Decreasing central line-associated bloodstream infections rates in intensive care units in low- and middle- income countries: An INICC approach

Rosenthal, Victor D. and Jin, Zhilin and Brown, Eric C. and Dongol,, Reshma and De Moros, Daisy A. and Alarcon-Rua, Johana and Perez, Valentina and Stagnaro, Juan P. and Alkhawaja, Safaa Abdulaziz and Jimenez-Alvarez, Luisa F. and Cano-Medina, Yuliana A. and Valderrama-Beltran, Sandra L. and Henao-Rodas, Claudia M. and Zuniga-Chavarria, Maria A. and El-Kholy, Amani Ali and Agha, Hala Mounir and Sahu, Suneeta and Mishra, Shakti B. and Bhattacharyya, Mahuya and Kharbanda, Mohit and Poojary, Aruna and Nair, Pravin K. and Myatra, Sheila N. and Chawla, Rajesh and Sandhu, Kavita and Mat Nor, Mohd Basri and Aguirre-Avalos, Guadalupe and Hernandez-Chena, Blanca E. and Sassoe-Gonzalez, Alejandro and Villegas-Mota, Isabel and Aleman- Bocanegra, Mary C. and Bat-Erdene, Ider and Carreazo, Nilton Y. and Castaneda-Sabogal, Alex and Janc, Jarosław and Hlinkova, Sona and Yildizdas, Dincer and Havan, Merve and Koker, Alper and Sungurtekin, Hulya and Dinleyici, Ener C. and Guclu, Ertugrul and Tao, Lili and Memish, Ziad A. and Yin, Ruijie (2023) Decreasing central line-associated bloodstream infections rates in intensive care units in low- and middle- income countries: An INICC approach. American Journal of Infection Control, 52 (5). pp. 580-587. ISSN ISSN: 0196-6553

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Abstract

Background: Central line (CL)-associated bloodstream infections (CLABSIs) occurring in the ICU are common and associated with a high burden. Methods: We implemented a multidimensional approach, incorporating an 11-element bundle, education, surveillance of CLABSI rates and clinical outcomes, monitoring compliance with bundle components, feedback of CLABSI rates and clinical outcomes, and performance feedback in 316 ICUs across 30 low- and middle-income countries (LMICs). Our dependent variables were CLABSI per 1,000-CL-days and in-ICU all-cause mortality rates. These variables were measured at baseline and during the intervention, specifically during the 2nd month, 3rd month, 4-16 months, and 17-29 months. Comparisons were conducted using a two-sample t-test. To explore the exposure-outcome relationship, we used a generalized linear mixed model with a Poisson distribution to model the number of CLABSIs. Results: During 1,837,750 patient-days, 283,087 patients, used 1,218,882 CL-days. CLABSI per 1,000 CL-days rates decreased from 15.34 at the baseline period to 7.97 in the 2nd month (RR=0.52; 95% CI=0.48-0.56; P<0.001), 5.34 in the 3rd month (RR=0.35; 95% CI= 0.32-0.38; P<0.001), and 2.23 in the 17-29 months (RR=0.15; 95% CI=0.13-0.17; P<0.001). In-ICU all-cause mortality rate decreased from 16.17% at baseline to 13.68% (RR=0.84; p=0.0013) at 17-29 months. Conclusions: The implemented approach was effective, and a similar intervention could be applied in other ICUs of LMICs to reduce CLABSI and in-ICU all-cause mortality rates.

Item Type:	Article (Journal)
Uncontrolled Keywords:	Hospital infection Nosocomial infection Health care–associated infection Device-associated infection Antibiotic resistance Developing countries Limited resources countries Low income countries Network
Subjects:	R Medicine > RC Internal medicine > RC82 Medical Emergencies, Critical Care, Intensive Care, First Aid
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button):	Kulliyyah of Medicine > Department of Anaesthesiology & Intensive Care Kulliyyah of Medicine
Depositing User:	Dr. Mohd Basri Mat Nor
Date Deposited:	24 Oct 2024 12:43
Last Modified:	24 Oct 2024 12:51
URI:	http://irep.iium.edu.my/id/eprint/112391

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