Korean Nosocomial Infections Surveillance System Research Articles

Trends of Device Utilization Ratios in Intensive Care Units During 10 Years in South Korea: Results from the Korean National Healthcare-Associated Infections Surveillance System

BackgroundDevice-associated healthcare-associated infection (DA-HAI) is an important issue related to safety of patients. It is important to reduce unnecessary device utilization in order to decrease DA-HAI rates. Therefore, we investigate to the time trend of device utilization (DU) ratios and DA-HAI rates to analyzed collected data for 10 years through the Korean National Healthcare-associated Infections Surveillance System (KONIS) which is voluntarily participating in hospitals.MethodsWe investigate the time trend of DU ratios and DA-HAI rates from 2006 through 2015 in KONIS participating intensive care units (ICUs). DA-HAI rates were calculated as the numbers of infections per 1,000 device-days and DU were calculated as a ratio of device-days to patient-days. The pooled incidences of DAIs and DU ratios were calculated for each year of participation.ResultsData were collected on 5,325,176 catheter-days and 6,358,829 patient-days in the 190 participating ICUs between July 2006 and June 2016. From 2006 to 2015, year-wise ventilator utilization ratio (V-UR) per 1000 patients-days increased significantly from 0.40 to 0.454 (F = 6.27, P < 0.0001), year-wise urinary catheter utilization ratio (UC-UR) show gradually increased trend from 0.83 to 0.84 but non-significantly (F = 1.66, P = 0.0951), and year-wise c-line utilization ratio (CL-UR) was gradually decreased non-significantly from 0.55 to 0.52 (F = 1.62, P = 0.1059). In subgroup analysis, Medical ICU (F = 2.79, P = 0.0034) or hospital with more than 900 beds (F = 3.07, P = 0.0015) related to increased significantly V-UR. Rate of ventilator associated pneumonia significantly decreased from 3.48 in 2006 to 1.00 in 2015 (per 1000 ventilator-days, F = 27.62, P < 0.0001). Also, rates of catheter associated UTI and c-line associated blood stream infection significantly decreased from 1.85 to 0.88 (per 1000 catheter-days, F = 10.14, P < 0.0001) and from 3.40 to 2.20 (per 1000 catheter-days, F = 14.17, P < 0.0001).ConclusionIn Korea, all of the DA-HAIs have shown a significant reduction in the last 10 years, however V-UR has year-wise significantly increased trend for past 10-years, also UC-UR and CL-UR have not decreased trend significantly. We need effort to make reduction of device utilization ratios.Disclosures E. J. Kim, Korean Nosocomial Infections Surveillance System (KONIS): Investigator, Research support; Y. HOURS. Choi, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research grant; H. Y. Kim, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research support; Y. G. Kwak, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research support; T. H. Kim, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research grant; H. B. Kim, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research grant; S. H. Park, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research grant; M. Lee, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research grant; S. O. Lee, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research grant; J. Y. Choi, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research grant; P. G. Choe, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research grant; S. K. Lim, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research grant; S. R. Kim, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research support; M. J. Shin, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research support; S. Y. Yoo, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research support; H. Yoo, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research support; J. Y. Choi, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research support; S. H. Han, Korean Nosocomial Infections Surveillance System (KONIS): Board Member, Research support

Trends in the distribution and antimicrobial susceptibility of causative pathogens of device-associated infection in Korean intensive care units from 2006 to 2013: results from the Korean Nosocomial Infections Surveillance System (KONIS)

