Device-associated Healthcare-associated Infections Research Articles

International nosocomial infection control consortium findings of device-associated infections rate in an intensive care unit of a Lebanese university hospital

Objectives:To determine the rates of device-associated healthcare-associated infections (DA-HAI), microbiological profile, bacterial resistance, length of stay (LOS), excess mortality and hand hygiene compliance in one intensive care unit (ICU) of a hospital member of the International Infection Control Consortium (INICC) in Beirut, Lebanon.Materials and Methods:An open label, prospective cohort, active DA-HAI surveillance study was conducted on adults admitted to a tertiary-care ICU in Lebanon from November 2007 to March 2010. The protocol and methodology implemented were developed by INICC. Data collection was performed in the participating ICUs. Data uploading and analyses were conducted at INICC headquarters on proprietary software. DA-HAI rates were recorded by applying the definitions of the National Healthcare Safety Network (NHSN) at the US Centers for Disease Control and Prevention (CDC). We analyzed the DA-HAI, mechanical ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLA-BSI), and catheter-associated urinary tract infection (CAUTI) rates, microorganism profile, excess LOS, excess mortality, and hand hygiene compliance.Results:A total of 666 patients hospitalized for 5,506 days acquired 65 DA-HAIs, an overall rate of 9.8% [(95% confidence interval (CI) 7.6–12.3], and 11.8 (95% CI 9.1–15.0) DA-HAIs per 1000 ICU-days. The CLA-BSI rate was 5.2 (95% CI 2.8–8.7) per 1000 catheter-days; the VAP rate was 8.1 (95% CI 5.5–11.7) per 1000 ventilator-days; and the CAUTI rate was 4.1 (95% CI 2.6–6.2) per 1000 catheter-days. LOS of patients was 7.3 days for those without DA-HAI, 13.8 days for those with CLA-BSI, 18.8 days for those with VAP. Excess mortality was 40.9% [relative risk (RR) 3.14; P 0.004] for CLA-BSI. Mortality of VAP and CAUTI was not significantly different from patients without DA-HAI. Escherichia coli was the most common isolated microorganism. Overall hand hygiene compliance was 84.9% (95% CI 82.3–87.3).Conclusions:DA-HAI rates, bacterial resistance, LOS and mortality were moderately high, below INICC overall data and above CDC-NHSN data. Infection control programs including surveillance and antibiotic policies are essential and continue to be a priority in Lebanon.

International Nosocomial Infection Control Consortium (INICC) report, data summary of 36 countries, for 2004-2009

The results of a surveillance study conducted by the International Nosocomial Infection Control Consortium (INICC) from January 2004 through December 2009 in 422 intensive care units (ICUs) of 36 countries in Latin America, Asia, Africa, and Europe are reported. During the 6-year study period, using Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN; formerly the National Nosocomial Infection Surveillance system [NNIS]) definitions for device-associated health care-associated infections, we gathered prospective data from 313,008 patients hospitalized in the consortium's ICUs for an aggregate of 2,194,897 ICU bed-days. Despite the fact that the use of devices in the developing countries' ICUs was remarkably similar to that reported in US ICUs in the CDC's NHSN, rates of device-associated nosocomial infection were significantly higher in the ICUs of the INICC hospitals; the pooled rate of central line-associated bloodstream infection in the INICC ICUs of 6.8 per 1,000 central line-days was more than 3-fold higher than the 2.0 per 1,000 central line-days reported in comparable US ICUs. The overall rate of ventilator-associated pneumonia also was far higher (15.8 vs 3.3 per 1,000 ventilator-days), as was the rate of catheter-associated urinary tract infection (6.3 vs. 3.3 per 1,000 catheter-days). Notably, the frequencies of resistance of Pseudomonas aeruginosa isolates to imipenem (47.2% vs 23.0%), Klebsiella pneumoniae isolates to ceftazidime (76.3% vs 27.1%), Escherichia coli isolates to ceftazidime (66.7% vs 8.1%), Staphylococcus aureus isolates to methicillin (84.4% vs 56.8%), were also higher in the consortium's ICUs, and the crude unadjusted excess mortalities of device-related infections ranged from 7.3% (for catheter-associated urinary tract infection) to 15.2% (for ventilator-associated pneumonia).

