Decreasing central line-associated bloodstream infections rates in intensive care units in 30 low- and middle-income countries: An INICC approach.
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Rosenthal Victor D, Jin Zhilin, Brown Eric C, Dongol Reshma, De Moros Daisy A, Alarcon-Rua Johana, Perez Valentina, Stagnaro Juan P, Alkhawaja Safaa, Jimenez-Alvarez Luisa F, Cano-Medina Yuliana A, Valderrama-Beltran Sandra L, Henao-Rodas Claudia M, Zuniga-Chavarria Maria A, El-Kholy Amani, Agha Hala, Sahu Suneeta, Mishra Shakti B, Bhattacharyya Mahuya, Kharbanda Mohit, Poojary Aruna, Nair Pravin K, Myatra Sheila N, Chawla Rajesh, Sandhu Kavita, Mehta Yatin, Rajhans Prasad, Abdellatif-Daboor Mohammad, Chian-Wern Tai, Gan Chin Seng, Mohd-Basri Mat Nor, Aguirre-Avalos Guadalupe, Hernandez-Chena Blanca E, Sassoe-Gonzalez Alejandro, Villegas-Mota Isabel, Aleman-Bocanegra Mary C, Bat-Erdene Ider, Carreazo Nilton Y, Castaneda-Sabogal Alex, Janc Jarosław, Hlinkova Sona, Yildizdas Dincer, Havan Merve, Koker Alper, Sungurtekin Hulya, Dinleyici Ener C, Guclu Ertugrul, Tao Lili, Memish Ziad A, Yin Ruijie
Аннотация
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. 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 second month, third month, 4 to 16 months, and 17 to 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 (relative risk (RR) = 0.52; 95% confidence interval [CI] = 0.48-0.56; P < .001), 5.34 in the 3rd month (RR = 0.35; 95% CI = 0.32-0.38; P < .001), and 2.23 in the 17 to 29 months (RR = 0.15; 95% CI = 0.13-0.17; P < .001). In-ICU all-cause mortality rate decreased from 16.17% at baseline to 13.68% (RR = 0.84; P = .0013) at 17 to 29 months.
CONCLUSIONS: The implemented approach was effective, and a similar intervention could be applied in other ICUs of low- and middle-income countries to reduce CLABSI and in-ICU all-cause mortality rates.