Major Article
International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module

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Highlights

  • We report INICC device-associated module data of 50 countries from 2010-2015.

  • We collected prospective data from 861,284 patients in 703 ICUs for 3,506,562 days.

  • DA-HAI rates and bacterial resistance were higher in the INICC ICUs than in CDC-NHSN's.

  • Device utilization ratio in the INICC ICUs was similar to CDC-NHSN's.

Background: We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.

Methods: During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days.

Results: Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs.

Conclusions: Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically.

Section snippets

Methods

The INICC Surveillance Online System has 15 modules. One of them is for surveillance of DA-HAI in adult and pediatric ICUs and neonatal ICUs (NICUs).5, 6

The data are collected using standardized INICC online forms, following CDC-NHSN methods for calculation of HAI rates and DU ratios, and HAI definitions of the CDC-NSHN that include laboratory and clinical criteria.3, 4 Definitions of HAI used during surveillance were those published by CDC in 2008,3 and their subsequent updates published in

Results

From January 1, 2010-December 31, 2015 we conducted a cohort prospective multicenter surveillance study of DA-HAI in 703 ICUs in 50 countries from Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific World Health Organization regions currently participating in INICC. Out of all hospitals, 62% were public or academic, and the remaining 38% were private. The identity of all INICC patients, hospitals, cities, and countries is confidential, in accordance with the INICC

Discussion

From 1975-2004 the CDC's former National Nosocomial Infections Surveillance system,1 and thereafter, the NHSN,2 have provided benchmarking US ICU data on DA-HAIs, which are invaluable for researchers and served as an inspiration and foundation to the INICC program, which started its prospective standardized surveillance in 1998.5, 6

Our findings show that although the DU ratio in INICC ICUs is analogous or even lower to the DU ratio reported of US ICUs by the CDC-NHSN system, DA-HAI rates

Acknowledgments

The authors thank the many health care professionals who assisted with the conduct of surveillance in their hospital; Débora López Burgardt, who works at INICC headquarters in Buenos Aires; and the INICC Advisory Board, country directors, and secretaries (Hail M. Alabdaley, Yassir Khidir Mohamed, Safaa Abdul Aziz AlKhawaja, Amani Ali El-Kholy, Vineya Rai, María Isabel Villegas-Mota, Souha S. Kanj, Hakan Leblebicioglu, Yatin Mehta, Bijie Hu, Lul Raka, Najiba M Abdulrazzaq, Sergio Cimerman,

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    For a list of all members of the International Nosocomial Infection Control Consortium and all coauthors of this study, see the Appendix.

    The funding for design, development, maintenance, technical support, data validation, and report generation of the Surveillance Online System, and the activities carried out at International Nosocomial Infection Control Consortium headquarters, were provided by VDR and the Foundation to Fight against Nosocomial Infections.

    All authors were involved in provision of study patients, critical revision of the manuscript for important intellectual content, and final approval of the manuscript. VDR was responsible for study conception and design, drafting of the manuscript, software development, technical support, report generation, data validation, data assembly, data interpretation, and epidemiologic and statistical analysis.

    Conflicts of interest: None to report.

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