International Nosocomial Infection Control Consortium Research Articles

International Nosocomial Infection Control Consortium (INICC) report of health care-associated infections, data summary of 25 countries for 2014 to 2023, Surgical Site Infections Module

Surgical site infection (SSI) rates are higher in low-resource countries (LRC) than in high-income counterparts. Prospective cohort study using the INICC Surveillance Online System, from 116 hospitals in 75 cities across 25 Latin-American, Asian, Eastern-European, and Middle-Eastern countries: Argentina, Bahrain, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Egypt, Honduras, India, Kosovo, Kuwait, Lebanon, Mexico, Mongolia, Pakistan, Papua New Guinea, Philippines, Poland, Romania, Saudi Arabia, Thailand, Turkey, Venezuela, Vietnam. CDC/NHSN definitions were applied. Surgical procedures (SPs) were categorized according to the International Classification of Diseases criteria. From 2014 to 2023, we collected data on 1,251 SSIs associated with 56,617 SPs. SSI rates were significantly higher in SPs of INICC compared to CDC/NHSN data: hip prosthesis (3.68% vs 0.67%, relative risk [RR]=5.46, 95% confidence interval [CI]=3.71-8.03, P<.001), knee prosthesis (2.02% vs 0.58%, RR=3.49, 95% CI=1.87-6.49, P<.001), coronary artery bypass (4.16% vs 1.37%, RR=3.03, 95% CI=2.35-3.91, P<.001), peripheral vascular bypass (15.69% vs 2.93%, RR=5.35, 95% CI=2.30-12.48, P<.001), abdominal aortic aneurysm repair (8.51% vs 2.12%, RR=4.02, 95% CI=2.11-7.65, P<.001), spinal fusion (6.47% vs 0.70%, RR=9.27, 95% CI=6.21-13.84, P<.001), laminectomy (2.68% vs 0.72%, RR=3.75, 95% CI=2.36-5.95, P<.001), among others. Elevated SSI rates in LRCs emphasize the need for effective interventions.

International Nosocomial Infection Control Consortium (INICC) report of health care associated infections, data summary of 45 countries for 2015 to 2020, adult and pediatric units, device-associated module

Reporting on the INICC study results from 2015 to 2020, conducted in 630 ICUs across 123 cities in 45 countries spanning Africa, Asia, Eastern Europe, Latin America, and the Middle East. Prospective ICU patient data collected via INICC Surveillance Online System. CDC/NHSN definitions applied for device-associated healthcare-associated infections (DA-HAI). We gathered data from 204,770 patients, 1,480,620 patient-days, 936,976 central line (CL)-days, 637,850 mechanical ventilator (MV)-days, and 1,005,589 urinary catheter (UC)-days. Our results showed 4,270 CL-associated bloodstream infections (CLABSI), 7,635 ventilator-associated pneumonias (VAP), and 3,005 UC-associated urinary tract infections (CAUTI). The combined rates of DA-HAIs were 7.28%, and 10.07 DA-HAIs per 1000 patient-days. CLABSI occurred at 4.55 per 1,000 CL-days, VAP at 11.96 per 1,000 MV-days, and CAUTI at 2.91 per 1,000 UC-days. In terms of resistance, Pseudomonas aeruginosa showed 50.73% resistance to imipenem, 44.99% to ceftazidime, 37.95% to ciprofloxacin, and 34.05% to amikacin. Meanwhile, Klebsiella spp had resistance rates of 48.29% to imipenem, 72.03% to ceftazidime, 61.78% to ciprofloxacin, and 40.32% to amikacin. Coagulase-negative Staphylococci and Staphylococcus aureus displayed oxacillin resistance in 81.33% and 53.83% of cases, respectively. The high rates of DA-HAI and bacterial resistance emphasize the ongoing need for continued efforts to control them.

Feasibility and effectiveness of disinfection of gloves during routine care: a scoping review protocol

IntroductionDisinfecting gloves during patient care has potential benefits and risks. In recent years, disinfection of disposable medical gloves for prolonged use has occurred in clinical practice. However, there is limited...

Multinational prospective cohort study of rates and risk factors for ventilator-associated pneumonia over 24 years in 42 countries of Asia, Africa, Eastern Europe, Latin America, and the Middle East: Findings of the International Nosocomial Infection Control Consortium (INICC).

