Decreasing central line-associated bloodstream infections rates in intensive care units in 30 low- and middle-income countries: An INICC approach

Victor D. Rosenthal; Zhilin Jin; Eric C. Brown; Reshma Dongol; Daisy A. De Moros; Johana Alarcon-Rua; Valentina Perez; Juan P. Stagnaro; Safaa Alkhawaja; Luisa F. Jimenez-Alvarez; Yuliana A. Cano-Medina; Sandra L. Valderrama-Beltran; Claudia M. Henao-Rodas; Maria A. Zuniga-Chavarria; Amani El-Kholy; Hala Agha; Suneeta Sahu; Shakti B. Mishra; Mahuya Bhattacharyya; Mohit Kharbanda; Aruna Poojary; Pravin K. Nair; Sheila N. Myatra; Rajesh Chawla; Kavita Sandhu; Yatin Mehta; Prasad Rajhans; Mohammad Abdellatif-Daboor; Tai Chian-Wern; Chin Seng Gan; Mat Nor Mohd-Basri; Guadalupe Aguirre-Avalos; Blanca E. Hernandez-Chena; Alejandro Sassoe-Gonzalez; Isabel Villegas-Mota; Mary C. Aleman- Bocanegra; Ider Bat-Erdene; Nilton Y. 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

doi:10.1016/j.ajic.2023.12.010

Decreasing central line-associated bloodstream infections rates in intensive care units in 30 low- and middle-income countries: An INICC approach

Victor D. Rosenthal
, Zhilin Jin
, Eric C. Brown
, Reshma Dongol
, Daisy A. De Moros
, Johana Alarcon-Rua
, Valentina Perez
, Juan P. Stagnaro
, Safaa Alkhawaja
, Luisa F. Jimenez-Alvarez
, Yuliana A. Cano-Medina
, Sandra L. Valderrama-Beltran
, Claudia M. Henao-Rodas
, Maria A. Zuniga-Chavarria
, Amani El-Kholy
, Hala Agha
, Suneeta Sahu
, Shakti B. Mishra
, Mahuya Bhattacharyya
, Mohit Kharbanda

Aruna Poojary, Pravin K. Nair, Sheila N. Myatra, Rajesh Chawla, Kavita Sandhu, Yatin Mehta, Prasad Rajhans, Mohammad Abdellatif-Daboor, Tai Chian-Wern, Chin Seng Gan, Mat Nor Mohd-Basri, Guadalupe Aguirre-Avalos, Blanca E. Hernandez-Chena, Alejandro Sassoe-Gonzalez, Isabel Villegas-Mota, Mary C. Aleman- Bocanegra, Ider Bat-Erdene, Nilton Y. 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

University of Miami Leonard M. Miller School of Medicine
INICC Foundation
Grande International Hospital
Hospital del Niño Dr. José Renán Esquivel
Santiago de Cali
Florida International University
Instituto Central de Medicina
Ministry of Health, Kingdom of Bahrain
Clínica Universitaria Colombia
Instituto del Corazón de Bucaramanga
Hospital Universitario San Ignacio
Fundacion Hospital San Jose De Buga
Hospital Clinica Biblica
Dar Alfouad Hospital
Cairo University
Apollo Hospitals Group
Siksha ‘O’ Anusandhan University
Advanced Medicare Research Institute Dhakuria Unit
Desun Hospital & Heart Institute Kolkata
Breach Candy Hospital
Holy Spirit Hospital
Tata Memorial Hospital
Apollo Hospital
Max Healthcare
Medanta (The Medicity)
Master Deenanath Mangeshkar Hospital
King Hussein Cancer Center
Universiti Kebangsaan Malaysia
University of Malaya
International Islamic University Malaysia
Hospital Civil de Guadalajara
Hospital General Regional 6 De Ciudad Madero
Hospital Regional de Alta Especialidad Ixtapaluca
Instituto Nacional de Perinatologia
Hospital San José De Monterrey Nuevo Leon
Intermed Hospital
Universidad Peruana de Ciencias Aplicadas
Seguro Social de Salud del Perú
Wrocław Military Hospital
Catholic University in Ruzomberok
Balcali Hospital Pediatric Intensive Care Unit
Ankara University
Akdeniz University
Pamukkale University
Osmangazi University
Sakarya University
Fudan University
Saudi Ministry of Health

Research output: Contribution to journal › Article › peer-review

9 Scopus citations

Abstract

Background: Central line (CL)-associated bloodstream infections (CLABSIs) occurring in the intensive care unit (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. 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.

