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

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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 ( IF 4.9 ) Pub Date : 2023-12-26 , DOI: 10.1016/j.ajic.2023.12.010
Victor Daniel Rosenthal , Zhilin Jin , Eric Christopher Brown , Reshma Dongol , Daisy Aguilar De Moros , Johana Alarcon-Rua , Valentina Perez , Juan Pablo Stagnaro , Safaa Alkhawaja , Luisa Fernanda da Jimenez-Alvarez , Yuliana Andrea Cano-Medina , Sandra Liliana Valderrama-Beltran , Claudia Milena Henao-Rodas , Maria Adelia Zuniga-Chavarria , Amani El-Kholy , Hala Agha , Suneeta Sahu , Shakti Bedanta Mishra , Mahuya Bhattacharyya , Mohit Kharbanda , Aruna Poojary , Pravin K. Nair , Sheila Nainan Myatra , Rajesh Chawla , Kavita Sandhu , Yatin Mehta , Prasad Rajhans , Mohammad Abdellatif-Daboor , Tai Chian-Wern , Gan Chin Seng , Mohd-Basri Mat Nor , Guadalupe Aguirre-Avalos , Blanca Estela Hernandez-Chena , Alejandro Sassoe-Gonzalez , Isabel Villegas-Mota , Mary Cruz Aleman- Bocanegra , Ider Bat-Erdene , Nilton Yhuri Carreazo , Alex Castaneda-Sabogal , Jarosław Janc , Sona Hlinkova , Dincer Yildizdas , Merve Havan , Alper Koker , Hulya Sungurtekin , Ener C. Dinleyici , Ertugrul Guclu , Lili Tao , Ziad A. Memish , Ruijie Yin

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.

中文翻译：

降低低收入和中等收入国家重症监护室中中心静脉导管相关血流感染率：INICC 方法

背景

ICU 中发生的中心静脉导管 (CL) 相关血流感染 (CLABSI) 很常见，且负担较高。

方法

我们实施了多维方法，包括 11 个要素的捆绑、教育、CLABSI 率和临床结果的监测、捆绑组件的合规性监控、CLABSI 率和临床结果的反馈，以及 30 个低中和中低收入国家 316 个 ICU 的绩效反馈。收入国家（LMIC）。我们的因变量是每 1,000 CL 天的 CLABSI 和 ICU 内全因死亡率。这些变量是在基线和干预期间测量的，特别是在第 2 个月、第 3 个月、4-16 个月和 17-29 个月期间。使用两个样本 t 检验进行比较。为了探索暴露与结果的关系，我们使用具有泊松分布的广义线性混合模型来对 CLABSI 的数量进行建模。

结果

在 1,837,750 个患者日期间，283,087 名患者使用了 1,218,882 个 CL 天。每 1,000 CL 天的 CLABSI 率从基线期的 15.34 降至第 2 个月的 7.97（RR=0.52；95% CI=0.48-0.56；P<0.001），第 3 个月为 5.34（RR=0.35；95%） CI= 0.32-0.38；P<0.001），17-29 个月为 2.23（RR=0.15；95% CI=0.13-0.17；P<0.001）。17-29 个月时，ICU 内全因死亡率从基线时的 16.17% 下降至 13.68%（RR=0.84；p=0.0013）。