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 Rosenthal,D G B Maki, C C Aj Rodrigues,Carlos Alvarezmoreno,Hakan Leblebicioglu,Martha Sobreyraoropeza,Regina Berba,N Madani,Eduardo Medeiros,Luis Cuellar,Zan Mitrev,Lourdes Duenas,Humberto Guanchegarcell,Trudell Mapp,Ss Kanj,Rosalia Fernandezhidalgo, Monica Viegas, B M A Q Di Nubila, D Q Lanzetta, L Fernandez, M A Q Rossetti, Aloia Romani, C Q Migazzi, C Q Barolin, Evelyn Martinez, D Sztokhamer, L C S Soroka, L P T Flynn,D T Rausch, A T Spagnolo,S Forciniti, Miguel Blasco, C B U Lezcano, C Lastra, D B W Angelieri,Reinaldo Salomao, M â M X Da Silva, M Vilins, S Blecher, G Y Grinberg,Claudia Linares, G R Aa Vergara, P Aa Arrieta, L Ab Osorio, M R Ac Ferrer, G S Ac Villa, A Guzman, O Ad Sussmann, B E Ad Mojica, N Ae Olarte, Alberto Valderrama, L Af Dajud, M Af Mendoza, P H A Af Bernate, M E R Ag Calderon, Javier Calzada, G Munoz, A Arguello, C M Ah Perez, A Casares, L J Ai De Machuca,Ashit Hegd,F Aj Kapadia, S K Ak Todi, P Ak Chakraborty,S Ak Chatterjee, M Al Chakravarthy, V Al Jawali, R Al Adhikary,S Am Singh,R K Am Kumar,K Am Radhakrishnan,Anil Karlekar, P An Kapoor, M An Pawar,F E Ao Udwadia, R Ao Ansari,Aruna Poojary, G Ao Koppikar, L Ao Bhandarkar, N Ap Sen, K Ap Subramani, J P Ap Raj, S N Aq Myatra, J V Aq Divatia, R Aq Kelkar, S Aq Biswas, H Aq Singhal, S Aq Raut, N Aq Mahale, V Aq Dhakate, S Aq Sampat, B Ar Ramachandran,N Zahreddine,N Sidani,Lamia Jurdi, Za Kanafani, T K Anguseva, Vilma Ampova, S T K Guroska, F As Higuera, H T At Hernandez, A Gomez, J R At Morales, J E V At Rodriguez, I P Au Serrato, M S Au Lopez,A Ruiz, R Av Campuzano, J M Av Brito,R Aw Abouqal, A Zeggwagh, K Aw Abidi, T Aw Dendane,F G Ax Alfaro, C Ax Alvarado, L M Ax De Leon, R Ax Navarro, J L Ax Moreno, R Ax Cerrud,Rita Rosales, Laura Bravo, Mario Caceres, E F Ay Maldonado, M J M Ay Espichan, L Ay Echenique,Alejandra Sabogal, I P Az Goicochea, A Sanchez, G R Az Alva, J G Az Ventura, M R Az Aguilar, N S Az Plasencia, T A Ba Espinoza, F S Ba Lopez, G Bb Angelo, S Bb Genuino,R J Bb Consunji, J B V Bb Mantaring, J A Bc Navoang, V D Bc Villanueva, M C V Bc Tolentino, A N Bd Yalcin, O Bd Turhan, S Bd Keskin, A Be Ozgultekin, G Be Turan, N Be Akgun,I Be Koksal, G Be Yýlmaz, A C Be Senel, E E Be Sozen,O A Bf Akan,M Bf Tulunay,M Bf Oral,N Bf Unal, S Esen,Fatma Ulger,Ahmet Dilek,C Bg Aygun, S Bg Kucukoduk,N Bh Erben, I Bh Ozgunes, G Bh Usluer, Y C Bi Sardan, G Bi Yildirim, A Bi Topeli, D Bj Ozdemir, E Bj Guclu,N S Bj Erdogan,F Bk Sirmatel, M Bk Cengiz,L Bk Yilmaz, E Bl Alp,Bilgehan Aygen, H Bm Bn Turgut,S Bm Bn Sacar, H Bm Bn Sungurtekin,D Bm Bn Uǧurcan

INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY（2010）

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摘要

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.

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