Original language	English
Pages (from-to)	580-587
Number of pages	8
Journal	American Journal of Infection Control
Volume	52
Issue number	5
DOIs	https://doi.org/10.1016/j.ajic.2023.12.010
State	Published - May 2024
Externally published	Yes

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Antibiotic resistance
Developing countries
Device-associated infection
Health care–associated infection
Hospital infection
Limited resources countries
Low income countries
Network
Nosocomial infection

Access to Document

10.1016/j.ajic.2023.12.010

Cite this

Rosenthal, V. D., Jin, Z., Brown, E. C., Dongol, R., De Moros, D. A., Alarcon-Rua, J., Perez, V., Stagnaro, J. P., Alkhawaja, S., Jimenez-Alvarez, L. F., Cano-Medina, Y. A., Valderrama-Beltran, S. L., Henao-Rodas, C. M., Zuniga-Chavarria, M. A., El-Kholy, A., Agha, H., Sahu, S., Mishra, S. B., Bhattacharyya, M., ... Yin, R. (2024). Decreasing central line-associated bloodstream infections rates in intensive care units in 30 low- and middle-income countries: An INICC approach. American Journal of Infection Control, 52(5), 580-587. https://doi.org/10.1016/j.ajic.2023.12.010

@article{443f833e87204827ba87f4f31a1d9d0c,

title = "Decreasing central line-associated bloodstream infections rates in intensive care units in 30 low- and middle-income countries: An INICC approach",

abstract = "Background: Central line (CL)-associated bloodstream infections (CLABSIs) occurring in the intensive care unit (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. 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.",

keywords = "Antibiotic resistance, Developing countries, Device-associated infection, Health care–associated infection, Hospital infection, Limited resources countries, Low income countries, Network, Nosocomial infection",

author = "Rosenthal, \{Victor D.\} and Zhilin Jin and Brown, \{Eric C.\} and Reshma Dongol and \{De Moros\}, \{Daisy A.\} and Johana Alarcon-Rua and Valentina Perez and Stagnaro, \{Juan P.\} and Safaa Alkhawaja and Jimenez-Alvarez, \{Luisa F.\} and Cano-Medina, \{Yuliana A.\} and Valderrama-Beltran, \{Sandra L.\} and Henao-Rodas, \{Claudia M.\} and Zuniga-Chavarria, \{Maria A.\} and Amani El-Kholy and Hala Agha and Suneeta Sahu and Mishra, \{Shakti B.\} and Mahuya Bhattacharyya and Mohit Kharbanda and Aruna Poojary and Nair, \{Pravin K.\} and Myatra, \{Sheila N.\} and Rajesh Chawla and Kavita Sandhu and Yatin Mehta and Prasad Rajhans and Mohammad Abdellatif-Daboor and Tai Chian-Wern and Gan, \{Chin Seng\} and Mohd-Basri, \{Mat Nor\} and Guadalupe Aguirre-Avalos and Hernandez-Chena, \{Blanca E.\} and Alejandro Sassoe-Gonzalez and Isabel Villegas-Mota and \{Aleman- Bocanegra\}, \{Mary C.\} and Ider Bat-Erdene and Carreazo, \{Nilton Y.\} and Alex Castaneda-Sabogal and Jaros{\l}aw Janc and Sona Hlinkova and Dincer Yildizdas and Merve Havan and Alper Koker and Hulya Sungurtekin and Dinleyici, \{Ener C.\} and Ertugrul Guclu and Lili Tao and Memish, \{Ziad A.\} and Ruijie Yin",

