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Background: The International Nosocomial Infection Control Consortium (INICC) is a non-profit healthcare-associated infection (HAI) control program with a surveillance system based on that of the US NHSN. INICC is a research network set up to control and reduce device-associated healthcare-associated infections (DA-HAI) by analyzing data collected voluntarily by hospitals worldwide.
Objective: To determine DA-HAI rate, length of stay (LOS) and mortality rates in 245 intensive care units (ICUs) of 164 hospitals of INICC from Argentina, Brazil, Bulgaria, China, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, Egypt, El Salvador, Greece, India, Jordan, Kosovo, Lebanon, Lithuania, Macedonia, Malaysia, Mexico, Morocco, Pakistan, Panama, Peru, Philippines, Puerto Rico, Saudi Arabia, Singapore, Sri Lanka, Sudan, Thailand, Tunisia, Turkey, Uruguay, Venezuela and Vietnam.
Methods: A prospective cohort, active DA-HAI surveillance study was conducted in patients admitted to ICUs from January 2004 to December 2009, by applying the INICC methodology. DA-HAI rates were recorded using the definitions of the CDC NHSN. Data were collected in the ICUs, and uploaded and analyzed at the INICC headquarters.
Results: During 6 years 243,143 patients hospitalized in an ICU for 1,597,886 days acquired 18,535 DA-HAIs, an overall rate of 11.6 infections per 1,000 ICU-days.
Ventilator-associated pneumonia posed the greatest risk (14.1 per 1000 ventilator-days in Adult ICUs (AICUs); 6.0 in Pediatric ICUs (PICU); 9.7 in Neonatal ICUs (NICUs), followed by central line-associated bloodstream infections (7.7 per 1000 catheter-days in AICUs; 8.0 in PICU; 12.3 in NICUs) and catheter-associated urinary tract infections (6.1 per 1000 catheter-days in AICUs; 4.3 in PICU).
In AICUs and PICUs, the LOS of patients without DA-HAI was 5.0 days; with CLABSI was 16.3 days; with VAP was 15.5 days; with CAUTI was 14.7 days.
In the NICUs, the LOS of patients without DA-HAI was 10.6 days; with CLABSI was 29.1 days; with VAP was 33.7 days.
In AICUs and PICUs, 13.3% of patients without DA-HAI died; 27.7% with CLABSI died; 40.7% with VAP died; and 15.9% with CAUTI died.
In NICUs, 8.5% of patients without DA-HAI died; 34.6% with CLABSI died; 23.7% with VAP died.
Conclusions: DA-HAIs in the ICUs of developing countries pose serious threats to patient safety. Active infection control programs that include surveillance and prevention guidelines can improve patient safety and must become a priority.
DAI rates by ICU type:
ICU type | Patients (n) | CL-BSI rate | VAP rate | CAUTI rate |
Burn | 191 | 0.0 | 22.2 | 5.0 |
Coronary | 19,516 | 6.6 | 10.5 | 3.5 |
Cardio-surgical | 11,591 | 1.1 | 7.7 | 2.5 |
Medical | 28,261 | 12.8 | 7.4 | 6.3 |
Medical-surgical | 91,138 | 7.8 | 15.9 | 6.1 |
New Born | 17,397 | 12.3 | 9.7 | 3.0 |
Neurosurgical | 5,867 | 15.0 | 25.2 | 14.0 |
Pediatric | 25,550 | 8.0 | 6.0 | 4.3 |
Respiratory | 762 | 17.7 | 44.9 | 14.5 |
Surgical | 39,514 | 5.4 | 12.2 | 5.1 |
Trauma | 3,101 | 2.8 | 39.7 | 6.5 |
Ward | 255 | 0.0 | 0.0 | 0.0 |
Overall | 243,143 | 8.0 | 12.8 | 6.0 |