For all countries, information on pathogens causing healthcare-associated infections is important in order to develop proper strategies for preventing and treating nosocomial infections. To assess the change in frequencies and antimicrobial resistance of pathogens causing device-associated infections (DAIs) in intensive care units (ICUs) in South Korea between July 2006 and June 2014. Data from the Korean Nosocomial Infections Surveillance System (KONIS) were analysed, including three major DAI types in ICUs. The frequency of Gram-negative bacteria gradually increased for central line-associated bloodstream infection (CLABSI) and ventilator-associated pneumonia (VAP) (from 24.6% to 32.6% and from 52.8% to 73.5%, respectively). By contrast, the frequency of Gram-positive bacteria decreased from 58.6% to 49.2% for CLABSI, and from 44.3% to 23.8% for VAP (P < 0.001). Staphylococcus aureus was the most frequent causative pathogen in CLABSI throughout the surveillance period, but for VAP was replaced as the most frequent pathogen by Acinetobacter baumannii as of 2010. Candida albicans was the most frequent pathogen for catheter-associated urinary tract infection. The meticillin resistance rate in S. aureus decreased from 95% to 90.2% (P < 0.001); amikacin resistance in Klebsiella pneumoniae and Escherichia coli decreased from 43.8% to 14.7% and from 15.0% to 1.8%, respectively (P < 0.001); imipenem resistance in A. baumannii increased from 52.9% to 89.8% (P < 0.001). The proportion of Gram-negative bacteria as nosocomial pathogens for CLABSI and VAP has increased. The prevalence of A. baumannii causing DAIs in Korean ICUs has increased rapidly, as has the rate of carbapenem resistance in these bacteria.

Trends in the incidence rate of device-associated infections in intensive care units after the establishment of the Korean Nosocomial Infections Surveillance System

The effectiveness of continuous nationwide surveillance on healthcare-associated infections should be investigated in each country. To assess the rate of device-associated infections (DAIs) in intensive care units (ICUs) since the establishment of the Korean Nosocomial Infections Surveillance System (KONIS). Nationwide data were obtained on the incidence rate of DAI in ICUs reported to KONIS by all participating hospitals. The three major DAIs were studied: ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CABSI), and catheter-associated urinary tract infection (CAUTI). The pooled and year-wise incidence rates (cases per 1000 device-days) of these DAIs were determined for the period 2006 and 2012. In addition, data from institutions that had participated in KONIS for at least three consecutive years were analysed separately. The number of ICUs participating in KONIS gradually increased from 76 in 2006 to 162 in 2012. Between 2006 and 2012, the incidence rate per 1000 device-days for VAP decreased significantly from 3.48 to 1.64 (F = 11, P < 0.01), for CAUTI the rate decreased non-significantly from 1.85 to 1.26 (F = 2.02, P = 0.07), and for CABSI the rate also decreased non-significantly from 3.4 to 2.57 (F = 1.73, P = 0.12). In the 132 ICUs that had participated in KONIS for at least three consecutive years, the VAP rate significantly decreased from the first year to third year (F = 20.57, P < 0.01), but the rates of CAUTI (F = 1.06, P = 0.35) and CABSI (F = 1.39, P = 0.25) did not change significantly. The decreased incidence rate of VAP in ICUs in Korea might be associated with the continuous prospective surveillance provided by KONIS.

Efforts to Prevent Surgical Site Infection After Colorectal Surgery.