year = "2024",

month = may,

doi = "10.1016/j.ajic.2023.12.010",

language = "English",

volume = "52",

pages = "580--587",

journal = "American Journal of Infection Control",

issn = "0196-6553",

publisher = "Elsevier Inc.",

number = "5",

}

Rosenthal, VD, Jin, Z, Brown, EC, Dongol, R, De Moros, DA, Alarcon-Rua, J, Perez, V, Stagnaro, JP, Alkhawaja, S, Jimenez-Alvarez, LF, Cano-Medina, YA, Valderrama-Beltran, SL, Henao-Rodas, CM, Zuniga-Chavarria, MA, El-Kholy, A, Agha, H, Sahu, S, Mishra, SB, Bhattacharyya, M, Kharbanda, M, Poojary, A, Nair, PK, Myatra, SN, Chawla, R, Sandhu, K, Mehta, Y, Rajhans, P, Abdellatif-Daboor, M, Chian-Wern, T, Gan, CS, Mohd-Basri, MN, Aguirre-Avalos, G, Hernandez-Chena, BE, Sassoe-Gonzalez, A, Villegas-Mota, I, Aleman- Bocanegra, MC, Bat-Erdene, I, Carreazo, NY, Castaneda-Sabogal, A, Janc, J, Hlinkova, S, Yildizdas, D, Havan, M, Koker, A, Sungurtekin, H, Dinleyici, EC, Guclu, E, Tao, L, Memish, ZA & Yin, R 2024, 'Decreasing central line-associated bloodstream infections rates in intensive care units in 30 low- and middle-income countries: An INICC approach', American Journal of Infection Control, vol. 52, no. 5, pp. 580-587. https://doi.org/10.1016/j.ajic.2023.12.010

TY - JOUR

T1 - Decreasing central line-associated bloodstream infections rates in intensive care units in 30 low- and middle-income countries

T2 - An INICC approach

AU - Rosenthal, Victor D.

AU - Jin, Zhilin

AU - Brown, Eric C.

AU - Dongol, Reshma

AU - De Moros, Daisy A.

AU - Alarcon-Rua, Johana

AU - Perez, Valentina

AU - Stagnaro, Juan P.

AU - Alkhawaja, Safaa

AU - Jimenez-Alvarez, Luisa F.

AU - Cano-Medina, Yuliana A.

AU - Valderrama-Beltran, Sandra L.

AU - Henao-Rodas, Claudia M.

AU - Zuniga-Chavarria, Maria A.

AU - El-Kholy, Amani

AU - Agha, Hala

AU - Sahu, Suneeta

AU - Mishra, Shakti B.

AU - Bhattacharyya, Mahuya

AU - Kharbanda, Mohit

AU - Poojary, Aruna

AU - Nair, Pravin K.

AU - Myatra, Sheila N.

AU - Chawla, Rajesh

AU - Sandhu, Kavita

AU - Mehta, Yatin

AU - Rajhans, Prasad

AU - Abdellatif-Daboor, Mohammad

AU - Chian-Wern, Tai

AU - Gan, Chin Seng

AU - Mohd-Basri, Mat Nor

AU - Aguirre-Avalos, Guadalupe

AU - Hernandez-Chena, Blanca E.

AU - Sassoe-Gonzalez, Alejandro

AU - Villegas-Mota, Isabel

AU - Aleman- Bocanegra, Mary C.

AU - Bat-Erdene, Ider

AU - Carreazo, Nilton Y.

AU - Castaneda-Sabogal, Alex

AU - Janc, Jarosław

AU - Hlinkova, Sona

AU - Yildizdas, Dincer

AU - Havan, Merve

AU - Koker, Alper

AU - Sungurtekin, Hulya

AU - Dinleyici, Ener C.

AU - Guclu, Ertugrul

AU - Tao, Lili

AU - Memish, Ziad A.

AU - Yin, Ruijie

PY - 2024/5

Y1 - 2024/5

N2 - Background: Central line (CL)-associated bloodstream infections (CLABSIs) occurring in the intensive care unit (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. 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.

AB - Background: Central line (CL)-associated bloodstream infections (CLABSIs) occurring in the intensive care unit (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. 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.

KW - Antibiotic resistance

KW - Developing countries

KW - Device-associated infection

KW - Health care–associated infection

KW - Hospital infection

KW - Limited resources countries

KW - Low income countries

KW - Network

KW - Nosocomial infection

UR - https://www.scopus.com/pages/publications/85184737909

UR - https://www.mendeley.com/catalogue/56a2fa3f-20fe-3d50-a89e-ad33eb1d99a7/

U2 - 10.1016/j.ajic.2023.12.010

DO - 10.1016/j.ajic.2023.12.010

M3 - Article

C2 - 38154739

AN - SCOPUS:85184737909

SN - 0196-6553

VL - 52

SP - 580

EP - 587

JO - American Journal of Infection Control

JF - American Journal of Infection Control

IS - 5

ER -

Decreasing central line-associated bloodstream infections rates in intensive care units in 30 low- and middle-income countries: An INICC approach

Abstract

UN SDGs

Keywords

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