Rates of ventilator-associated pneumonia (VAP) in low- and middle-income countries (LMIC) are several times above those of high-income countries. The objective of this study was to identify risk factors (RFs) for VAP cases in ICUs of LMICs. Prospective cohort study. This study was conducted across 743 ICUs of 282 hospitals in 144 cities in 42 Asian, African, European, Latin American, and Middle Eastern countries. The study included patients admitted to ICUs across 24 years. In total, 289,643 patients were followed during 1,951,405 patient days and acquired 8,236 VAPs. We analyzed 10 independent variables. Multiple logistic regression identified the following independent VAP RFs: male sex (adjusted odds ratio [aOR], 1.22; 95% confidence interval [CI], 1.16-1.28; P < .0001); longer length of stay (LOS), which increased the risk 7% per day (aOR, 1.07; 95% CI, 1.07-1.08; P < .0001); mechanical ventilation (MV) utilization ratio (aOR, 1.27; 95% CI, 1.23-1.31; P < .0001); continuous positive airway pressure (CPAP), which was associated with the highest risk (aOR, 13.38; 95% CI, 11.57-15.48; P < .0001); tracheostomy connected to a MV, which was associated with the next-highest risk (aOR, 8.31; 95% CI, 7.21-9.58; P < .0001); endotracheal tube connected to a MV (aOR, 6.76; 95% CI, 6.34-7.21; P < .0001); surgical hospitalization (aOR, 1.23; 95% CI, 1.17-1.29; P < .0001); admission to a public hospital (aOR, 1.59; 95% CI, 1.35-1.86; P < .0001); middle-income country (aOR, 1.22; 95% CI, 15-1.29; P < .0001); admission to an adult-oncology ICU, which was associated with the highest risk (aOR, 4.05; 95% CI, 3.22-5.09; P < .0001), admission to a neurologic ICU, which was associated with the next-highest risk (aOR, 2.48; 95% CI, 1.78-3.45; P < .0001); and admission to a respiratory ICU (aOR, 2.35; 95% CI, 1.79-3.07; P < .0001). Admission to a coronary ICU showed the lowest risk (aOR, 0.63; 95% CI, 0.51-0.77; P < .0001). Some identified VAP RFs are unlikely to change: sex, hospitalization type, ICU type, facility ownership, and country income level. Based on our results, we recommend focusing on strategies to reduce LOS, to reduce the MV utilization ratio, to limit CPAP use and implementing a set of evidence-based VAP prevention recommendations.

Multinational Prospective Cohort Study of Mortality Risk Factors in 198 ICUs of 12 Latin American Countries over 24 Years: The Effects of Healthcare-Associated Infections

BackgroundThe International Nosocomial Infection Control Consortium (INICC) has found a high ICU mortality rate in Latin America.MethodsA prospective cohort study in 198 ICUs of 96 hospitals in 46 cities in 12 Latin American countries to identify mortality risk factors (RF), and data were analyzed using multiple logistic regression.ResultsBetween 07/01/1998 and 02/12/2022, 71,685 patients, followed during 652,167 patient-days, acquired 4700 HAIs, and 10,890 died. We prospectively collected data of 16 variables. Following 11 independent mortality RFs were identified in multiple logistic regression: ventilator-associated pneumonia (VAP) acquisition (adjusted odds ratio [aOR] = 1.17; 95% CI: 1.06–1.30; p < 0.0001); catheter-associated urinary tract infection (CAUTI) acquisition (aOR = 1.34; 95% CI: 1.15–1.56; p < 0.0001); older age, rising risk 2% yearly (aOR = 1.02; 95% CI: 1.01–1.02; p < 0.0001); longer indwelling central line(CL)-days, rising risk 3% daily (aOR = 1.03; 95% CI: 1.02–1.03; p < 0.0001); longer indwelling urinary catheter(UC)-days, rising risk 1% daily (aOR = 1.01; 95% CI: 1.01–1.26; p < 0.0001); higher mechanical ventilation (MV) (aOR = 6.47; 95% CI: 5.96–7.03; p < 0.0001) and urinary catheter-utilization ratio (aOR = 1.19; 95% CI: 1.11–1.27; p < 0.0001); lower-middle level income country (aOR = 2.94; 95% CI: 2.10–4.12; p < 0.0001); private (aOR = 1.50; 95% CI: 1.27–1.77; p < 0.0001) or public hospital (aOR = 1.47; 95% CI: 1.24–1.74; p < 0.0001) compared with university hospitals; medical hospitalization instead of surgical (aOR = 1.67; 95% CI: 1.59–1.75; p < 0.0001); neurologic ICU (aOR = 4.48; 95% CI: 2.68–7.50; p < 0.0001); adult oncology ICU (aOR = 3.48; 95% CI: 2.14–5.65; p < 0.0001); and others.ConclusionSome of the identified mortality RFs are unlikely to change, such as the income level of the country, facility ownership, hospitalization type, ICU type, and age. But some of the mortality RFs we found can be changed, and efforts should be made to reduce CL-days, UC-days, MV-utilization ratio, UC-utilization ratio, and lower VAPs and CAUTI rates.