See Article on Page 235-242 A surgical-site infection (SSI) is one of the most interesting issues among surgeons and is the second most frequent nosocomial infection (20%) after urinary tract infection (36%) [1]. The severity of a SSI can vary from trivial to very significant as it can be highly associated with morbidity and mortality. It can also increase the clinical and financial burden because affected patients will need to undergo longer hospitalizations [2]. The causes of SSIs have been considered to be related to three factors: the patient, the contaminating organisms, and the operative procedure [3,4,5]. The patient-related factors, the most important factors in the development of SSIs [6], include old age, immunocompromised condition, and comorbidity such as cirrhosis, diabetes, chronic obstructive pulmonary disease, and cancer [3,5,6,7,8]. The contaminating organisms isolated from SSIs are expected to have originated from the patient's endogenous flora. They will be polymicrobial if the procedure involves opening the colon or rectum [3]. The procedure-related factors consist of inadequate skin preparation, poor preoperative shaving, a long duration of surgery, inadequate ventilation of the operating room, and massive tissue trauma [3,5,7,9,10,11]. In colorectal surgery, surgeons especially give more attention to taking care of the surgical site to avoid infection because wounds of opened viscus organs, such as the colon and the rectum, are considered a clean-contaminated wound, even though the surgery is performed without contamination. A clean wound, in general, is not related with a SSI. Furthermore, fecal contamination and bacterial translocation during the colorectal surgery can cause a postoperative infection and increase the morbidity and mortality. These unpleasant SSIs can be prevented by using several processes, including preoperative skin antisepsis, maintenance of normothermia during surgery, appropriate hair removal, use of a wound protector, and administration of prophylactic antibiotics (PAs). Particularly, in colorectal surgery, the traditional regimens to prevent SSIs are prolonged fasting, bowel preparation, and antibiotic prophylaxis. Because PAs have reduced the incidence of SSIs in colorectal surgery, the colon surgery guidelines recommend that PAs be administered perioperatively [12]. The U.S. Food and Drug Administration approved second-generation cephalosporin monotherapy or a combination of first-generation cephalosporin with metronidazole or ampicillin-sulbactam as PAs for colorectal surgery. However, although previous studies recommended that the duration of prophylaxis be within 24 hours after surgery and showed that long-term prophylaxis was not useful for reducing the wound infection rate [13,14], the current practices in Korea tend to administer different combinations and to use different durations of PAs in different hospitals [15]. The abuse of antibiotics is well known to increase resistance to the antibiotic; in fact, the number of SSIs caused by antibiotic-resistant bacteria and fungi is on the rise [3,11,16,17], which is the reason continuous research for preventing SSIs has been emphasized. For better results, a national consensus for SSI prevention should be reached at the government level in Korea. The American College of Surgeons National Surgical Quality Improvement Program is a national program in the United States to measure surgical outcomes in order to improve surgical care. It has constructed a surgery-related database that has been nationally validated [18]. In Korea, the Korean Nosocomial Infections Surveillance System (KONIS) was established in 2006 [19]. This system uses the KONIS Web-based Reporting and Analysis Program provided by voluntary participation of hospitals for the collection and sharing of SSI data. Recently, KONIS has tried to involve more hospitals and to make a qualified database. This continuous effort is instrumental if the incidence rate of SSIs is to be decreased, which would also decrease the financial burden of health care and increase the quality of surgical outcomes.

A preliminary study for the development of indices and the current state of surgical site infections (SSIs) in Korea: the Korean Surgical Site Infection Surveillance (KOSSIS) program.

PurposeWe aimed to develop an effective system for surgical site infection (SSI) surveillance and examine the current domestic state of SSIs for common abdominal surgeries in Korea.MethodsThe Korean Surgical Site Infection Surveillance (KOSSIS) program was developed as an SSI surveillance system. A prospective multicenter study in nine university-affiliated or general hospitals was conducted for patients who underwent gastrectomy, cholecystectomy, appendectomy, colectomy, or proctectomy between August 16 and September 30 in 2012. Patients were monitored for up to 30 days by combining direct observation and a postdischarge surgeon survey. Data on SSIs were prospectively collected with KOSSIS secretarial support according to a common protocol. Operation-specific SSI rates were stratified according to risk factors and compared with data from the Korean Nosocomial Infections Surveillance System (KONIS) and National Healthcare Safety Network. A focus group interview was conducted with participating hospitals for feedback.ResultsA total of 1,088 operations were monitored: 207 gastrectomies, 318 cholecystectomies, 270 appendectomies, 197 colectomies, and 96 proctectomies. Operation-specific SSI rates determined by the KOSSIS program were substantially higher than those found in KONIS (7.73% [95% confidence interval, 4.5%-12.3%] vs. 3.4% for gastrectomies, 10.15% [95% confidence interval, 6.1%-15.2%] vs. 4.0% for colectomy, and 13.5% [95% confidence interval, 7.4%-22.0%] vs. 4.2% for proctectomy).ConclusionDespite a short surveillance period and heterogenous group of hospitals, our results suggest that KOSSIS could be a useful program to enhance SSI surveillance in Korea.