Device-associated infection rates in 398 intensive care units in Shanghai, China: International Nosocomial Infection Control Consortium (INICC) findings

To determine device-associated healthcare-associated infection (DA-HAI) rates and the microorganism profile in 398 intensive care units (ICUs) of 70 hospitals in Shanghai, China. An open-label, prospective, cohort, active DA-HAI surveillance study was conducted on patients admitted to 398 tertiary-care ICUs in China from September 2004 to December 2009, implementing the methodology developed by the International Nosocomial Infection Control Consortium (INICC). The data were collected in the participating ICUs, and uploaded and analyzed at the INICC headquarters on proprietary software. DA-HAI rates were registered by applying the definitions of the US Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN). We analyzed the rates of DAI-HAI, ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI), and their microorganism profiles. During the 5 years and 4 months of the study, 391 527 patients hospitalized in an ICU for an aggregate of 3,245,244 days, acquired 20,866 DA-HAIs, an overall rate of 5.3% (95% confidence interval (CI) 5.3-5.4) and 6.4 (95% CI 6.3-6.5) infections per 1000 ICU-days. VAP posed the greatest risk (20.8 per 1000 ventilator-days, 95% CI 20.4-21.1), followed by CAUTI (6.4 per 1000 catheter-days, 95% CI 6.3-6.6) and CLABSI (3.1 per 1000 catheter-days, 95% CI 3.0-3.2). The most common isolated microorganism was Acinetobacter baumannii (19.1%), followed by Pseudomonas aeruginosa (17.2%), Klebsiella pneumoniae (11.9%), and Staphylococcus aureus (11.9%). DA-HAIs in the ICUs of Shanghai pose a far greater threat to patient safety than in ICUs in the USA. This is particularly the case for the VAP rate, which is much higher than the rates found in developed countries. Active infection control programs that carry out infection surveillance and implement prevention guidelines can improve patient safety and must become a priority.

Socioeconomic impact on device-associated infections in limited-resource neonatal intensive care units: findings of the INICC

To evaluate the impact of country socioeconomic status and hospital type on device-associated healthcare-associated infections (DA-HAIs) in neonatal intensive care units (NICUs). Data were collected on DA-HAIs from September 2003 to February 2010 on 13,251 patients in 30 NICUs in 15 countries. DA-HAIs were defined using criteria formulated by the Centers for Disease Control and Prevention. Country socioeconomic status was defined using World Bank criteria. Central-line-associated bloodstream infection (CLA-BSI) rates in NICU patients were significantly lower in private than academic hospitals (10.8 vs. 14.3 CLA-BSI per 1,000 catheter-days; p<0.03), but not different in public and academic hospitals (14.6 vs. 14.3 CLA-BSI per 1,000 catheter-days; p = 0.86). NICU patient CLA-BSI rates were significantly higher in low-income countries than in lower-middle-income countries or upper-middle-income countries [37.0 vs. 11.9 (p<0.02) vs. 17.6 (p<0.05) CLA-BSIs per 1,000 catheter-days, respectively]. Ventilator-associated-pneumonia (VAP) rates in NICU patients were significantly higher in academic hospitals than in private or public hospitals [13.2 vs. 2.4 (p<0.001) vs. 4.9 (p<0.001) VAPs per 1,000 ventilator days, respectively]. Lower-middle-income countries had significantly higher VAP rates than low-income countries (11.8 vs. 3.8 per 1,000 ventilator-days; p<0.001), but VAP rates were not different in low-income countries and upper-middle-income countries (3.8 vs. 6.7 per 1,000 ventilator-days; p =0.57). When examined by hospital type, overall crude mortality for NICU patients without DA-HAIs was significantly higher in academic and public hospitals than in private hospitals (5.8 vs. 12.5%; p<0.001). In contrast, NICU patient mortality among those with DA-HAIs was not different regardless of hospital type or country socioeconomic level. Hospital type and country socioeconomic level influence DA-HAI rates and overall mortality in developing countries.

Device-associated infections rates in adult, pediatric, and neonatal intensive care units of hospitals in the Philippines: International Nosocomial Infection Control Consortium (INICC) findings

This study investigated the rate of device-associated health care-associated infection (DA-HAI), microbiological profiles, bacterial resistance, length of stay (LOS), and mortality rate in 9 intensive care units (ICUs) of 3 hospital members of the International Nosocomial Infection Control Consortium (INICC) in the Philippines. This was an open-label, prospective cohort, active DA-HAI surveillance study of adult, pediatric, and newborn patients admitted to 9 tertiary care ICUs in the Philippines between January 2005 and December 2009, implementing methodology developed by the INICC. Data collection was performed in the participating ICUs, and data were uploaded and analyzed at the INICC headquarters using proprietary software. DA-HAI rates were registered based on definitions promulgated by the Centers for Disease Control and Prevention's National Healthcare Safety Network. Over a 5-year period, 4952 patients hospitalized in ICUs for a total of 40,733 days acquired 199 DA-HAIs, for an overall rate of 4.9 infections per 1,000 ICU-days. Ventilator-associated pneumonia posed the greatest risk (16.7 per 1,000 ventilator-days in the adult ICUs, 12.8 per 1,000 ventilator-days in the pediatric ICU, and 0.44 per 1,000 ventilator-days in the neonatal ICUs), followed by central line-associated bloodstream infections (4.6 per 1,000 catheter-days in the adult ICUs, 8.23 per 1,000 ventilator-days in the pediatric ICU, and 9.6 per 1,000 ventilator-days in the neonatal ICUs) and catheter-associated urinary tract infections (4.2 per 1,000 catheter-days in the adult ICUs and 0.0 in the pediatric ICU). DA-HAIs pose far greater threats to patient safety in Philippine ICUs than in US ICUs. The establishment of active infection control programs that involve infection surveillance and implement guidelines for prevention can improve patient safety and should become a priority.

