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461 International Nosocomial Infection Control Consortium report, data summary for 2003-2008: Impact of the country socio economic level and type of hospital on CLABSI rates in Adult and Pediatric ICUs of 25 limited resources countries

Saturday, March 20, 2010
Grand Hall (Hyatt Regency Atlanta)
Victor D. Rosenthal , INICC, Buenos Aires, Argentina
Altaf Ahmed , Liaquat National Hospital, Karachi, Pakistan
Silom Jamulitra , Songklanagarind Hospital, Songkla, Thailand
Eduardo A. Medeiros , Hospital São Paulo, São Paulo, Brazil
Ajita Mehta , PD Hinduja National Hospital & Medical Research Centre, Mumbai, India
Carlos Álvarez Moreno , Hospital Universitario San Ignacio, Universidad Pontificia Javeriana, Bogotá, Colombia
Hakan Leblebicioglu , Ondokuz Mayis University Medical School, Samsun, Turkey
Ilham Abu Khader , Jordan University Hospital, Amman, Jordan
Martha Sobreyra Oropeza , Hospital de la Mujer, Mexico City, Mexico
Josephine Anne Navoa-Ng, MD , St. Luke's Medical Center, Quezon City, Philippines
Luis Cuellar , Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru
Rédouane Abouqal , Ibn Sina, Rabat, Morocco
Humberto Guanche Garcell , Hospital Docente Clínico Quirúrgico "Joaquín Albarrán Domínguez", Havana, Cuba
Lourdes Dueñas , Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
Zan Mitrev , Filip II Special Cardiosurgery Hospital, Skopje, Macedonia
Bijie Hu, MD, PHD , Zhongshan Hospital of Fudan University, Shanghai, China
Vaidotas Gurskis , Kaunas University of Medicine, Children Clinic, Kaunas, Lithuania
SS Kanj , American University of Beirut Medical Center, Beirut, Lebanon
Trudell Mapp , Clínica Hospital San Fernando, Panama, Panama
Rosalía Fernández Hidalgo , Hospital Clínica Bíblica, San Jose, Costa Rica
Nejla Ben Jaballah , Hôpital d'Enfants, Tunis, Tunisia
Lul Raka , National Institute for Public Health of Kosova and Medical School, Prishtina University, Prishtina, Serbia and Montenegro
Le Thi Anh Thu , Cho Ray Hospital, Ho Chi Minh City, Vietnam
Achilleas Gikas , University Hospital of Heraklion, Heraklion, Greece
María Eugenia Guzmán Siritt , Hospital Militar Dr. Carlos Arvelo, Caracas, Venezuela
Background: Central line associated blood stream infections (CLABSI) rates in limited resources countries are significantly higher than international standards of developed countries; but is it not known if limited resources countries’ socio economic level and the hospital type are associated with a different CLABSI rate.

Objective: To determine if CLABSI rates in 154 intensive care units (ICUs) of 25 limited resources countries are significantly affected by the country socio-economic level (Low Income; Middle Low Income, and Middle High Income) and by the hospital type (Academic, Public or Private).

Methods: An open label, prospective cohort, active DAI surveillance study was conducted on adult and pediatric patients admitted to 154 tertiary-care ICUs of 25 low, middle low, and middle high income countries: Argentina, Brazil, China, Colombia, Costa Rica, Cuba, Greece, India, Jordan, Kosovo, Lebanon, Lithuania, Macedonia, Mexico, Morocco, Pakistan, Panama, Peru, Philippines, Salvador, Thailand, Tunisia, Turkey, Venezuela and Vietnam.

The protocol and methodology were developed by INICC. Data collection was performed in the participating ICU. Data uploading and analysis were conducted at INICC headquarters. Rates of DAI were recorded through applying the definitions of the CDC NNIS/NHSN system.  Epi Info 6.04b and SPSS 16.0 were used for epidemiological and statistical data analysis.

We analyzed the DAI (mechanical ventilator-associated pneumonia [VAP], central line associated bloodstream infection [CLAB], and catheter-associated urinary tract infection [CAUTI]) rates by socio-economic level according to the World Bank categorization (Low income; middle low income, and middle high income) and by hospital type (Public, Academic, and Private) and compared the results calculating device associated rates per 1000 devices, and 95% confidence intervals.

Results: From January 2003 to December 2008, at this study 236,980 patients were enrolled from 25 limited resources countries.

DAIs rates were calculated stratified by socio economic level of the country and hospital type.

Overall CLABSI rate in low income countries was 19.1 CLABSIs per 1000 CL days (95% CI, 18.05-20.1); in middle-low income countries was 7.0 (95% CI, 6.5-7.5); and in middle-high income countries was 7.6 (95% CI, 7.3-7.8).

Overall CLABSI rate at academic hospitals was 10 CLABSIs per 1000 CL days (95% CI, 9.6-10.3); at public hospitals was 9.2 (95% CI, 8.6-9.9); and at private hospitals was 5.8 (95% CI, 5.4-6.3).

Conclusions: Low income countries have significantly higher CLABSI rate than middle income countries. Private hospitals have a CLABSI rate significantly lower than public or academic hospitals. Country income and hospital type are associated with the DAIs rates of limited resources countries.