Korean Nosocomial Infections Surveillance System, Intensive Care Unit Module Report: Data Summary from July 2012 through June 2013

Received: April 28, 2015 Revised: July 13, 2015 Accepted: November 26, 2015 Correspondence to: Tae Hyong Kim, Division of Infections Diseases, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul 04401, Korea Tel: 02-709-9194, Fax: 02-709-9083 E-mail: geuncom@schmc.ac.kr *This study was supported by a grant of year 2012-2013 from the Korea Centers for Disease Control and Prevention. 전국병원감염감시체계 중환자실 부문 결과 보고: 2012년 7월부터 2013년 6월

Korean Nosocomial Infections Surveillance System, Intensive Care Unit Module Report: Summary of Data from July 2013 through June 2014

Received: May 20, 2015 Revised: October 19, 2015 Accepted: November 5, 2015 Correspondence to: Jun Yong Choi, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: 02-2228-1974, Fax: 02-393-6884 E-mail: seran@yuhs.ac *This study was supported by a grant of year 2013-2014 from the Korea Centers for Disease Control and Prevention. 전국병원감염감시체계 중환자실 부문 결과 보고: 2013년 7월부터 2014년 6월

918Trends of device-associated infections in intensive care units after the establishment of national nosocomial infection surveillance system: results from the Korean Nosocomial Infections Surveillance System

918Trends of device-associated infections in intensive care units after the establishment of national nosocomial infection surveillance system: results from the Korean Nosocomial Infections Surveillance System

Improvement plan for the korean nationwide surveillance of antimicrobial resistance program.

In recent years, the sudden increase in the prevalence of antimicrobial-resistant bacteria and the emergence of multidrug-resistant bacteria have become serious worldwide problems. Therefore, in 2000, the World Health Organization (WHO) declared antimicrobial resistance to be an international danger, and has been working with its member nations to promote the appropriate use of antimicrobials as a solution to the antimicrobial resistance threat [1]. The recent emergence of New Delhi metallo-β-lactamase carbapenem-resistant Enterobacteriaceae has motivated us to increase our alertness to antimicrobial-resistant organisms [2]. Thus, surveillance of healthcare-associated infection has been enhanced. Surveillance for antimicrobial resistance is being executed mainly in European countries and in the U.S. In Korea, with the enactment of the Infectious Disease Control and Prevention Act in December 2010, infectious diseases caused by 6 types of multidrug-resistant bacteria-vancomycin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, methicillin-resistant S. aureus, multidrug-resistant Pseudomonas aeruginosa, multidrug-resistant Acinetobacter baumannii, and carbapenem-resistant Enterobacteriaceae-were legally designated for sentinel surveillance [3]. The prevalence of antimicrobial resistance in bacteria varies substantially from country to country and according to the date of the analysis and the hospital characteristics, because it is influenced significantly by the use of antimicrobial drugs and the degree of success of efforts to control the spread of resistant bacteria. The purposes of an antimicrobial resistance surveillance system (ARSS) are as follows: (1) to detect antimicrobial susceptibility patterns; (2) to monitor the identity, transmission, and expression of antimicrobial-resistance genes; (3) to provide important information on the development of bacterial resistance mechanisms in different regions; and (4) to allow changes in antimicrobial prescription practices and participation of infection control professionals. Well-designed antimicrobial resistance surveillance systems are needed when fighting bacterial resistance. The parameters of an ideal ARSS are as follows: global geography, year-on-year longevity, multiple species selection, centralized methods and test sites, large sample size, monitoring for many antimicrobial drugs, incorporation of epidemiology, and frequent data distribution [4]. Implementation of an ARSS requires 4 components: administrative commitments, system organization (participant, expert, and coordinator), financial support (from government agencies and the pharmaceutical industry), and data analysis and reporting systems (online and offline). The scope of ARSS networks is divided into global, continental, and nationwide. The global representative ARSSs are the Alexander Project, MYSTIC Program, SENTRY Program, PROTEKT System, and WHO Program. The European ARSS (EARSS; EARS-Net) is the surveillance system implemented in Europe, and the ARSSs available in the U.S. are the National Nosocomial Infections Surveillance, Intensive Care Antimicrobial Resistance Epidemiology, National Antimicrobial Resistance Monitoring System, International Surveillance Program for Emerging Antimicrobial Resistance, and Surveillance for Emerging Antimicrobial Resistance Connected to healthcare. In Korea, the nationwide ARSSs are the Korean Nationwide Surveillance of Antimicrobial Resistance (KONSAR), Korean Nosocomial Infections Surveillance System, and Korean Antimicrobial Resistance Monitoring System. Since 1997, the KONSAR program has been collecting data on antimicrobial-resistant bacteria from participating laboratories [5], and has therefore played an integral role in informing interested parties about the current state and severity of domestic antimicrobial resistance in bacteria by analyzing and reporting bacterial antimicrobial susceptibility data. However, the KONSAR program releases all its laboratory data to research papers or newsletters only after analysis; therefore, a web-based system that can analyze data in real time is needed [6]. To create such a system, a knowledge-based rule check system capable of detecting errors by setting the exact data variables as the definition of the specimen, the species identification method, and the antimicrobial susceptibility test methods must be defined. Furthermore, various analysis functions such as data comparison between entire hospitals and participating laboratories, and between peer groups, must be made possible on the internet. According to a recent KONSAR report [7], susceptibility to antimicrobials, including colistin, was analyzed without dividing Acinetobacter spp. into A. baumannii and non-baumannii Acinetobacter. This is a problem that has yet to be resolved. At the government level, blaOXA-23-like or ISAba1-activated blaOXA-51-like gene tests for detecting carbapenem-resistant A. baumannii need to be supported. For manufacturers that supply identification kits and for clinical microbiology laboratories, the development of testing methods that can accurately identify A. baumannii is also needed.

