Abstract:
BACKGROUND. The International Nosocomial Infection Control Consortium (INICC) was established in 15 developing countries to reduce infection rates in resource-limited hospitals by focusing on education and feedback of outcome surveillance (infection rates) and process surveillance (adherence to infection control measures). We report a time-sequence analysis of the effectiveness of this approach in reducing rates of central line-associated bloodstream infection (CLABSI) and associated deaths in 86 intensive care units with a minimum of 6-month INICC membership. METHODS. Pooled CLABSI rates during the first 3 months (baseline) were compared with rates at 6-month intervals during the first 24 months in 53,719 patients (190,905 central line-days). Process surveillance results at baseline were compared with intervention period data. RESULTS. During the first 6 months, CLABSI incidence decreased by 33percent (from 14.5 to 9.7 CLABSIs per 1,000 central line-days). Over the first 24 months there was a cumulative reduction from baseline of 54percent (from 16.0 to 7.4 CLABSIs per 1,000 central line-days; relative risk, 0.46 [95percent confidence interval, 0.33-0.63]; P .001). The number of deaths in patients with CLABSI decreased by 58percent. During the intervention period, hand hygiene adherence improved from 50percent to 60percent (P .001); the percentage of intensive care units that used maximal sterile barriers at insertion increased from 45percent to 85percent (P .001 ), that adopted chlorhexidine for antisepsis increased from 7percent to 27percent (P=.018 ), and that sought to remove unneeded catheters increased from 37percent to 83percent (P=.004); and the duration of central line placement decreased from 4.1 to 3.5 days (P .001). CONCLUSIONS. Education, performance feedback, and outcome and process surveillance of CLABSI rates significantly improved infection control adherence, reducing the CLABSI incidence by 54percent and the number of CLABSI-associated deaths by 58percent in INICC hospitals during the first 2 years. © 2010 by The Society for Healthcare Epidemiology of America. All rights reserved.