Ondokuz Mayis University Medical School, Samsun, Turkey.
Ann Clin Microbiol Antimicrob. 2013 May 4;12:10. doi: 10.1186/1476-0711-12-10.
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.
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.
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.
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.
中心静脉导管相关血流感染（CLAB）与住院时间延长、医院成本增加以及与之相关的死亡率升高长期相关。来自发达国家的不同研究表明，实践捆绑可以降低重症监护病房（ICU）中 CLAB 的发生率。然而，捆绑策略对发展中国家（如土耳其）成人 ICU 中的影响尚未得到系统分析。本研究旨在分析国际医院感染控制联合会（INICC）多维感染控制方法对减少土耳其 8 个城市 13 家 INICC 成员医院 13 个 ICU 中 CLAB 发生率的影响。
我们进行了主动、前瞻性的前后对照研究，以确定 4017 名入住 ICU 的成人的 CLAB 发生率。我们应用了疾病预防控制中心/国家卫生系统网络（CDC/NHSN）和 INICC 监测方法的定义。该研究分为基线期和干预期。在基线期，进行了 CLAB 发生率的主动结局监测。在干预期，实施了 INICC 降低 CLAB 的多维方法，包括以下措施：1-感染控制干预措施捆绑，2-教育，3-结局监测，4-过程监测，5-CLAB 发生率反馈，以及 6-感染控制实践的绩效反馈。将基线期获得的 CLAB 率与干预期获得的 CLAB 率进行比较。
在基线期，我们记录了 3129 个中心静脉置管（CL）日，而在干预期，我们记录了 23463 个 CL 日。我们使用随机效应泊松回归来解释医院内 CLAB 率在时间上的聚类。基线 CLAB 率为 22.7/1000 CL 天，在干预期间下降至 12.0/1000 CL 天（IRR 0.613；95%CI 0.43-0.87；P<0.007）。这相当于 CLAB 发病率降低了 39%。
多维感染控制方法的实施与土耳其成人 ICU 中 CLAB 率的显著降低相关，因此应广泛实施。