Device-associated infection rates in adult intensive care units of Cuban university hospitals: International Nosocomial Infection Control Consortium (INICC) findings

To determine the rate of device-associated healthcare-associated infection (DA-HAI), microbiological profile, length of stay (LOS), extra mortality, and hand hygiene compliance in two intensive care units (ICUs) of two hospital members of the International Infection Control Consortium (INICC) of Havana, Cuba. An open label, prospective cohort, active DA-HAI surveillance study was conducted on adults admitted to two tertiary-care ICUs in Cuba from May 2006 to December 2009, implementing the methodology developed by INICC. Data collection was performed in the participating ICUs, and data were uploaded and analyzed at the INICC headquarters on proprietary software. DA-HAI rates were registered by applying the definitions of the US Centers for Disease Control and Prevention National Healthcare Safety Network (CDC NHSN). We analyzed the mechanical ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLA-BSI), and catheter-associated urinary tract infection (CAUTI) rates, microorganism profile, extra length of stay (ELOS), extra mortality, and hand hygiene compliance. During 14 512 days of hospitalization, 1982 patients acquired 444 DA-HAIs, an overall rate of 22.4% (95% CI 20.6-24.3) or 30.6 (95% CI 27.8-33.5) DA-HAIs per 1000 ICU-days. The CLA-BSI rate was 2.0 (95% CI 1.2-3.1) per 1000 central line-days, the VAP rate was 52.5 (95% CI 47.2-58.3) per 1000 ventilator-days, and the CAUTI rate was 8.1 (95% CI 6.5-10.0) per 1000 catheter-days. LOS of patients was 4.9 days for those without DA-HAI, 23.3 days for those with CLA-BSI, and 23.8 days for those with VAP. CAUTI LOS was not calculated due to the lack of data. Extra mortality was 47% (relative risk (RR) 2.42; p=0.0693) for VAP and 17% (RR 1.52; p=0.5552) for CLA-BSI. The only patient with CAUTI died, but there was too little mortality data regarding this infection type to consider this significant. Escherichia coli was the most commonly isolated microorganism. The overall hand hygiene compliance was 48.6% (95% CI 42.8-54.3). DA-HAI rates, LOS, and mortality were found to be high, and hand hygiene low. It is of primary importance that infection control programs that include outcome and process surveillance are implemented in Cuba.

Device-associated infections rates in pediatrics and neonatal intensive care units in El Salvador: Findings of the INICC

This study aimed to determine the rate of device-associated, health care-associated infection (DA-HAI), the excess in length of stay, the mortality, and the hand hygiene compliance in a pediatric intensive care unit (PICU) and a neonatal ICU (NICU) in a hospital member of the International Infection Control Consortium (INICC) in El Salvador. A prospective cohort, active DA-HAI surveillance study was conducted on patients admitted in the pediatric and neonatal ICUs from January 2007 to November 2009. The protocol and methodology implemented were developed by INICC. Data were collected in the participating ICUs, and analyzed at INICC headquarters by proprietary software. DA-HAI rates were recorded by applying the definitions of the Centers for Disease Control and Prevention National Healthcare Safety Network. Of 1,145 patients hospitalized in the PICU for 9,517 days, 177 acquired DA-HAIs (overall rate 15.5%), and 18.6 DA-HAIs per 1,000 ICU-days. Furthermore, 1,270 patients hospitalized in the NICU for 30,663 days acquired 302 DA-HAIs (overall rate 23.8%), and 9.8 DA-HAIs per 1,000 ICU-days. The central line-associated bloodstream infection (CLA-BSI) rates in the NICU and PICU were 9.9 and 10.0 per 1,000 catheter-days respectively. The ventilator-associated pneumonia (VAP) rate was 16.1 per 1,000 ventilator-days in the NICU and 12.1 in the PICU.The catheter-associated urinary tract infection (CAUTI) rate was 5.8 per 1,000 catheter-days in the PICU. DA-HAI rates in the PICU and NICU of our hospital were higher than international standards; infection control programs including surveillance and antibiotic policies must be a priority in El Salvador.

