Impact of Education and Process Surveillance on Device-Associated Health Care-Associated Infection Rates in a Turkish ICU: Findings of the International Nosocomial Infection Control Consortium (INICC)

Abstract

Objective: The aim of this study was to analyze the impact of process and outcome surveillance on rates of device-associated health care-associated infections (DA-HAI) in an intensive care unit (ICU) in Turkey over a four-year period. Material and Methods: An open label, prospective cohort, active DA-HAI surveillance study was conducted on 685 patients admitted to the ICU of a university hospital in Turkey from January 2004 to December 2007, implementing the methodology developed by the International Nosocomial Infection Control Consortium. DA-HAI rates were recorded according to Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN) definitions. We analyzed the rates of DA-HAI, mechanical ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLA-BSI), and catheter-associated urinary tract infection (CAUTI), as well as microorganism profile, extra length of stay, and hand hygiene compliance. Pooled DA-HAI rates were calculated and compared by year. Results: The DA-HAI rate per 100 patients declined as follows: for 2004, the DA-HAI rate was 58.4%; for 2005, it was 38.9%; for 2006, it was 34.8%; and for 2007, it was 10.9%. The DA-HAI rate per 1,000 bed-days also declined: for 2004, it was 42.8, and for 2007 it was 10.7. The rates decreased from 25.8 to 13.4 for VAP; from 29.9 to 25.0 for CLA-BSI; and from 9.2 to 6.2 for CAUTI cases per 1,000 device-days during the study period. Conclusion: Process and outcome surveillance of DA-HAI significantly reduced DA-HAI. Turkish Başlık: Bir Türk Yoğun Bakım Ünitesinde Eğitim ve Sürveyansın Alet İlişkili Hastane Enfeksiyon Hızları Üzerine Etkisi: Uluslar Arası Nozokomiyal Enfeksiyon Kontrol Konsorsiyum Verileri Anahtar Kelimeler: Hastane enfeksiyonları, ventilatör ilişkili pnömoni, santral kateter ilişkili kan dolaşımı enfeksiyonu, kateter ilişkili idrar yolu enfeksiyonu, sürveyans, el hijyeni, yoğun bakım ünitesi Amaç: Bu çalışmanın amacı, Türkiye'deki bir yoğun bakım ünitesinin dört yıllık eğitim ve sürveyansının alet ilişkili hastane enfeksiyon hızları üzerine etkisinin değerlendirilmesidir. Gereç ve Yöntem: Çalışma prospektif kohort, açık-etiketli, aktif, alet ilişkili hastane enfeksiyon takibi ile, Türkiye'deki bir üniversite hastanesinin yoğun bakım ünitesinde Ocak 2004 ve Aralık 2007 tarihleri arasında kabul edilen 685 hastada uluslar arası nozokomiyal enfeksiyon kontrol konsorsiyumunun geliştirdiği yöntemlerin uygulandığı bir çalışmadır. Alet ilişkili hastane enfeksiyon hızları “Amerikan Hastalık Kontrol ve Önleme Merkezleri (CDC)” ve “Ulusal Sağlık Hizmeti Güvenlik Çalışma Ağı (NHSN)” tanımlarına göre kayıt edildi. Alet ilişkili enfeksiyon hızları, ventilatör ilişkili pnömoni hızları, santral kateter ilişkili kan dolaşımı enfeksiyon hızları, kateter ilişkili idrar yolu enfeksiyon hızları, mikroorganizma profilleri, ekstra hastane kalış günleri ve el hijyeni uyumları analiz edildi. Alet ilişkili enfeksiyon hızları hesaplandı ve yıllara göre karşılaştırıldı. Bulgular: Yüz hasta başına düşen alet ilişkili hastane enfeksiyon hızları 2004 için %58.4, 2005 için %38.9, 2006 için %34.8 ve 2007 için %10.9 olarak izlenmiştir. Buna ek olarak 1000 hastane günü başına düşen alet ilişkili hastane enfeksiyon hızları da 2004 için 42.8, 2007 için 10.7'dir. Ventilatör ilişkili pnömoni hızları 25.8'den 13.4'e, santral kateter ilişkili kan kültürü enfeksiyon hızları 29.9'dan 25.0'a, kateter ilişkili idrar yolu enfeksiyon hızları ise 9.2'den 6.2'ye gerilemiştir. Sonuç: Alet ilişkili hastane enfeksiyonlarının sürveyansı, bu enfeksiyonları belirgin şekilde azaltmıştır.

