Medical College of Buenos Aires, Argentina.
Infect Control Hosp Epidemiol. 2010 Dec;31(12):1264-72. doi: 10.1086/657140. Epub 2010 Oct 28.
The International Nosocomial Infection Control Consortium (INICC) was established in 15 developing countries to reduce infection rates in resource-limited hospitals by focusing on education and feedback of outcome surveillance (infection rates) and process surveillance (adherence to infection control measures). We report a time-sequence analysis of the effectiveness of this approach in reducing rates of central line-associated bloodstream infection (CLABSI) and associated deaths in 86 intensive care units with a minimum of 6-month INICC membership.
Pooled CLABSI rates during the first 3 months (baseline) were compared with rates at 6-month intervals during the first 24 months in 53,719 patients (190,905 central line-days). Process surveillance results at baseline were compared with intervention period data.
During the first 6 months, CLABSI incidence decreased by 33% (from 14.5 to 9.7 CLABSIs per 1,000 central line-days). Over the first 24 months there was a cumulative reduction from baseline of 54% (from 16.0 to 7.4 CLABSIs per 1,000 central line-days; relative risk, 0.46 [95% confidence interval, 0.33-0.63]; P < .001). The number of deaths in patients with CLABSI decreased by 58%. During the intervention period, hand hygiene adherence improved from 50% to 60% (P < .001); the percentage of intensive care units that used maximal sterile barriers at insertion increased from 45% to 85% (P < .001), that adopted chlorhexidine for antisepsis increased from 7% to 27% (P < .001), and that sought to remove unneeded catheters increased from 37% to 83% (P < .001); and the duration of central line placement decreased from 4.1 to 3.5 days (P < .001).
Education, performance feedback, and outcome and process surveillance of CLABSI rates significantly improved infection control adherence, reducing the CLABSI incidence by 54% and the number of CLABSI-associated deaths by 58% in INICC hospitals during the first 2 years.
国际医院感染控制联盟（INICC）成立于 15 个发展中国家，旨在通过教育和反馈结果监测（感染率）和过程监测（感染控制措施的遵守情况）来降低资源有限医院的感染率。我们报告了在至少有 6 个月 INICC 会员资格的 86 个重症监护病房中，采用这种方法降低中心静脉导管相关血流感染（CLABSI）率和相关死亡率的时间序列分析结果。
将 53719 名患者（190905 个中心静脉导管日）前 3 个月（基线）的 CLABSI 率与前 24 个月每 6 个月的率进行比较。将基线时的过程监测结果与干预期数据进行比较。
在前 6 个月，CLABSI 的发病率下降了 33%（从每 1000 个中心静脉导管日 14.5 例降至 9.7 例）。在前 24 个月，从基线开始累积减少了 54%（从每 1000 个中心静脉导管日 16.0 例降至 7.4 例；相对风险，0.46 [95%置信区间，0.33-0.63]；P <.001）。CLABSI 患者的死亡人数减少了 58%。在干预期间，手卫生依从性从 50%提高到 60%（P <.001）；使用最大无菌屏障进行插入的重症监护病房百分比从 45%增加到 85%（P <.001），采用洗必泰进行消毒的比例从 7%增加到 27%（P <.001），试图去除不必要的导管的比例从 37%增加到 83%（P <.001）；中心静脉导管留置时间从 4.1 天减少到 3.5 天（P <.001）。
通过对 CLABSI 率进行教育、绩效反馈以及结果和过程监测，显著提高了感染控制的依从性，使 INICC 医院在头 2 年内 CLABSI 的发病率降低了 54%，CLABSI 相关死亡人数减少了 58%。
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