Device-associated nosocomial infections in limited-resources countries: findings of the International Nosocomial Infection Control Consortium (INICC).
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).


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Rosenthal
Victor D
VD
International Nosocomial Infection Control Consortium, Buenos Aires, Argentina. victor_rosenthal@inicc.org
D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D003906:Developing Countries / Q000706:statistics & numerical data*; D024881:Drug Resistance, Bacterial; D004866:Equipment Contamination / Q000706:statistics & numerical data*; D019983:Guideline Adherence; D006295:Health Resources / Q000191:economics*; D006801:Humans; D017053:Infection Control / Q000592:standards*; D007362:Intensive Care Units / Q000592:standards / Q000706:statistics & numerical data*; D007902:Length of Stay; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000517:prevention & control; D012307:Risk Factors; D018571:Sentinel Surveillance; D014546:Urinary Catheterization / Q000009:adverse effects; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D012122:Ventilators, Mechanical / Q000009:adverse effects / Q000382:microbiology