Impact of Outcome and Process Surveillance on Central-Line Associated Bloodstream Infection Rates in a New Born ICU of El Salvador: INICC Findings

Background: Central line-associated bloodstream infection (CLABSI) has been shown to pose a great threat to patient safety. Studies done in the industrialized countries have shown that a systematized institutional approach, which assures a very high level of compliance with essential infection control practices, has brought striking reductions in the incidence of CLABSI in patients within an intensive care unit (ICU).

In 2002 we established the international nosocomial infection control consortium (INICC) in developing countries and found that CLABSI rates in the ICUs of these countries’ hospitals are 3 to 5 times higher than rates in US ICUs. We have focused our efforts to reduce the incidence of device-associated infection in these hospitals on education and outcome surveillance—rates of device-associated infection—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 a Neonatal ICU (NICU) of El Salvador, member of the INICC.

 

Methods: Process surveillance includes observation, monitoring and performance feedback of adherence to hand-hygiene guidelines, central line care, such as presence of sterile dressing in insertion site, good condition of the dressing, and 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 were collected in the participating NICU, and uploaded and analyzed at the INICC headquarters.

Pooled CLABSI rates within the NICU during the first 8 months (baseline) of participation in INICC were compared with the rates at the subsequent intervention period during the following 21 months (intervention).

 

Results: During the baseline period, 467 NICU patients were enrolled, and 803 during the intervention period. Patients’ characteristics were similar over the two periods (gestational age, P: 0.273, age of mother, P: 0.693). The rate of CLABSI per 1,000 catheter days during the intervention period was significantly lower than during the baseline period, 12.5 (22/1,258) vs 8.98 (90/5,487) CLABSI per 1000 central line days (RR, 0.72; 95% CI, 0.52-1.00; P: 0.0458).

Conclusions: Ongoing process surveillance together with outcome surveillance of CLABSI rates were associated with a 28% reduction in the incidence of CLABSI rate.