Comparison of US and non-US central venous catheter infection rates: evaluation of processes and indicators in infection control study.
OBJECTIVE
We sought to identify the presence or absence of international variation in central venous catheter-associated bloodstream infection (BSI) rates and to examine associated infection control practices that might underlie the differences.


METHODS
The Evaluation of Processes and Indicators in Infection Control (EPIC) study was conducted as a prospective surveillance study.


METHODS
The study took place in intensive care units (ICUs) from 14 countries, which were from the Asian Pacific (3), Europe (7), Middle East (2), and South America (2), in addition to 41 US hospitals.


METHODS
We compared the National Nosocomial Infections Surveillance catheter-associated BSI rate between the non-US and US units. We also compared the following organization factors between the 2 groups: hospital factors (ownership, average daily census of patients); ICU type (medical vs surgical); number of beds; and infection control-related factors (number of staff, number of hours spent on study ICU surveillance, years of experience, number of inservice sessions on line infection, number of blood cultures drawn/1000 patients).


RESULTS
We found no significant difference in catheter-associated BSI rates between non-US and US hospitals (5.02 +/- 0.75 vs 3.82 +/- 0.42/1000 days, respectively; P =.27). Non-US hospitals were more likely to be government-owned (10/14 vs 7/41;P <.001) and to have larger daily patient census (795 +/- 84 vs 276 +/- 47 patients; P <.001). There was no difference in ICU type or number of beds. Infection control committees were present in all US and non-US hospitals. No significant differences were found in the number of staff involved in surveillance in the study ICU, years of experience, hours spent on surveillance, or the provision of inservices on line care. The use of barriers during line insertion also did not differ.


CONCLUSIONS
Catheter-associated BSIs in patients in the ICU were not significantly different between non-US and US hospitals. All hospitals had infection control committees, and there were no significant differences in time spent and numbers of persons involved in ICU surveillance activities. These findings suggest that many aspects of the standards of care do not differ between the 2 groups.
Memish
Ziad A
ZA
King Abdulaziz Medical City, King Fahad National Guard Hospital, PO Box 22490, Riyadh 11426, Saudi Arabia.
Arabi
Yaseen
Y
Cunningham
Gwen
G
Kritchevsky
Stephen
S
Braun
Barbara
B
Richards
Cheryl
C
Weber
Stefan
S
Pereira
Crèsio Romeu
CR
D001208:Asia / Q000453:epidemiology; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000706:statistics & numerical data; D002408:Catheters, Indwelling / Q000382:microbiology*; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology; D005060:Europe / Q000453:epidemiology; D006801:Humans; D017053:Infection Control / Q000592:standards; D007362:Intensive Care Units / Q000592:standards / Q000706:statistics & numerical data; D008877:Middle East / Q000453:epidemiology; D013020:South America / Q000453:epidemiology; D018709:Statistics, Nonparametric; D014481:United States / Q000453:epidemiology