Risk factors for mortality in ICU patients in 10 middle eastern countries: The role of healthcare-associated infections

PurposeThe International Nosocomial Infection Control Consortium (INICC) found a high mortality rate in ICUs of the Middle East (ME). Our goal was to identify mortality risk factor (RF) in ICUs of the ME. MaterialsFrom 08/01/2003 to 02/12/2022, we conducted a prospective cohort study in 236 ICUs of 77 hospitals in 44 cities in 10 countries of ME. We analyzed 16 independent variables using multiple logistic regression. Results66,440 patients, hospitalized during 652,167 patient-days, and 13,974 died.We identified following mortality RF: Age (adjusted odds ratio (aOR):1.02;p < 0.0001) rising risk 2% yearly; length of stay (LOS) (aOR:1.02;p < 0.0001) rising the risk 2% per day; central line (CL)-days (aOR:1.01;p < 0.0001) rising risk 1% per day; mechanicalventilator (MV) utilization-ratio (aOR:14.51;p < 0.0001); CL-associated bloodstream infection (CLABSI) acquisition (aOR):1.49;p < 0.0001); ventilator-associated pneumonia (VAP) acquisition (aOR:1.50;p < 0.0001); female gender (OR:1.14;p < 0.0001); hospitalization at a public-hospital (OR:1.31;p < 0.0001); and medical-hospitalization (aOR:1.64;p < 0.0001). High-income countries showed lowest risk (aOR:0.59;p < 0.0001). ConclusionSome identified RF are unlikely to change, such as country income-level, facility ownership, hospitalization type, gender, and age. Some can be modified; LOS, CL-use, MV-use, CLABSI, VAP. So, to lower the mortality risk in ICUs, we recommend focusing on strategies to shorten the LOS, reduce CL and MV-utilization, and use evidence-based recommendations to prevent CLABSI and VAP.

The impact of healthcare-associated infections on mortality in ICU: A prospective study in Asia, Africa, Eastern Europe, Latin America, and the Middle East

The International Nosocomial Infection Control Consortium has found a high ICU mortality rate. Our aim was to identify all-cause mortality risk factors in ICU-patients. Multinational, multicenter, prospective cohort study at 786 ICUs of 312 hospitals in 147 cities in 37 Latin American, Asian, African, Middle Eastern, and European countries. Between 07/01/1998 and 02/12/2022, 300,827 patients, followed during 2,167,397 patient-days, acquired 21,371 HAIs. Following mortality risk factors were identified in multiple logistic regression: Central line-associated bloodstream infection (aOR:1.84; P<.0001); ventilator-associated pneumonia (aOR:1.48; P<.0001); catheter-associated urinary tract infection (aOR:1.18;P<.0001); medical hospitalization (aOR:1.81; P<.0001); length of stay (LOS), risk rises 1% per day (aOR:1.01; P<.0001); female gender (aOR:1.09; P<.0001); age (aOR:1.012; P<.0001); central line-days, risk rises 2% per day (aOR:1.02; P<.0001); and mechanical ventilator (MV)-utilization ratio (aOR:10.46; P<.0001). Coronary ICU showed the lowest risk for mortality (aOR: 0.34;P<.0001). Some identified risk factors are unlikely to change, such as country income-level, facility ownership, hospitalization type, gender, and age. Some can be modified; Central line-associated bloodstream infection, ventilator-associated pneumonia, catheter-associated urinary tract infection, LOS, and MV-utilization. So, to lower the risk of death in ICUs, we recommend focusing on strategies to shorten the LOS, reduce MV-utilization, and use evidence-based recommendations to prevent HAIs.

Reducing central-line-associated bloodstream infections by half: it is possible

Healthcare-associated bloodstream infection (BSI) and especially central-line-associated bloodstream infection (CLABSI) are known to be preventable in up to 70% of cases [ 1 Pronovost P.J. Watson S.R. Goeschel C.A. Hyzy R. Berenholtz S. Sustaining reductions in central-line associated bloodstream infections in Michigan intensive care units: a 10-year analysis. Am J Med Qual. 2016; 31: 197-202 Crossref PubMed Scopus (63) Google Scholar , 2 Latif A.L. Kelly B. Edrees H. Kent P. Weaver S. Jovanovic B. et al. Implementing a multifaceted intervention to decrease central line associated bloodstream infection in SEHA (Abu Dhabi Health Services Company) intensive care units: the Abu Dhabi experience. Infect Control Hosp Epidemiol. 2015; 36: 816-822 Crossref PubMed Scopus (21) Google Scholar , 3 Umscheid C.A. Mitchell M.D. Doshi J.A. Agarwal R. Williams K. Brennan P. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol. 2011; 32: 101-114 Crossref PubMed Scopus (673) Google Scholar ]. In acute care hospitals, mean CLABSI rates of 1.44–20.90 per 1000 central-line-days (CLD) in the intensive care units (ICUs) of the International Nosocomial Infection Control Consortium (2010–2015) have been reported [ [4] Rosenthal V. Al-Abdely H. El-Kholy A.A. Aziz AlKhawaja S.A. Leblebicioglu H. Mehta Y. et al. International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010–2015: device-associated module. Am J Infect Control. 2016; 44: 1495-1504 Abstract Full Text Full Text PDF PubMed Scopus (182) Google Scholar ]. The Belgian incidence of healthcare-associated BSI, at 8.4 per 10,000 patient-days, has changed little during recent years in acute care hospitals (www.nsih.be). One healthcare-associated BSI out of four was classified as CLABSI. At University Hospitals Leuven, surveillance of CLABSI started in the year 2012. Because of an initially high CLABSI rate of 4.4 and 6.1 per 1000 CLD in non-ICU and ICU units respectively, a hospital-wide quality improvement project was initiated.

