < 0.0001). CONCLUSION: Some identified RF are unlikely to change, such as country income-level, facility ownership, hospitalization type, gender, and age. Some can be modified; LOS, CL-use, MV-use, CLABSI, VAP. So, to lower the mortality risk in ICUs, we recommend focusing on strategies to shorten the LOS, reduce CL and MV-utilization, and use evidence-based recommendations to prevent CLABSI and VAP.

Impact of International Nosocomial Infection Control Consortium's multidimensional approach on central line-associated bloodstream infection rates in Bahrain.

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.