Decreasing central line-associated bloodstream infections rates in intensive care units in 30 low- and middle-income countries: An INICC approach

Rosenthal VD 1 , Jin Z 2 , Brown EC 2 , Dongol R 3 , De Moros DA 4 , Alarcon-Rua J 5 Show all authors , Perez V 6 , Stagnaro JP 7 , Alkhawaja S 8 , Jimenez-Alvarez LF 9 , Cano-Medina YA 10 , Valderrama-Beltran SL 11 , Henao-Rodas CM 12 , Zuniga-Chavarria MA 13 , El-Kholy A 14 , Agha H 15 , Sahu S 16 , Mishra SB 17 , Bhattacharyya M 18 , Kharbanda M 19 , Poojary A 20 , Nair PK 21 , Myatra SN 22 , Chawla R 23 , Sandhu K 24 , Mehta Y 25 , Rajhans P 26 , Abdellatif-Daboor M 27 , Chian-Wern T 28 , Gan CS 29 , Mohd-Basri MN 30 , Aguirre-Avalos G 31 , Hernandez-Chena BE 32 , Sassoe-Gonzalez A 33 , Villegas-Mota I 34 , Aleman-Bocanegra MC 35 , Bat-Erdene I 36 , Carreazo NY 37 , Castaneda-Sabogal A 38 , Janc J 39 , Hlinkova S 40 , Yildizdas D 41 , Havan M 42 , Koker A 43 , Sungurtekin H 44 , Dinleyici EC 45 , Guclu E 46 , Tao L 47 , Memish ZA 48 , Yin R 2