The impact of COVID-19 on health care–associated infections in intensive care units in low- and middle-income countries: International Nosocomial Infection Control Consortium (INICC) findings

BackgroundThis study examines the impact of the COVID-19 pandemic on health care–associated infection (HAI) incidence in low- and middle-income countries (LMICs).MethodsPatients from 7 LMICs were followed up during hospital intensive care unit (ICU) stays from January 2019 to May 2020. HAI rates were calculated using the International Nosocomial Infection Control Consortium (INICC) Surveillance Online System applying the Centers for Disease Control and Prevention's National Healthcare Safety Network (CDC-NHSN) criteria. Pre–COVID-19 rates for 2019 were compared with COVID-19 era rates for 2020 for central line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated events (VAEs), mortality, and length of stay (LOS).ResultsA total of 7,775 patients were followed up for 49,506 bed days. The 2019 to 2020 rate comparisons were 2.54 and 4.73 CLABSIs per 1,000 central line days (risk ratio [RR] = 1.85, p = .0006), 9.71 and 12.58 VAEs per 1,000 mechanical ventilator days (RR = 1.29, p = .10), and 1.64 and 1.43 CAUTIs per 1,000 urinary catheter days (RR = 1.14; p = .69). Mortality rates were 15.2% and 23.2% for 2019 and 2020 (RR = 1.42; p < .0001), respectively. Mean LOS for 2019 and 2020 were 6.02 and 7.54 days (RR = 1.21, p < .0001), respectively.DiscussionThis study documents an increase in HAI rates in 7 LMICs during the first 5 months of the COVID-19 pandemic and highlights the need to reprioritize and return to conventional infection prevention practices.

Rates of urinary catheter-associated urinary tract infection in Saudi MOH hospitals: a 2-year multi-centre study

Background: The published rates of catheter-associated urinary tract infection (CAUTI) in Saudi Arabia were derived from single-centre studies or nationally non-representative studies. Objectives: The aim of this study was to estimate CAUTI rates and urinary catheter utilisation (UCU) ratios in 99 Saudi Ministry of Health (MOH) hospitals from all regions. Methods: A prospective surveillance study was conducted in 15 different types of intensive care units (ICUs) between January 2018 and December 2019. The data were entered into the Health Electronic Surveillance Network (HESN) programme. The methods of the US National Healthcare Safety Network (NHSN) and the Gulf Cooperation Council (GCC) centre for infection control were used. Results: During 2 years of surveillance covering 919,615 patient-days and 573,720 urinary catheter days, a total of 965 CAUTI events were identified. The overall MOH CAUTI rate was 1.68 (95%confidence interval (CI) 1.58–1.79) per 1,000 urinary catheter days, and the overall UCU was 0.624 (95%CI 0.623–0.625). CAUTI rates were highest in paediatric medical (5.73) and adult medical (2.02) ICUs. UCU were highest in neurosurgical (0.795) and medical surgical (0.743) ICUs. CAUTI standardised infection ratios across different ICUs in Saudi MOH hospitals were 16% lower than NHSN hospitals, 47% lower than GCC hospitals and 69% lower than International Nosocomial Infection Control Consortium (INICC) hospitals. Urinary catheter standardised utilisation ratios across different ICUs in Saudi MOH hospitals were 15% higher than NHSN hospitals, 9% higher than INICC hospitals and 13% lower than GCC hospitals. Conclusions: The current study is a unique national CAUTI benchmark that can potentially help in the fight against healthcare-associated infection.

