Evaluating the outcome of a bundle with 11 components and the INICC multidimensional approach in decreasing rates of central line-associated bloodstream infections across nine Asian countries

Rosenthal, Victor Daniel and Yin, Ruijie and Myatra, Sheila Nainan and Divatia, Jigeeshu Vasishth and Biswas, Sanjay K and Shrivastava, Anjana Mahesh and Perez, Valentina and Wang, Qi Yuee and Todi, Subhash Kumar and Tang, Swee Fong and Tai, Chian Wern and Lee, Pei-Chuen and Sengupta, Deep and Sarma, Smita and Sandhu, Kavita and Rodrigues, Camilla and Nag, Bikas and Mat Nor, Mohd Basri (2025) Evaluating the outcome of a bundle with 11 components and the INICC multidimensional approach in decreasing rates of central line-associated bloodstream infections across nine Asian countries. Journal of Vascular Access, 26 (3). pp. 762-771. ISSN 1129-7298 E-ISSN 1724-6032

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Abstract

Background: Central line-associated bloodstream infection (CLABSI) rates in intensive care units (ICUs) across Latin America exceed those in high-income countries significantly. Methods: We implemented the INICC multidimensional approach, incorporating an 11-component bundle, in 122 ICUs spanning nine Asian countries. We computed the CLABSI rate using the CDC/NSHN definition and criteria. The CLABSI rate per 1000 CL-days was calculated at baseline and throughout different phases of the intervention, including the 2nd month, 3rd month, 4–16 month, and 17–29 month periods. A two-sample t-test was employed to compare baseline CLABSI rates with intervention rates. Additionally, we utilized a generalized linear mixed model with a Poisson distribution to analyze the association between exposure and outcome. Results: A total of 124,946 patients were hospitalized over 717,270 patient-days, with 238,595 central line (CL)-days recorded. The rates of CLABSI per 1000 CL-days significantly decreased from 16.64 during the baseline period to 6.51 in the 2nd month (RR = 0.39; 95% CI = 0.36–0.42; p < 0.001), 3.71 in the 3rd month (RR = 0.22; 95% CI = 0.21–0.25; p < 0.001), 2.80 in the 4–16 month (RR = 0.17; 95% CI = 0.15–0.19; p < 0.001), and 2.18 in the 17–29 month (RR = 0.13; 95% CI = 0.11–0.15; p < 0.001) intervals. A multilevel Poisson regression model demonstrated a sustained, continuous, and statistically significant decrease in ratios of incidence rates, reaching 0.35 (p < 0.0001) during the 17–29 month period. Moreover, the all-cause in-ICU mortality rate significantly decreased from 13.23% to 10.96% (p = 0.0001) during the 17–29 month period. Conclusions: Our intervention led to an 87% reduction in CLABSI rates, with a 29-month follow-up.

Item Type:	Article (Journal)
Additional Information:	5608/115309
Uncontrolled Keywords:	Central line-associated bloodstream infections, bloodstream infection, limited resources countries, network, Asia, INICC
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 Kulliyyah of Medicine > Department of Anaesthesiology & Intensive Care
Depositing User:	Dr. Mohd Basri Mat Nor
Date Deposited:	28 Oct 2024 14:38
Last Modified:	16 Dec 2025 12:18
Queue Number:	2025-12-Q787
URI:	http://irep.iium.edu.my/id/eprint/115309

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