Korean Nosocomial Infections Surveillance System, Intensive Care Unit Module Report: Summary of Data from July 2011 through June 2012

Received: July 2, 2014 Revised: November 7, 2014 Accepted: November 25, 2014 Correspondence to: Tae Hyong Kim, Division of Infections Diseases, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul 140-743, Korea Tel: 02-709-9194, Fax: 02-709-9083 E-mail: geuncom@schmc.ac.kr *This study was supported by a grant of year 2011-2012 from the Korea Centers for Disease Control and Prevention. 전국병원감염감시체계 중환자실 부문 결과 보고:

Differences in the Risk Factors for Surgical Site Infection between Total Hip Arthroplasty and Total Knee Arthroplasty in the Korean Nosocomial Infections Surveillance System (KONIS)

To compare the characteristics and risk factors for surgical site infections (SSIs) after total hip arthroplasty (THA) and total knee arthroplasty (TKA) in a nationwide survey, using shared case detection and recording systems. Retrospective cohort study. Twenty-six hospitals participating in the Korean Nosocomial Infections Surveillance System (KONIS). From 2006 to 2009, all patients undergoing THA and TKA in KONIS were enrolled. SSI occurred in 161 (2.35%) of 6,848 cases (3,422 THAs and 3,426 TKAs). Pooled mean SSI rates were 1.69% and 2.82% for THA and TKA, respectively. Of the cases we examined, 42 (26%) were superficial-incisional SSIs and 119 (74%) were "severe" SSIs; of the latter, 24 (15%) were deep-incisional SSIs and 95 (59%) were organ/space SSIs. In multivariate analysis, a duration of preoperative hospital stay of greater than 3 days was a risk factor for total SSI after both THA and TKA. Diabetes mellitus, revision surgery, prolonged duration of surgery (above the 75th percentile), and the need for surgery due to trauma were independent risk factors for total and severe SSI after THA, while male sex and an operating room without artificial ventilation were independent risk factors for total and severe SSI after TKA. A large volume of surgeries (more than 10 procedures per month) protected against total and severe SSI, but only in patients who underwent TKA. Risk factors for SSI after arthroplasty differ according to the site of the arthroplasty. Therefore, clinicians should take into account the site of arthroplasty in the analysis of SSI and the development of strategies for reducing SSI.