775. Risk Factors for Healthcare Associated Central Line-Associated Bloodstream Infection (CLABSI) to Identify Novel Infection Prevention Areas - A Case-Control Study

BackgroundThe International Nosocomial Infection Control Consortium surveillance reported Central line-associated bloodstream infection (CLABSI) rate of 4.1 per 1000 central-line days in 703 ICUs in 50 countries. MethodsAt the Singapore General Hospital (SGH) a 1,700-bed tertiary care hospital, we conducted a retrospective matched case control study over a 3-year period from 2018 to 2020, to identify risk-factors associated with the development of healthcare associated CLABSI in adult inpatients. Cases and controls were patients ≥18 years of age with central lines in situ for at least 48hrs from date of admission. Case definition was based on National Healthcare Safety Network (NHSN) framework to diagnose Bloodstream Infection (BSI) and CLABSI events. Controls had to be admitted within 30 days of the date of admission of the case patients and should not have developed CLABSI. Cases were matched to controls on a 1:2 ratio.Results127 cases and 252 controls were included in the analysis. Cases and controls did not differ in age, gender, BMI, presence of diabetes mellitus or presently enforced infection prevention measures (e.g. Central line bundle care). More cases were receiving chemotherapy (10.2% versus 0.8%, p< 0.001), were on TPN (17.3% versus 8.3%, p=0.015) and had been admitted to critical care (73.2% versus 60.7%, p=0.017). Cases were also more likely to have peripherally inserted central venous catheters (37% versus 25%, p=0.017) and have the insertion done in the radiology department under radiological guidance (69.3% versus 55.2%, p=0.011). The median length of stay (LOS) was 44 days (IQR: 0 – 86.8) for cases and 19 days (IQR: 0 - 66.6) for controls (p< 0.001). Inpatient mortality was 25.2% (n=32) for cases 13.9% (n=35) for controls (p-value < 0.010). In multivariate analysis, receiving chemotherapy (OR 11.1, 95%CI: 2.2 – 54.3, p=0.003), being admitted to intensive care unit (ICU) (OR 2.0, 95%CI: 1.1 – 3.8, p=0.019), having a Peripherally Inserted Central Cather (OR 1.8, 95% CI 1.0-3.4, p=0.045), and being colonized with MRSA (OR 1.9, 95%CI: 1.2 – 3.2, p=0.013) were associated with healthcare associated CLABSI. ConclusionNovel approaches are required to reduce risk of healthcare associated CLABSI, focusing on interventions for chemotherapy administration, care within ICUs and PICC lines.Disclosures All Authors: No reported disclosures

Device-Associated Hospital-Acquired Infections: Does Active Surveillance With Bundle Care Offer a Pathway to Minimize Them?

Background and objectiveThe prevalence of hospital-acquired infections (HAIs) is underreported in developing nations due to a lack of systematic active surveillance. This study reports the burden of device-associated HAIs (DA-HAIs) based on two years of active surveillance with in situ bundle care in closed intensive care units (ICUs) of a tertiary care hospital.Materials and methodsA prospective surveillance study was carried out in 140-bedded ICUs (2,100-bed hospital) of a tertiary care private medical college hospital. Daily active surveillance for catheter-associated urinary tract infection (CAUTI), ventilator-associated event (VAE), and central line-associated bloodstream infection (CLABSI) was done by trained infection control nurses (ICNs) along with quality champion nurses with HAI surveillance forms with bundle care auditing, which was attached to the case sheets of all patients on devices. The surveillance definitions of DA-HAIs were adapted from the Centers for Disease Control and Prevention (CDC)’s National Healthcare Safety Network (CDC-NHSN) 2017 surveillance criteria. Data were analyzed at the end of every month to generate the cumulative device-associated infection (DAI) rates and device utilization ratio (DUR). These data were compared with NHSN and International Nosocomial Infection Control Consortium (INICC) - India HAI rates and communicated to corresponding ICUs and also presented at the hospital infection control committee (HICC) meeting.ResultsThe surveillance data were reported over 71,877 patient days during the study period. The DUR of urinary catheters, ventilator, and central line were 0.53, 0.16, and 0.22, respectively. CAUTI, VAE, and CLABSI rates were 0.97, 10.5, and 0.43 per 1,000 device days, respectively. Among 166 DA-HAIs reported, 182 pathogens were identified. Klebsiella pneumoniae was the most common organism isolated, accounting for 37.4% of all DA-HAI cases, followed by Acinetobacter baumanii (30.8%). Most of the Gram-negative organisms were carbapenem-resistant (153/175; 87.4%). Vancomycin resistance rate in Enterococcus was 28.5% (2/7).ConclusionDUR and CAUTI, VAE, CLABSI rates were less/on par with the benchmarks of INICC and CDC-NHSN in almost all ICUs of our tertiary care unit. Gram-negative pathogen with 87.4% carbapenem resistance worsened the scenario. Proper active surveillance with bundle care and training by ICNs made a significant difference in all DA-HAI rates, especially VAE, which decreased to 10.5 from 23.6 per 1,000 ventilator days. Sustained active surveillance of HAI and bundle care auditing by a trained infection prevention team with a stringent antibiotic policy are the need of the hour to combat DAIs.