Keywords

• Health care-associated infection, ventilator-associated pneumonia, central line-associated bloodstream infection, catheter-associated urinary tract infection, outcome and process surveillance, hand hygiene, intensive care unit

Impact of Education and Process Surveillance on Device-Associated Health Care-Associated Infection Rates in a Turkish ICU: Findings of the International Nosocomial Infection Control Consortium (INICC)

Öz

References

1. van der Kooi TI, de Boer AS, Manniën J, Wille JC, Beaumont MT, Mooi BW, et al. Incidence and risk factors of device-associated infections and associated mortality at the intensive care in the Dutch surveillance system. Intensive Care Med 2007;33:271-8. [CrossRef]
2. Navoa-Ng JA, Berba R, Galapia YA, Rosenthal VD, Villanueva VD, Tolentino MC, et al. Device-associated infections rates in adult, pediatric, and neonatal intensive care units of hospitals in the Philippines: International Nosocomial Infection Control Con- sortium (INICC) findings. Am J Infect Control 2011;39:548-54. [CrossRef]
3. Rosenthal VD, Udwadia FE, Muñoz HJ, Erben N, Higuera F, Abidi K, et al. Time-dependent analysis of extra length of stay and mor- tality due to ventilator-associated pneumonia in intensive-care units of ten limited-resources countries: findings of the Interna- tional Nosocomial Infection Control Consortium (INICC). Epide- miol Infect 2011;139:1757-63. [CrossRef]
4. Rosenthal VD. Health-care-associated infections in developing countries. Lancet 2011;377:186-8. [CrossRef]
5. Rosenthal VD, Guzman S, Migone O, Crnich CJ. The attributable cost, length of hospital stay, and mortality of central line-asso- ciated bloodstream infection in intensive care departments in Argentina: A prospective, matched analysis. Am J Infect Control 2003;31:475-80. [CrossRef]
6. Rosenthal VD, Guzman S, Migone O, Safdar N. The attributable cost and length of hospital stay because of nosocomial pneu- monia in intensive care units in 3 hospitals in Argentina: a pro- spective, matched analysis. Am J Infect Control 2005;33:157-61. [CrossRef]
7. Higuera F, Rangel-Frausto MS, Rosenthal VD, Soto JM, Castañon J, Franco G, et al. Attributable cost and length of stay for pa- tients with central venous catheter-associated bloodstream infec- tion in Mexico City intensive care units: a prospective, matched analysis. Infect Control Hosp Epidemiol 2007;28:31-5. [CrossRef]
8. Marra AR, Cal RG, Durão MS, Correa L, Guastelli LR, Moura DF Jr, et al. Impact of a program to prevent central line-associated bloodstream infection in the zero tolerance era. Am J Infect Con- trol 2010;38:434-9. [CrossRef]

