Impact of Outcome and Process Surveillance on Central-Line Associated Bloodstream Infection Rates in 4 ICUs of Philippines: INICC Findings

Background: In 2002 we established the international nosocomial infection control consortium (INICC) in countries of the developing world and found that the CLABSI in the intensive care units (ICUs) of these countries’ hospitals are 3 to 5 times higher than rates in USA ICUs. INICC has focused efforts to reduce the incidence of device-associated healthcare-associated infection (DA-HAI) in these hospitals 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 device-associated infection—and performance feedback of each ICU's surveillance data to the healthcare personnel working in that unit.

 

Objective: We report the impact on CLABSI rates of process surveillance of measures to prevent CLABSI and outcome surveillance of CLABSI rates, in 4 ICUs (one coronary, one pediatric, one medical surgical, and one neurosurgical) in Philippines members of the INICC.

 

Methods: Process surveillance includes observation, monitoring and performance feedback of adherence to hand-hygiene, central line care—presence of sterile dressing in insertion site, good condition of the dressing, date marked on insertion site dressing, and on administration set—.

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

CLABSI rates were registered by applying the definitions of the CDC NHSN. Data collection was performed in the participating ICU, and data were uploaded and analyzed at the INICC headquarters. Pooled CLABSI 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 24 months (range 11 to 26 months) (intervention).

Results: During the baseline period, 234 ICU patients were enrolled, and 2,044 during the intervention period.

Patients’ characteristics were similar over the two periods (patient gender, P: 0.628; ASIS score, P: 0.296; angina pectoris, P: 0.3455; hepatic insufficiency, P: 0.0523; abdominal surgery, P: 0.0928; thoracic surgery, P: 0.0928; trauma, P: 0.4736; cancer, P: 0.1514; previous infection, P: 0.3852). Compliance with central line site care improved during the intervention period (presence of gauze in the CL insertion site, 86.9% vs. 98.8% [RR = 1.14, 95% CI = 1.02 - 1.26, P-value = 0.0178]). The rate of CLABSI per 1,000 central line days during the intervention period was significantly lower, 14.3 (5/351) vs 4.3 (13/3,033) CLABSI per 1000 central line days (RR, 0.30; 95% CI, 0.11-0.84; P: 0.0154).

Conclusions: Ongoing process surveillance and outcome surveillance were associated with a 70% reduction in the incidence of CLABSI rate.