Affiliations 

  • 1 Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Infection Prevention, INICC Foundation, International Nosocomial Infection Control Consortium, Miami, USA. Electronic address: [email protected]
  • 2 Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
  • 3 Department of Infection Prevention, Grande International Hospital, Kathamandu, Nepal
  • 4 Department of Infection Prevention, Hospital Del Nino Dr Jose Renan Esquivel De Panama, Panama, Panama
  • 5 Department of Infection Prevention, Clinica Sebastian De Belalcazar, Cali, Colombia
  • 6 Department of Biological Sciences, Florida International University, Miami, Fl, USA
  • 7 Department of Infection Prevention, Instituto Central De Medicina, Provincia De Buenos Aires, La Plata, Argentina
  • 8 Department of Infection Prevention, Salmaniya Medical Complex, Manama, Bahrain
  • 9 Department of Infection Prevention, Clinica Universitaria Colombia, Bogota, Colombia
  • 10 Department of Infection Prevention, Instituto Del Corazon De Bucaramanga, Bogota, Colombia
  • 11 Department of Infection Prevention, Pontificia Universidad Javeriana Hospital Universitario San Ignacio, Bogota, Colombia
  • 12 Department of Infection Prevention, Fundacion Hospital San Jose De Buga, Guadalajara De Buga, Colombia
  • 13 Department of Infection Prevention, Hospital Clinica Biblica, San Jose De Costa Rica, Costa Rica
  • 14 Department of Infection Prevention, Dar Alfouad Hospital 6th Of October City, 6th Of October City, Egypt
  • 15 Department of Infection Prevention, Cairo University Specialized Pediatric Hospital Cardio Thoracic Icu, Cairo, Egypt
  • 16 Department of Infection Prevention, Apollo Hospital Bhubaneswar, Bhubaneswar, India
  • 17 Department of Infection Prevention, IMS And SUM Hospital, Bhubaneswar, India
  • 18 Department of Infection Prevention, Advanced Medicare Research Institute Dhakuria Unit, Kolkata, India
  • 19 Department of Infection Prevention, Desun Hospital & Heart Institute Kolkata, Kolkata, India
  • 20 Department of Infection Prevention, Breach Candy Hospital Trust, Mumbai, India
  • 21 Department of Infection Prevention, Holy Spirit Hospital, Mumbai, India
  • 22 Department of Critical Care, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
  • 23 Department of Infection Prevention, Indraprastha Apollo Hospital Delhi, New Delhi, India
  • 24 Department of Infection Prevention, Max Super Speciality Hospital Saket Delhi, New Delhi, India
  • 25 Department of Critical Care, Medanta The Medicity, New Delhi, India
  • 26 Department of Infection Prevention, Deenanath Mangeshkar Hospital And Research Center Erandwane Pune, Pune, India
  • 27 Department of Infection Prevention, King Hussein Cancer Center, Amman, Jordan
  • 28 Department of Infection Prevention, Universiti Kebangsaan Malaysia Specialist Children's Hospital, Kuala Lumpur, Malaysia
  • 29 Department of Infection Prevention, University Malaya Medical Centre Pediatric Intensive Care, Kuala Lumpur, Malaysia
  • 30 Department of Infection Prevention, International Islamic University Malaysia Department Of Anesthesia And Critical Care, Kuantan, Malaysia
  • 31 Department of Critical Care, Hospital Civil De Guadalajara Fray Antonio Alcalde Terapia Intensiva, Guadalajara, Mexico
  • 32 Department of Infection Prevention, Hospital General Regional 6 De Ciudad Madero, Madero, Mexico
  • 33 Department of Infection Prevention, Hospital Regional De Alta Especialidad De Ixtapaluca, Ixtapaluca, Mexico
  • 34 Department of Infection Prevention, Instituto Nacional De Perinatologia Unidad De Cuidados Intensivos Neonatales, Mexico City, Mexico
  • 35 Department of Infection Prevention, Hospital San José De Monterrey Nuevo Leon, Monterrey, Nuevo Leon, Mexico
  • 36 Department of Infection Prevention, Intermed Hospital, Ulaanbaatar, Mongolia
  • 37 Department of Infection Prevention, Universidad Peruana de Ciencias Aplicadas, Hospital de Emergencias Pediatricas, Lima, Peru
  • 38 Department of Infection Prevention, Hospital Victor Lazarte Echegaray, Trujillo, Peru
  • 39 Department of Anesthesiology and Intensive Therapy, 4th Clinical Military Hospital with Polyclinic, Wroclaw, Poland
  • 40 Department of Infection Prevention, Catholic University In Ruzomberok Faculty Of Health Central Military Hospital Snp Ruzomberok, Ruzomberok, Slovakia
  • 41 Department of Infection Prevention, Balcali Hospital Pediatric Intensive Care Unit, Adana, Turkey
  • 42 Department of Infection Prevention, Ankara University Faculty Of Medicine, Ankara, Turkey
  • 43 Department of Infection Prevention, Akdeniz University Medical School, Antalya, Turkey
  • 44 Department of Infection Prevention, Pamukkale University Hospital, Denizli, Turkey
  • 45 Department of Infection Prevention, Eskisehir Osmangazi University, Eskisehir, Turkey
  • 46 Department of Infection Prevention, Sakarya University Training And Research Hospital, Sakarya, Turkey
  • 47 Department of Infection Prevention, Zhongshan Hospital, Fudan University, Shanghai, China
  • 48 Department of Infection Prevention, King Saud Medical City, Ministry of Health, Riyadh, Arabia
Am J Infect Control, 2023 Dec 26.
PMID: 38154739 DOI: 10.1016/j.ajic.2023.12.010

Abstract

BACKGROUND: Central line (CL)-associated bloodstream infections (CLABSIs) occurring in the intensive care unit (ICU) are common and associated with a high burden.

METHODS: We implemented a multidimensional approach, incorporating an 11-element bundle, education, surveillance of CLABSI rates and clinical outcomes, monitoring compliance with bundle components, feedback of CLABSI rates and clinical outcomes, and performance feedback in 316 ICUs across 30 low- and middle-income countries. Our dependent variables were CLABSI per 1,000-CL-days and in-ICU all-cause mortality rates. These variables were measured at baseline and during the intervention, specifically during the second month, third month, 4 to 16 months, and 17 to 29 months. Comparisons were conducted using a two-sample t test. To explore the exposure-outcome relationship, we used a generalized linear mixed model with a Poisson distribution to model the number of CLABSIs.

RESULTS: During 1,837,750 patient-days, 283,087 patients, used 1,218,882 CL-days. CLABSI per 1,000 CL-days rates decreased from 15.34 at the baseline period to 7.97 in the 2nd month (relative risk (RR) = 0.52; 95% confidence interval [CI] = 0.48-0.56; P 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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