Designing and Implementing National Program of Health Electronic Surveillance Network (HESN); Infection Control Module in Saudi Arabia

Surveillance of health care associated infections is the keystone of Infection Prevention and Control program in any health care setting. Without a reliable surveillance system, it is difficult to monitor the health care associated infections (device associated as well as non-device associated infections). The Infection Control Practitioners (ICPs) in the Kingdom of Saudi Arabia used to collect the Surveillance data manually almost more than a decade back, and then shifted to an electronic Surveillance System few years back, International Nosocomial Infection Control Consortium (INICC). As conventional manual surveillance requires resources and standardization of definitions. Finally, a national, web based, semi-automated system of Health Electronic Surveillance Network (HESN) was developed in the year 2012, but the Surveillance module of Health care associated infections was started in late 2016. Pilot study was done initially for the period of few months in five MOH Hospitals and later 96 MOH Hospitals were added gradually by the end of year 2019. The system is first of its kind as it covers certain public health modules including surveillance, infectious diseases, immunizations of newborns, needle stick injuries, blood and body fluid exposures and dialysis events surveillance. The data is entered by the Infection control department in HESN, followed by Regional Coordinators and supervised by the office of General Directorate of Infection Prevention and Control. Data validation is done by the internal and external validation teams and surprise audit visits to the hospitals. In addition to advantages of being quick, safe and online data management, there are certain limitations as the system is new for most of the ICPs. Therefore, with the passage of time, almost all the Infection control practitioners will adopt it well.

International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2013-2018, Adult and Pediatric Units, Device-associated Module

We report the results of INICC surveillance study from 2013 to 2018, in 664 intensive care units (ICUs) in 133 cities, of 45 countries, from Latin-America, Europe, Africa, Eastern-Mediterranean, Southeast-Asia, and Western-Pacific. Prospective data from patients hospitalized in ICUs were collected through INICC Surveillance Online System. CDC-NHSN definitions for device-associated healthcare-associated infection (DA-HAI) were applied. We collected data from 428,847 patients, for an aggregate of 2,815,402 bed-days, 1,468,216 central line (CL)-days, 1,053,330 mechanical ventilator (MV)-days, 1,740,776 urinary catheter (UC)-days. We found 7,785 CL-associated bloodstream infections (CLAB), 12,085 ventilator-associated events (VAE), and 5,509 UC-associated urinary tract infections (CAUTI). Pooled DA-HAI rates were 5.91% and 9.01 DA-HAIs/1,000 bed-days. Pooled CLAB rate was 5.30/1,000 CL-days; VAE rate was 11.47/1,000 MV-days, and CAUTI rate was 3.16/1,000 UC-days. P aeruginosa was non-susceptible (NS) to imipenem in 52.72% of cases; to colistin in 10.38%; to ceftazidime in 50%; to ciprofloxacin in 40.28%; and to amikacin in 34.05%. Klebsiella spp was NS to imipenem in 49.16%; to ceftazidime in 78.01%; to ciprofloxacin in 66.26%; and to amikacin in 42.45%. coagulase-negative Staphylococci and S aureus were NS to oxacillin in 91.44% and 56.03%, respectively. Enterococcus spp was NS to vancomycin in 42.31% of the cases. DA-HAI rates and bacterial resistance are high and continuous efforts are needed to reduce them.

The use of cinnamon oil as antibacterial agent to eliminate some antibiotic-resistant bacteria isolated from water sources

The use of cinnamon oil as antibacterial agent to eliminate some antibiotic-resistant bacteria isolated from water sources

Rates of Ventilator Associated Pneumonia in Saudi Ministry of Health Hospitals; A Two-year Multi-Center Study

