Rosenthal Victor D
International Nosocomial Infection Control Consortium, Buenos Aires, Argentina.
Am J Infect Control. 2008 Dec;36(10):S171.e7-12. doi: 10.1016/j.ajic.2008.10.009.
The rates of health care-associated infections (HAIs) and bacterial resistance in developing countries are 3 to 5 times higher than international standards. HAIs increase length of stay (10 days), costs (US $5000 to US $12,000), and mortality (by a factor of 2 to 3).
The International Nosocomial Infection Control Consortium (INICC), founded in 1998, is the only source of aggregated international data on the epidemiology of device-associated infections (DAIs). Its advisory board includes 12 representatives from developed countries, who help guide INICC's activities, and 8 country coordinators. The INICC network has about 5400 active researchers in 98 intensive care units (ICUs) in 18 countries on 4 continents that conduct infection control research and surveillance using standardized DAI surveillance definitions and methodologies.
Participating hospitals use the Centers for Disease Control and Prevention (CDC) surveillance method and DAI definitions. Unlike the CDC, the INICC collects data from patients with and without DAI and matches patients to evaluate risk factors, attributable mortality, length of stay, and costs and conducts process surveillance to measure and improve compliance with infection control guidelines.
INICC's surveillance at 98 ICUs in 18 limited resources countries on 4 continents for 10 years has significantly improved infection control guidelines compliance and reduced DAI rates and mortality rates. After 11 years of implementing process surveillance intervention in 77 ICUs of 34 cities of 14 countries, including observation of 88,661 opportunities for hand hygiene, education, performance monitoring, feedback, and peer support from high-level hospital administrators, hand-hygiene compliance among ICU healthcare workers increased from 35.1% to 60.7% (RR 1.73, P < 0.01). In 78 ICUs of 37 cities of 13 countries, by implementing outcome and process surveillance interventions, INICC reduced central line associated bloodstream infection (CLAB) rates from 16.1 to 10.1 CLABs per 1000 CL days (RR: 0.63, P < 0.01), ventilator associated pneumonia (VAP) from 22.5 to 18.6 VAPs per1000 device days (RR: 0.83, P < 0.01), and catheter associated urinary tract infections (CAUTI) rates from 8.2 to 6.9 CAUTIs per 1000 device days (RR: 0.85, P = 0.02).
Implementation of INICC outcome and process surveillance, education, monitoring and performance feedback methodologies increases compliance with hand hygiene and other infection-control interventions and reduces rates of DAIs.
发展中国家医疗保健相关感染（HAIs）和细菌耐药率比国际标准高3至5倍。医疗保健相关感染会延长住院时间（10天）、增加费用（5000美元至12000美元）并提高死亡率（2至3倍）。
国际医院感染控制协会（INICC）成立于1998年，是设备相关感染（DAIs）流行病学综合国际数据的唯一来源。其顾问委员会包括12名来自发达国家的代表，他们帮助指导INICC的活动，以及8名国家协调员。INICC网络在四大洲18个国家的98个重症监护病房（ICU）中有约5400名活跃研究人员，这些研究人员使用标准化的设备相关感染监测定义和方法进行感染控制研究和监测。
参与的医院使用美国疾病控制与预防中心（CDC）的监测方法和设备相关感染定义。与CDC不同，INICC收集有和没有设备相关感染患者的数据，并对患者进行匹配以评估风险因素、归因死亡率、住院时间和费用，并进行过程监测以衡量和提高对感染控制指南的依从性。
INICC在四大洲18个资源有限国家的98个重症监护病房进行了10年的监测，显著提高了对感染控制指南的依从性，并降低了设备相关感染率和死亡率。在14个国家34个城市的77个重症监护病房实施了11年的过程监测干预后，包括观察88661次手卫生机会、教育、绩效监测、反馈以及来自医院高层管理人员的同行支持，重症监护病房医护人员的手卫生依从性从35.1%提高到60.7%（相对危险度1.73，P<0.01）。在13个国家37个城市的78个重症监护病房，通过实施结果和过程监测干预，INICC将中心静脉导管相关血流感染（CLAB）率从每1000个中心静脉导管日16.1例降至10.1例（相对危险度：0.63，P<0.01），呼吸机相关性肺炎（VAP）从每1000个设备日22.5例降至18.6例（相对危险度：0.83，P<0.01），导尿管相关尿路感染（CAUTI）率从每1000个设备日8.2例降至6.9例（相对危险度：0.85，P=0.02）。
实施INICC的结果和过程监测、教育、监测和绩效反馈方法可提高对手卫生和其他感染控制干预措施的依从性，并降低设备相关感染率。
