National Multi-Center Prospective Study To Evaluate Device-Associated Nosocomial Infection Rates in Intensive Care Units of Mexico: Benchmark with NNIS American Rates

Abstract

OBJECTIVES: To measure the incidence of device-associated nosocomial infections in ICUs in Mexico and to compare with NNIS rates. METHODS: We performed a prospective nosocomial infection surveillance study during 9 months in four Mexican ICUs. Nosocomial infections were identified using the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance (NNIS) system definitions, and site-specific nosocomial infection rates were calculated. RESULTS: We collected data on 1184 patients, 6707 bed days, 6950 central vascular catheter days, 2692 mechanical ventilator days, and 3593 urinary catheter days. The overall nosocomial infection rate was 30.82% (365/1184) and 54.42 per 1000 patient days (365/6707). The most common site of infection were ventilator-associated pneumonia (VAP) (46.57%, 170/365), and central venous catheter–related bloodstream infections (CBSIs) (39.45%, 144/365), followed by catheter-associated urinary tract infection (CA-UTIs) (13.97%, 51/365). The VAP rate was 29.34 per 1000 device days (79/2692) (benchmark with NNIS rate, RR: 3.12; CI 95% 2.50–3.90, p= 0.0000). The rate of CBSIs rate was 20.71 per 1000 device days (144/6950) (benchmark with NNIS rate, RR: 5.42; CI 95% 4.59–6.41, p=0.0000). The symptomatic CA-UTI rate was 7.79 per 1000 device-days (28/3593) (benchmark with NNIS rate, RR: 1.99; CI 95% 1.37–2.88; p= 0.0002). CONCLUSION: When compared with NNIS rates, we found our pneumonia rate three times the NNIS rate, the BSI rate five times NNIS rate, and our urinary tract infection rate twice the NNIS rate. In Mexico, we need to develop more effective interventions to reduce nosocomial infections, especially CBSIs.