BACKGROUND: Although the rates of ventilator associated pneumonia (VAP) have been estimated in Saudi Arabia, however national surveillance data for VAP has never been reported earlier. OBJECTIVES: To estimate VAP rates and ventilator utilization ratios in 105 Ministry of health (MOH) hospitals and to benchmark them with International Standards. METHODS: It was a prospective surveillance study in 15 different types of intensive care units (ICUs) between January 2018 and December 2019. The data were entered into the health electronic surveillance network (HESN) program. The methods of US National Healthcare Safety Network (NHSN) and the Gulf Cooperation Council (GCC) center for infection control were used. RESULTS: During two years of surveillance covering 1,469,658 patient-days and 569,961 ventilator-days, a total 1,694 VAP events were identified. The overall MOH VAP rate was 2.97 (95% confidence 2.83-3.11) per 1000 ventilator-days and the overall ventilator utilization ratio was 0.39 (95% confidence 0.387- 0.389). VAP rates were highest in adult medical (4.40), pediatric cardiothoracic (3.64), and adult medical surgical ICUs (3.61). VAP standardized infection ratio across all types of ICUs in MOH hospitals were 29% lower than GCC hospitals, 78% lower than International Nosocomial Infection Control Consortium (INICC) hospitals, and 191% higher than NHSN hospitals. Ventilator standardized utilization ratio in all types of ICUs in MOH hospitals were 19% lower than GCC hospitals, 32% higher than INICC hospitals, and 50% higher than NHSN hospitals. CONCLUSIONS: Using huge standardized data, the current report can serve as a unique national VAP benchmark, fostering a culture of competitiveness between the hospitals and regions.

An eight-year multicenter study on short-term peripheral intravenous catheter-related bloodstream infection rates in 100 intensive care units of 9 countries in Latin America: Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama, and Venezuela. Findings of the International Nosocomial Infection Control Consortium (INICC).

Data on short-term peripheral intravenous catheter-related bloodstream infections per 1,000 peripheral venous catheter days (PIVCR BSIs per 1,000 PVC days) rates from Latin America are not available, so they have not been thoroughly studied. International Nosocomial Infection Control Consortium (INICC) members conducted a prospective, surveillance study on PIVCR BSIs from January 2010 to March 2018 in 100 intensive care units (ICUs) among 41 hospitals, in 26 cities of 9 countries in Latin America (Argentina, Brazil, Colombia, Costa Rica, Dominican-Republic, Ecuador, Mexico, Panama, and Venezuela). The Centers for Disease Control and Prevention (CDC) National Health Safety Network (NHSN) definitions were applied, and INICC methodology and INICC Surveillance Online System software were used. In total, 10,120 ICU patients were followed for 40,078 bed days and 38,262 PVC days. In addition, 79 PIVCR BSIs were identified, with a rate of 2.06 per 1,000 PVC days (95% confidence interval [CI], 1.635-2.257). The average length of stay (ALOS) of patients without a PIVCR BSI was 3.95 days, and the ALOS was 5.29 days for patients with a PIVCR BSI. The crude extra ALOS was 1.34 days (RR, 1.33; 95% CI, 1.0975-1.6351; P = .040).The mortality rate in patients without PIVCR BSI was 3.67%, and this rate was 6.33% in patients with a PIVCR BSI. The crude extra mortality was 1.70 times higher. The microorganism profile showed 48.5% gram-positive bacteria (coagulase-negative Staphylococci 25.7%) and 48.5% gram-negative bacteria: Acinetobacter spp, Escherichia coli, and Klebsiella spp (8.5% each one), Pseudomonas aeruginosa (5.7%), and Candida spp (2.8%). The resistances of Pseudomonas aeruginosa were 0% to amikacin and 50% to meropenem. The resistance of Acinetobacter baumanii to amikacin was 0%, and the resistance of coagulase-negative Staphylococcus to oxacillin was 75%. Our PIVCR BSI rates were higher than rates from more economically developed countries and were similar to those of countries with limited resources.

Burden of central-line-associated bloodstream infections in 106 Ministry of Health hospitals of Saudi Arabia: a 2-year surveillance study

Background: Although the Saudi Ministry of Health (MOH) is managing the majority of inpatient bed capacity in Saudi Arabia, surveillance data for central-line-associated bloodstream infections (CLABSI) have never been reported at a national level. Objectives: To estimate unit-specific CLABSI rates along with central line utilization ratios in MOH hospitals. Additionally, to benchmark such rates and ratios with recognized regional and international benchmarks. Methods: A prospective surveillance study was conducted in 106 MOH hospitals between January 2018 and December 2019. The data from 14 different types of intensive care units (ICUs) were entered into the Health Electronic Surveillance Network (HESN) program. The surveillance methodology was similar to the methods of the US National Healthcare Safety Network (NHSN) and the Gulf Cooperation Council (GCC) Center for Infection Control. Results: During the 2 years of surveillance in ICU setting covering 1,475,177 patient-days and 475,913 central line-days, a total of 1,542 CLABSI events were identified. The overall CLABSI rate was 3.24 (95% confidence interval [CI], 3.08–3.40) per 1,000 central line-days, and the overall central line utilization ratio was 0.32 (95% CI, 0.322–0.323). CLABSI-standardized infection ratios in HESN hospitals were very similar (1.01) to GCC hospitals, but 3.2 times higher than NHSN hospitals and 36% lower than International Nosocomial Infection Control Consortium (INICC) hospitals. Central-line-standardized utilization ratio in MOH hospitals was 15–30% lower than the three benchmarks. Conclusions: The overall CLABSI rate was 3.24 per 1,000 central line-days, and the overall central line utilization ratio was 0.32. MOH CLABSI rates were very similar to GCC hospitals, but higher than NHSN hospitals and lower than INICC hospitals. MOH central line utilization is slightly lower than the three benchmarks.