International Nosocomial Infection Control Consortium (INICC) report, data summary for 2003-2008, issued June 2009

We report the results of the International Infection Control Consortium (INICC) surveillance study from January 2003 through December 2008 in 173 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study, using Centers for Disease Control and Prevention (CDC) US National Healthcare Safety Network (NHSN; formerly the National Nosocomial Infection Surveillance system [NNIS]) definitions for device-associated health care-associated infection, we collected prospective data from 155,358 patients hospitalized in the consortium's hospital ICUs for an aggregate of 923,624 days. Although device utilization in the developing countries' ICUs was remarkably similar to that reported from US ICUs in the CDC's NHSN, rates of device-associated nosocomial infection were markedly higher in the ICUs of the INICC hospitals: the pooled rate of central venous catheter (CVC)-associated bloodstream infections (BSI) in the INICC ICUs, 7.6 per 1000 CVC-days, is nearly 3-fold higher than the 2.0 per 1000 CVC-days reported from comparable US ICUs, and the overall rate of ventilator-associated pneumonia (VAP) was also far higher, 13.6 versus 3.3 per 1000 ventilator-days, respectively, as was the rate of catheter-associated urinary tract infection (CAUTI), 6.3 versus 3.3 per 1000 catheter-days, respectively. Most strikingly, the frequencies of resistance of Staphylococcus aureus isolates to methicillin (MRSA) (84.1% vs 56.8%, respectively), Klebsiella pneumoniae to ceftazidime or ceftriaxone (76.1% vs 27.1%, respectively), Acinetobacter baumannii to imipenem (46.3% vs 29.2%, respectively), and Pseudomonas aeruginosa to piperacillin (78.0% vs 20.2%, respectively) were also far higher in the consortium's ICUs, and the crude unadjusted excess mortalities of device-related infections ranged from 23.6% (CVC-associated bloodstream infections) to 29.3% (VAP).

The International Nosocomial Infection Control Consortium (INICC): Goals and objectives, description of surveillance methods, and operational activities

We have shown that intensive care units (ICUs) in countries with limited resources have rates of device-associated health care-associated infection (HAI), including central line-related bloodstream infection (CLAB), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infection (CAUTI), 3 to 5 times higher than rates reported from North American, Western European, and Australian ICUs. The International Nosocomial Infection Control Consortium (INICC) is an international ongoing collaborative HAI control program with a surveillance system based on that of the US National Healthcare Safety Network. The INICC was founded 10 years ago to promote evidence-based infection control in hospitals in limited-resource countries and in hospitals of developed countries without sufficient experience in HAI surveillance and control, through the analysis and feedback of surveillance data collected voluntarily by the member hospitals. It developed from a handful of South American hospitals in 1998 to a dynamic network of 98 ICUs in 18 countries, and is the only source of aggregate standardized international data on HAI epidemiology. Herein we report the criteria and mechanisms for gaining membership in INICC; the training of personnel in INICC hospitals; the INICC protocol for outcome surveillance of CLABs, VAPs, and CAUTIs in ICUs, microorganism profiles, bacterial resistance, antibiotic use, extra length of stay, extra costs, extra mortality, and risk factor analysis, and for process surveillance, including compliance rates for hand hygiene, vascular catheter care, urinary catheter care, and measures for prevention of VAP; and the use of surveillance data feedback as a powerful weapon for control of HAIs. The INICC will continue to evolve in its quest to find more effective and efficient ways to assess patient risk and improve patient safety in hospitals.

International Nosocomial Infection Control Consortium report, data summary for 2002-2007, issued January 2008

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from 2002 through 2007 in 98 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study, using Centers for Disease Control and Prevention (CDC) National Nosocomial Infections Surveillance System (NNIS) definitions for device-associated health care-associated infection, we collected prospective data from 43,114 patients hospitalized in the Consortium's hospital ICUs for an aggregate of 272,279 days. Although device utilization in the INICC ICUs was remarkably similar to that reported from US ICUs in the CDC's National Healthcare Safety Network, rates of device-associated nosocomial infection were markedly higher in the ICUs of the INICC hospitals: the pooled rate of central line-associated bloodstream infections (CLABs) in the INICC ICUs, 9.2 per 1000 CL-days, is nearly 3-fold higher than the 2.4-5.3 per 1000 CL-days reported from comparable US ICUs, and the overall rate of ventilator-associated pneumonia was also far higher, 19.5 vs 1.1-3.6 per 1000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 6.5 versus 3.4-5.2 per 1000 catheter-days. Most strikingly, the frequencies of resistance of Staphylococcus aureus isolates to methicillin (MRSA) (80.8% vs 48.1%), Enterobacter species to ceftriaxone (50.8% vs 17.8%), and Pseudomonas aeruginosa to fluoroquinolones (52.4% vs 29.1%) were also far higher in the Consortium's ICUs, and the crude unadjusted excess mortalities of device-related infections ranged from 14.3% (CLABs) to 27.5% (ventilator-associated pneumonia).