Infection Control Guidelines - INICC

Investigación original / Original research
International Journal of Infectious Diseases 15 (2011) e357–e362
Contents lists available at ScienceDirect
Device-associated infection rates in
intensive care units of Brazilian hospitals:
findings of the International Nosocomial
Infection Control Consortium
Reinaldo Salomao, 1 Victor D. Rosenthal, 2 Gorki Grimberg, 3
Simone Nouer, 4 Sergio Blecher, 1 Silvia Buchner-Ferreira, 2
Rosa Vianna, 4 and Maria Ângela Maretti-da-Silva 1
Suggested citation
Salomao R, Rosenthal VD, Grimberg G, Nouer S, Blecher S, Buchner-Ferreira S, et al. Device-associated
infection rates in intensive care units of Brazilian hospitals: findings of the International Nosocomial
Infection Control Consortium. Rev Panam Salud Publica. 2008;24(3):195–202.
Original Article ABSTRACT Objectives. To measure device-associated infection (DAI) rates, microbiological profiles,
bacterial resistance, extra length of stay, and attributable mortality in intensive care units
(ICUs) in three Brazilian hospitals that are members of the International Nosocomial Infection
Device-associated infection Control rates Consortium in intensive (INICC). care units in El Salvador:
Methods. Prospective cohort surveillance of DAIs was conducted in five ICUs in three city
International Nosocomial Infection hospitals in Brazil Control by applying Consortium the definitions of the U.S. (INICC) Centers for Findings
Disease Control and Prevention
National Nosocomial Infections Surveillance System (CDC-NNIS).
Lourdes Dueñas 1 Results. Between , Ana C. Bran de Casares 1 April 2003 and February 2006, , Victor D. Rosenthal 2 1 031 patients hospitalized in five , Lilian Jesús Machuca 1 ICUs for
an aggregate 10 293 days acquired 307 DAIs, a rate of 29.8% or 29.8 DAIs per 1 000 ICUdays.
The ventilator-associated pneumonia (VAP) rate was 20.9 per 1 000 ventilator-days; the
1 Hospital Nacional de Niños Benjamin Bloom, rate for San central Salvador, venous catheter-associated El Salvador bloodstream infections (CVC-BSI) was 9.1 per 1 000
2 International Nosocomial Infection Control catheter-days; Consortium, and the Buenos rate for Aires, catheter-associated Argentina urinary tract infections (CAUTI) was 9.6 per
!
1000 catheter-days. Ninety-five percent of all Staphylococcus aureus DAIs were caused by
Abstract
methicillin-resistant strains. Infections caused by Enterobacteriaceae were resistant to ceftriaxone
in 96.7% of cases, resistant to ceftazidime in 79.3% of cases, and resistant to piperacillintazobactam
in 85.7% of cases. Pseudomonas aeruginosa DAIs were resistant to ciprofloxacin
Introduction: 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
in 71.3% of cases, resistant to ceftazidime in 75.5% of cases, and resistant to imipenem in
member of the International Infection Control Consortium (INICC) in El Salvador.
27.7% of cases. Patients with DAIs in the ICUs of the hospitals included in this study presented
Methodology: A prospective cohort, active DA-HAI surveillance study was conducted on patients admitted in the pediatric and neonatal
extra mortality rates of 15.3% (RR 1.79, P = 0.0149) for VAP, 27.8% (RR 2.44, P = 0.0004)
ICUs from January 2007 to November 2009. The protocol and methodology implemented were developed by INICC. Data were collected in
for CVC-BSI, and 10.7% (RR 1.56, P = 0.2875) for CAUTI.
the participating ICUs, and analyzed at INICC headquarters by proprietary software. DA-HAI rates were recorded by applying the definitions
Conclusion. The DAI rates were high in the ICUs of the Brazilian hospitals included in this
of the Centers for Disease Control and Prevention National Healthcare Safety Network.
study. Patient safety can be improved through the implementation of an active infection control
program comprising surveillance of DAIs and infection prevention guidelines. These ac-
Results: 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
tions should become a priority in every country.
