Abstract
BackgroundThe impact of infection prevention and control (IPC) programs in limited resource countries such as Russia are largely unknown due to a lack of reliable data. The aim of this study is to evaluate the effect of an IPC program with respect to healthcare associated infection (HAI) prevention and to define the incidence of HAIs in a Russian ICU.MethodsA pioneering IPC program was implemented in a neuro-ICU at Burdenko Neurosurgery Institute in 2010 and included hand hygiene, surveillance, contact precautions, patient isolation, and environmental cleaning measures. This prospective observational cohort study lasted from 2011 to 2016, included high-risk ICU patients, and evaluated the dynamics of incidence, etiological spectrum, and resistance profile of four types of HAIs, including subgroup analysis of device-associated infections. Survival analysis compared patients with and without HAIs.ResultsWe included 2038 high-risk patients. By 2016, HAI cumulative incidence decreased significantly for respiratory HAIs (36.1% vs. 24.5%, p-value = 0.0003), urinary-tract HAIs (29.1% vs. 21.3%, p-value = 0.0006), and healthcare-associated ventriculitis and meningitis (HAVM) (16% vs. 7.8%, p-value = 0.004). The incidence rate of EVD-related HAVM dropped from 22.2 to 13.5 cases per 1000 EVD-days. The proportion of invasive isolates of Klebsiella pneumoniae and Acinetobacter baumannii resistant to carbapenems decreased 1.7 and 2 fold, respectively. HAVM significantly impaired survival and independently increasing the probability of death by 1.43.ConclusionsThe implementation of an evidence-based IPC program in a middle-income country (Russia) was highly effective in HAI prevention with meaningful reductions in antibiotic resistance.
Highlights
The impact of infection prevention and control (IPC) programs in limited resource countries such as Russia are largely unknown due to a lack of reliable data
Infection prevention and control (IPC) programs have been repeatedly shown to be effective at decreasing the incidence of healthcare-associated infections (HAIs)
We focused on the subgroup of device-related infections, such as central line-associated bloodstream infections (CLABSI), ventilator-associated pneumonia (VAP), catheter-associated urinary-tract infections (CAUTI), and external ventricular drain (EVD)-associated healthcare-associated ventriculitis and meningitis (HAVM)
Summary
The impact of infection prevention and control (IPC) programs in limited resource countries such as Russia are largely unknown due to a lack of reliable data. The aim of this study is to evaluate the effect of an IPC program with respect to healthcare associated infection (HAI) prevention and to define the incidence of HAIs in a Russian ICU. Infection prevention and control (IPC) programs have been repeatedly shown to be effective at decreasing the incidence of healthcare-associated infections (HAIs). In 1999 the CDC identified seven key evidence-based elements of an effective IPC strategy including voluntary participation of all hospitals, standardized case definitions and protocols, targeted interventions for high risk patient populations, risk adjusted comparisons of infection rates across hospitals, education and adequacy of resources, and feedback to healthcare providers [2]. According to the latest World Bank report, Russia has a gross national income per capita of US $9720, corresponding to a middle-income country [8]
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