Impact of a multidimensional infection control approach on central line-associated bloodstream infections rates in adult intensive care units of 8 cities of Turkey: findings of the International Nosocomial Infection Control Consortium (INICC)
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  • 作者：Hakan Leblebicioglu (1)
    Recep ?ztürk (2)
    Victor Daniel Rosenthal (3)
    ?zay Ar?kan Akan (4)
    Fatma Sirmatel (5)
    Davut Ozdemir (6)
    Cengiz Uzun (7)
    Huseyin Turgut (8)
    Gulden Ersoz (9)
    Iftíhar Koksal (10)
    Asu ?zgültekin (11)
    Saban Esen (1)
    Fatma Ulger (1)
    Ahmet Dilek (1)
    Hava Yilmaz (1)
    Yalim Dikmen (2)
    G?khan Aygún (2)
    Melek Tulunay (4)
    Mehmet Oral (4)
    Necmettin ünal (4)
    Mustafa Cengiz (5)
    Leyla Yilmaz (5)
    Mehmet Faruk Geyik (6)
    Ahmet ?ahin (6)
    Selvi Erdogan (6)
    Suzan Sacar (8)
    Hülya Sungurtekin (8)
    Do?a? U?urcan (8)
    Ali Kaya (9)
    Necdet Kuyucu (9)
    Gürdal Yylmaz (10)
    Sel?uk Kaya (10)
    Hülya Ulusoy (10)
    Asuman ?nan (11)
  • 关键词：Catheter related infections ; Central line ; associated bloodstream infection ; Device ; associated infections ; Healthcare ; associated infections ; Bundle ; International nosocomial infection control consortium ; Multidimensional approach ; Hand hygiene ; Developing countries ; Limited ; resource countries
  • 刊名：Annals of Clinical Microbiology and Antimicrobials
  • 出版年：2013
  • 出版时间：December 2013
  • 年：2013
  • 卷：12
  • 期：1
  • 全文大小：234KB
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  • 作者单位：Hakan Leblebicioglu (1)
    Recep ?ztürk (2)
    Victor Daniel Rosenthal (3)
    ?zay Ar?kan Akan (4)
    Fatma Sirmatel (5)
    Davut Ozdemir (6)
    Cengiz Uzun (7)
    Huseyin Turgut (8)
    Gulden Ersoz (9)
    Iftíhar Koksal (10)
    Asu ?zgültekin (11)
    Saban Esen (1)
    Fatma Ulger (1)
    Ahmet Dilek (1)
    Hava Yilmaz (1)
    Yalim Dikmen (2)
    G?khan Aygún (2)
    Melek Tulunay (4)
    Mehmet Oral (4)
    Necmettin ünal (4)
    Mustafa Cengiz (5)
    Leyla Yilmaz (5)
    Mehmet Faruk Geyik (6)
    Ahmet ?ahin (6)
    Selvi Erdogan (6)
    Suzan Sacar (8)
    Hülya Sungurtekin (8)
    Do?a? U?urcan (8)
    Ali Kaya (9)
    Necdet Kuyucu (9)
    Gürdal Yylmaz (10)
    Sel?uk Kaya (10)
    Hülya Ulusoy (10)
    Asuman ?nan (11)

    1. Ondokuz Mayis University Medical School, Samsun, Turkey
    2. Istanbul University Cerrahpasa Medical School, Istanbul, Turkey
    3. International Nosocomial Infection Control Consortium, Buenos Aires, Argentina
    4. Ankara University School of Medicine Ibni-Sina Hospital, Ankara, Turkey
    5. Faculty of Medicine, Harran University, Sanliurfa, Turkey
    6. Duzce University Medical School Infectious Diseases and Clinical Microbiology, Duzce, Turkey
    7. German Hospital, Istanbul, Turkey
    8. Pamukkale University, Denizli, Turkey
    9. Faculty of Medicine, Mersin University, Mersin, Turkey
    10. Karadeniz Technical University School of Medicine, Trabzon, Turkey
    11. Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
  • ISSN：1476-0711
文摘
Background Central line-associated bloodstream infections (CLABs) have long been associated with excess lengths of stay, increased hospital costs and mortality attributable to them. Different studies from developed countries have shown that practice bundles reduce the incidence of CLAB in intensive care units. However, the impact of the bundle strategy has not been systematically analyzed in the adult intensive care unit (ICU) setting in developing countries, such as Turkey. The aim of this study is to analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach to reduce the rates of CLAB in 13 ICUs of 13 INICC member hospitals from 8 cities of Turkey. Methods We conducted active, prospective surveillance before-after study to determine CLAB rates in a cohort of 4,017 adults hospitalized in ICUs. We applied the definitions of the CDC/NHSN and INICC surveillance methods. The study was divided into baseline and intervention periods. During baseline, active outcome surveillance of CLAB rates was performed. During intervention, the INICC multidimensional approach for CLAB reduction was implemented and included the following measures: 1- bundle of infection control interventions, 2- education, 3- outcome surveillance, 4- process surveillance, 5- feedback of CLAB rates, and 6- performance feedback on infection control practices. CLAB rates obtained in baseline were compared with CLAB rates obtained during intervention. Results During baseline, 3,129 central line (CL) days were recorded, and during intervention, we recorded 23,463 CL-days. We used random effects Poisson regression to account for clustering of CLAB rates within hospital across time periods. The baseline CLAB rate was 22.7 per 1000 CL days, which was decreased during the intervention period to 12.0 CLABs per 1000 CL days (IRR 0.613; 95% CI 0.43 -0.87; P 0.007). This amounted to a 39% reduction in the incidence rate of CLAB. Conclusions The implementation of multidimensional infection control approach was associated with a significant reduction in the CLAB rates in adult ICUs of Turkey, and thus should be widely implemented.

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