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 Key words urinary Bacterial tract infection infection; (CAUTI) cross rate infection/epidemiology; was 5.8 per 1,000 catheter-days drug in the resistance, PICU. bacterial; hospitals;
of infection our hospital control; were higher infection than international control practitioners; standards; infection intensive control care programs units;
Conclusions: DA-HAI rates in the PICU and NICU
including surveillance and antibiotic policies must length be a priority of stay; in El mortality; Salvador. Brazil.
Key words: health care-associated infection; nosocomial; intensive care unit; developing country; International Nosocomial Infection
1 Division of Infection Control, Santa Marcelina
3
Control Consortium; INICC; mortality
correspondence to Dr. Victor Rosenthal, Lavalleja Division of Infection Control, Porto Alegre General
Hospital, Porto Alegre, Hospital, São Paulo, Brazil.
305, Floor 9, Apt B, (1414) Buenos Aires, Argen-
Brazil.
International Journal of Infectious Diseases
journal homepage: www.elsevier.com/locate/ijid
Device-associated infection rates in adult intensive care units of Cuban university
hospitals: International Nosocomial Infection Control Consortium (INICC) findings
H. Guanche-Garcell a , O. Requejo-Pino b , V.D. Rosenthal c, *, C. Morales-Pérez a ,
O. Delgado-González b , D. Fernández-González b
a Joaquín Albarrán Domínguez Surgical Training Hospital, Havana, Cuba
b Gral. Calixto García University Hospital, Havana, Cuba
c International Nosocomial Infection Control Consortium, Buenos Aires, Argentina
ARTICLE INFO
SUMMARY
Investigación original / Original research
Article history:
Objectives: To determine the rate of device-associated healthcare-associated infection (DA-HAI),
Received 25 June 2010
microbiological profile, length of stay (LOS), extra mortality, and hand hygiene compliance in two
Received in revised form 20 December 2010
intensive care units (ICUs) of two hospital members of the International Infection Control Consortium
Accepted 1 February 2011
(INICC) of Havana, Cuba.
Methods: An open label, prospective cohort, active DA-HAI surveillance study was conducted on adults
Corresponding Editor: Ziad Memish, Riyadh, admitted to two tertiary-care ICUs in Cuba from May 2006 to December 2009, implementing the
Saudi Arabia
methodology developed by INICC. Data collection was performed in the participating ICUs, and data
Device-associated infection rates and mortality
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
Keywords:
in intensive care units of Peruvian hospitals:
Nosocomial infection
Hospital infection
Health care acquired infection
findings Cuba of the International Nosocomial
Developing country
Intensive Care Unit
Infection Control Consortium
(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.
Results: 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 ventilatordays,
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).
Conclusions: 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.
ß 2011 International Society for Infectious27
Diseases. Published by Elsevier Ltd. All rights reserved.
Cuellar LE, Fernandez-Maldonado E, Rosenthal VD, Castaneda-Sabogal A, Rosales R, Mayorga-
Espichan MJ, et al. Device-associated infection rates and mortality in intensive care units of Peruvian
hospitals: findings of the International Nosocomial Infection Control Consortium. Rev Panam Salud
Publica. 2008;24(1):16–24.
Luis E. Cuellar, 1 Eduardo Fernandez-Maldonado, 2 Victor D. Rosenthal, 3
Alex Castaneda-Sabogal, 4 Rosa Rosales, 1 Manuel J. Mayorga-Espichan, 2
Luis A. Camacho-Cosavalente, 3 and Luis I. Castillo-Bravo 1
Suggested citation
1. Introduction
surveillance has been reported by the US Centers for Disease
Control and Prevention (CDC) Study of the Efficacy of Nosocomial
In the USA, as well as in several other high-income countries, Infection Control (SENIC) as an efficacious tool to reduce DA-HAIs.
ABSTRACT Objectives. To measure device-associated infection (DAI) rates, microbiological profiles,
2