198 Impact of Outcome and Process Surveillance on Hand Hygiene and Device Associated Infection Rates in an ICU of Lebanon: INICC Findings

Saturday, April 2, 2011
Trinity Ballroom (Hilton Anatole)
SS Kanj , American University of Beirut Medical Center, Beirut, Lebanon
Nada Zahreddine , American University of Beirut Medical Center, Beirut, Lebanon
Victor D. Rosenthal, MD , International Nosocomial Infection Control Consortium, Buenos Aires, Argentina
Lamia Alamuddin , American University of Beirut Medical Center, Beirut, Lebanon
Nisrine Sidani , American University of Beirut Medical Center, Beirut, Lebanon
Zeina Kanafani , American University of Beirut Medical Center, Beirut, Lebanon
Background: Healthcare–associated infections from invasive medical devices in the intensive care unit (ICU)—central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infection (CAUTI)—have been shown to pose the greatest threat to patient safety.

In 2002 we established the international nosocomial infection control consortium (INICC) in countries of the developing world and found that rates of device-associated healthcare-associated infections (DA-HAI) in the ICUs of these countries’ hospitals are 3 to 5 times higher than rates in US ICUs.

Our efforts to reduce the incidence of DA-HAIs in these hospitals were focused on education and outcome surveillance—rates of DA-HAI—and process surveillance—compliance with hand hygiene and other basic infection control practices shown to reduce the incidence of DA-HAI—and performance feedback of each ICU's surveillance data to the healthcare personnel working in that unit.


Objective: We report the impact on DA-HAI rates of process surveillance and outcome surveillance of DA-HAI rates, in a Medical Surgical ICU in Lebanon, member of the INICC.

Methods: Process surveillance includes observation, monitoring and performance feedback of adherence to hand-hygiene guidelines.

Outcome surveillance includes measurement of patients’ characteristics, central line days, CLABSIs, length of stay, costs, mortality, microorganism profile and bacterial resistance.

DA-HAI rates were registered by applying the definitions of the CDC NHSN. Data were collected in the participating ICU, and uploaded and analyzed at the INICC headquarters.

Pooled rates of HH compliance and DA-HAI rates within the ICU during the first 3 months (baseline) of participation in INICC were compared with the rates at the subsequent intervention period during the following 25 months (intervention).


Results: HH compliance improved from baseline to intervention period (61% vs 88%; P: 0.01).

During the baseline period, 40 ICU patients were enrolled, and 637 during the intervention period.

Patients’ characteristics were similar over the two periods (patient gender, P: 0.75; patient age, P: 0.06; abdominal surgery, P: 0.72; cancer, P: 0.56).

The DAI rate per 1,000 bed days during the intervention period was significantly lower than during the baseline period, 20.3 (9/444) vs 10.1 (52/5,147) (RR, 0.50; 95% CI, 0.25-1.01; P: 0.04).

The rate of DA-HAI per 100 patients was also significantly lower: 22.5% (9/40) vs. 8.2% (52/637) (RR, 0.36; 95% CI, 0.18 – 0.74, P: 0.003).

Conclusions: Ongoing process surveillance of HH, together with outcome surveillance of DA-HAI rates, significantly improved compliance with HH, and were associated with a 50% reduction in the incidence of DA-HAI rate.