PIN155 Economic Burden of Surgical Site Infections in Turkey

Surgical site infections (SSI) are the most common hospital-acquired infection (HAI) and associated with increased morbidity, mortality and economic burden. The objective of this study was to estimate annual economic burden of SSIs for Turkish public and private hospitals. In the study 2 different SSI rates were considered: 4.3% (reported in the study of Leblebicioglu (2015), which are the findings of the International Nosocomial Infection Control Consortium (INICC)) and 0.7% (reported by National Health Service Related Infections Surveillance Network (USHIESA), Ministry of Health (MoH) (2018)). Annual surgery numbers reported by General Directorate of Healthcare Services, MoH were projected to 2020 by using compound annual growth rate between 2014-2018. Costs reported in the study of Çiftçi et al. (2005) were inflated to April 2020 by using consumer price index of Turkish Statistical Institute (TUIK). Overall number of SSI cases in Turkey was estimated to be 233,401 and 37,332 with INICC and USHIESA SSI rates respectively. Additional cost of SSI was estimated as 15,221 TL (2,220 USD). Overall economic burden of SSI for Turkey was estimated to be 3,552,593,239 TL (518,059,532 USD) and 568,234,186 TL (82,863,170 USD) with INICC and USHIESA SSI rates respectively in 2020. According to this study, economic burden of SSIs in Turkey was estimated for 2020. SSIs have significant economic burden on Turkish healthcare system as reported for Europe and USA. Given the discrepancies observed in reported SSI rates, it is proposed that more research on the topic is needed, as decision-makers need accurate and reliable data to generate insights and take appropriate action.

Device associated \u2013health care associated infections monitoring, prevention and cost assessment at intensive care unit of University Hospital in Poland (2015\u20132017)

BackgroundDevice-associated health care-associated infections (DA-HAIs) in intensive care unit (ICU) patients constitute a major therapeutic issue complicating the regular hospitalisation process and having influence on patients’ condition, length of hospitalisation, mortality and therapy cost.MethodsThe study involved all patients treated > 48 h at ICU of the Medical University Teaching Hospital (Poland) from 1.01.2015 to 31.12.2017. The study showed the surveillance and prevention of DA-HAIs on International Nosocomial Infection Control Consortium (INICC) Surveillance Online System (ISOS) 3 online platform according to methodology of the INICC multidimensional approach (IMA).ResultsDuring study period 252 HAIs were found in 1353 (549F/804M) patients and 14,700 patient-days of hospitalisation. The crude infections rate and incidence density of DA-HAIs was 18.69% and 17.49 ± 2.56 /1000 patient-days. Incidence density of ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLA-BSI) and catheter-associated urinary tract infection (CA-UTI) per 1000 device-days were 12.63 ± 1.49, 1.83 ± 0.65 and 6.5 ± 1.2, respectively. VAP(137) constituted 54.4% of HAIs, whereas CA-UTI(91) 36%, CLA-BSI(24) 9.6%.The most common pathogens in VAP and CA-UTI was multidrug-resistant (MDR) Acinetobacter baumannii (57 and 31%), and methicillin-resistant Staphylococcus epidermidis (MRSE) in CLA-BSI (45%). MDR Gram negative bacteria (GNB) 159 were responsible for 63.09% of HAIs. The length of hospitalisation of patients with a single DA-HAI at ICU was 21(14–33) days, while without infections it was 6.0 (3–11) days; p = 0.0001. The mortality rates in the hospital-acquired infection group and no infection group were 26.1% vs 26.9%; p = 0.838; OR 0.9633;95% CI (0.6733–1.3782). Extra cost of therapy caused by one ICU acquired HAI was US$ 11,475/Euro 10,035. Hand hygiene standards compliance rate was 64.7%, while VAP, CLA-BSI bundles compliance ranges were 96.2–76.8 and 29–100, respectively.ConclusionsDA-HAIs was diagnosed at nearly 1/5 of patients. They were more frequent than in European Centre Disease Control report (except for CLA-BSI), more frequent than the USA CDC report, yet less frequent than in limited-resource countries (except for CA-UTI). They prolonged the hospitalisation period at ICU and generated substantial additional costs of treatment with no influence on mortality. The Acinetobacter baumannii MDR infections were the most problematic therapeutic issue. DA-HAIs preventive methods compliance rate needs improvement.