9. Blamoun J, Alfakir M, Rella ME, Wojcik JM, Solis RA, Anees Khan M, et al. Efficacy of an expanded ventilator bundle for the reduc- tion of ventilator-associated pneumonia in the medical intensive care unit. Am J Infect Control 2009;37:172-5. [CrossRef]
10. Kritchevsky SB, Braun BI, Kusek L, Wong ES, Solomon SL, Parry MF, et al. The impact of hospital practice on central venous cath- eter associated bloodstream infection rates at the patient and unit level: a multicenter study. Am J Med Qual 2008;23:24-38. [CrossRef]
11. Kollef M. SMART approaches for reducing nosocomial infections in the ICU. Chest 2008;134:447-56. [CrossRef]
12. Coffin SE, Klompas M, Classen D, Arias KM, Podgorny K, Ander- son DJ, et al. Strategies to prevent ventilator-associated pneu- monia in acute care hospitals. Infect Control Hosp Epidemiol 2008;29 Suppl 1:S31-40. [CrossRef]
13. Al-Tawfiq JA, Abed MS. Decreasing ventilator-associated pneu- monia in adult intensive care units using the Institute for Health- care Improvement bundle. Am J Infect Control 2010;38:552-6. [CrossRef]
14. Guanche-Garcell H, Requejo-Pino O, Rosenthal VD, Morales- Perez C, Delgado-Gonzalez O, Fernandez-Gonzalez D. Device- associated infection rates in adult intensive care units of Cuban university hospitals: International Nosocomial Infection Control Consortium (INICC) findings. Int J Infect Dis 2011;15:e357-62. [CrossRef]
15. Rosenthal VD, Maki DG, Jamulitrat S, Medeiros EA, Todi SK, Go- mez DY, et al. International Nosocomial Infection Control Con- sortium (INICC) report, data summary for 2003-2008, issued June 2009. Am J Infect Control 2010;38:95-104.e2. [CrossRef]
16. Dudeck MA, Horan TC, Peterson KD, Allen-Bridson K, Mor- rell GC, Pollock DA, et al. National Healthcare Safety Network (NHSN) Report, Data Summary for 2009, Device-associated Module. Am J Infect Control 2011;39:349-67. [CrossRef]
17. Edwards JR, Peterson KD, Mu Y, Banerjee S, Allen-Bridson K, Morrell G, et al. National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control 2009;37:783-805. [CrossRef]
18. Rosenthal VD, Maki DG, Graves N. The International Nosocomial Infection Control Consortium (INICC): goals and objectives, de- scription of surveillance methods, and operational activities. Am J Infect Control 2008;36:e1-12. [CrossRef]
19. O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control 2011;39 (4 Suppl 1):S1-34. [CrossRef]
20. Marschall J, Mermel LA, Classen D, Arias KM, Podgorny K, An- derson DJ, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29 Suppl 1:S22-30. [CrossRef]
21. Lo E, Nicolle L, Classen D, Arias KM, Podgorny K, Anderson DJ, et al. Strategies to prevent catheter-associated urinary tract in- fections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29 Suppl 1:S41-50. [CrossRef]
22. Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA. Guideline for prevention of catheter-associated urinary tract in- fections 2009. Infect Control Hosp Epidemiol 2010;31:319-26. [CrossRef]
23. Arman D, Arda B, Sardan YC, Kayacan CB, Esen F, Topeli İskit A, et al. [Saglik hizmeti ile iliskili pnömoninin onlenmesi kilavuzu]. Turkish Journal of Hospital Infections 2008;12 Suppl 2:3-14.
24. Ulusoy S, Akan H, Arat M, Baskan S, Bavbek S, Cakar N, et al. [Damar ici kateter infeksiyonlarinin onlenmesi kilavuzu]. Turkish Journal of Hospital Infections 2005;9 Suppl 1:3-32.
25. Ozinel MA, Bakir M, Cek M, Zorlu F, Güven M, Bozfakioglu S. [Uri- ner kateter infeksiyonlarinin onlenmesi kilavuzu]. Turkish Journal of Hospital Infections 2004;8 Suppl 1:3-12.
26. Siegel JD, Rhinehart E, Jackson M, Chiarello L. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. Am J Infect Control 2007;35 (10 Suppl 2):S65-164. [CrossRef]
27. Usluer G, Esen S, Dokuzoguz B, Ural O, Akan H, Arcagok C, et al. [Izolasyon onlemleri kilavuzu]. Turkish Journal of Hospital Infec- tions 2006;10 Suppl 2:5-28.
28. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance defi- nition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309-32. [CrossRef]
29. Mattar S, Centella A, Gamboa F, Arrieta S. [Evaluation of screen- ing methods (catalase, sediment, reactive strip and Gram stain) in urinary tract infection in a Colombian university hospital]. Enferm Infecc Microbiol Clin 1994;12:123-6.
30. Hugonnet S, Harbarth S, Sax H, Duncan RA, Pittet D. Nursing re- sources: a major determinant of nosocomial infection? Curr Opin Infect Dis 2004;17:329-33. [CrossRef]
31. Rosenthal VD. Device-associated nosocomial infections in lim- ited-resources countries: findings of the International Nosoco- mial Infection Control Consortium (INICC). Am J Infect Control 2008;36:S171.e7-12.
32. Leblebicioglu H, Rosenthal VD, Arikan OA, Ozgültekin A, Yalcin AN, Koksal I, et al. Device-associated hospital-acquired infection rates in Turkish intensive care units. Findings of the International Nosocomial Infection Control Consortium (INICC). J Hosp Infect 2007;65:251-7. [CrossRef]
33. Buyuktuna SA, Turhan O, Cengiz M, Ramazanoglu A, Yalcin AN. Nosocomial Infections and Agents Determined by Consultations in Intensive Care Unit. Trakya Univ Tip Fak Derg 2010;27:150-5.
34. Rosenthal VD, Guzman S, Orellano PW. Nosocomial infections in medical-surgical intensive care units in Argentina: attributable mortality and length of stay. Am J Infect Control 2003;31:291-5. [CrossRef]