Prospective Nationwide Surveillance of Surgical Site Infections after Gastric Surgery and Risk Factor Analysis in the Korean Nosocomial Infections Surveillance System (KONIS)

To evaluate the risk factors for surgical site infection (SSI) after gastric surgery in patients in Korea. A nationwide prospective multicenter study. Twenty university-affiliated hospitals in Korea. The Korean Nosocomial Infections Surveillance System (KONIS), a Web-based system, was developed. Patients in 20 Korean hospitals from 2007 to 2009 were prospectively monitored for SSI for up to 30 days after gastric surgery. Demographic data, hospital characteristics, and potential perioperative risk factors were collected and analyzed, using multivariate logistic regression models. Of the 4,238 case patients monitored, 64.9% (2,752) were male, and mean age (± SD) was 58.8 (± 12.3) years. The SSI rates were 2.92, 6.45, and 10.87 per 100 operations for the National Nosocomial Infections Surveillance system risk index categories of 0, 1, and 2 or 3, respectively. The majority (69.4%) of the SSIs observed were organ or space SSIs. The most frequently isolated microorganisms were Staphylococcus aureus and Klebsiella pneumoniae. Male sex (odds ratio [OR], 1.67 [95% confidence interval (CI), 1.09-2.58]), increased operation time (1.20 [1.07-1.34] per 1-hour increase), reoperation (7.27 [3.68-14.38]), combined multiple procedures (1.79 [1.13-2.83]), prophylactic administration of the first antibiotic dose after skin incision (3.00 [1.09-8.23]), and prolonged duration (≥7 days) of surgical antibiotic prophylaxis (SAP; 2.70 [1.26-5.64]) were independently associated with increased risk of SSI. Male sex, inappropriate SAP, and operation-related variables are independent risk factors for SSI after gastric surgery.

Current Status of Healthcare-associated Infections in Korea

In this article, the annual reports of the Korean Noso­ comial Infections Surveillance System (KONIS) were referred for the description of the current status of healthcare­associated infections (HAI) in Korea. KONIS has been established with the cooperation of the Korean Society for Nosocomial Infection Control and the Korea Centers for Disease Control and Prevention since 2006. The KONIS surveillance of healthcare­ associated infections at intensive care units (ICU) and surgical site infections was performed by 116 ICUs of 63 hospitals in 2009. According to the 2010 report of KONIS, the infection rate per 1,000 patient­days in ICU is 7.65. The device­associated infection rates of blood­ stream infection, urinary tract infection, and pneumonia are 3.27, 4.80, and 1.86, respectively. Surgical site in­ fection (SSI) rates of gastric surgery, colon surgery, rec tal surgery, craniotomy, ventricular shunt and spinal fusion are 3.3%, 4.7%, 5.8%, 3.6%, 5.1% and 3.9%, respectively. The SSI rates of gastrectomy and knee prosthesis are over 90 percentiles of the 국내 의료관련감염 현황 data of National Healthcare Safety Network, USA. In conclusion, the current healthcare­associated infection rates are higher than those of other developed countries. Through the harmonized communication of various specialists such as infectious diseases physicians, clinical microbiologists, and infection control nurses, the HAI should be monitored and pre­ vented.

Risk factors for device-associated infection related to organisational characteristics of intensive care units: findings from the Korean Nosocomial Infections Surveillance System

Device-associated infections (DAIs) have been the major causes of morbidity and mortality of patients in intensive care units (ICUs). This study evaluated the risk factors for DAIs in ICUs. Ninety-six medical or surgical ICUs of 56 hospitals participated in the Korean Nosocomial Infections Surveillance System between July 2007 and June 2008. The occurrence of catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CABSI), and ventilator-associated pneumonia (VAP) were monitored and DAI rates were calculated. Data associated with ICU characteristics were collected and Poisson regression was used for statistical analysis. Rates of CAUTI, CABSI, and VAP were 3.87 per 1000 urinary catheter days, 2.23 per 1000 central line days, and 1.89 per 1000 mechanical ventilator days, respectively. Rates of CAUTI were higher in ICUs in Seoul (P=0.032) and ICUs of major teaching hospitals (P=0.010). The ICUs of university-affiliated hospitals showed lower CAUTI rates (P=0.013). CABSI rates were higher in Seoul (P=0.001) and in medical ICUs (P=0.026). VAP rates were lower in ICUs of hospitals with more than 900 beds compared with hospitals with 400-699 beds (P=0.026). VAP rates were higher in surgical ICUs (P<0.0001) and increased 1.13-fold with each 100-unit increase in beds per infection control professional (P=0.003). The organisational and institutional characteristics of ICUs may influence DAI rates and there is a need for improvement in the incidence of VAP, CAUTI or CABSI.