title: Socioeconomic impact on device-associated infections in limited-resource neonatal intensive care units: findings of the INICC.
abstract: OBJECTIVE
  To evaluate the impact of country socioeconomic status and hospital type on device-associated healthcare-associated infections (DA-HAIs) in neonatal intensive care units (NICUs).
  
  
  METHODS
  Data were collected on DA-HAIs from September 2003 to February 2010 on 13,251 patients in 30 NICUs in 15 countries. DA-HAIs were defined using criteria formulated by the Centers for Disease Control and Prevention. Country socioeconomic status was defined using World Bank criteria.
  
  
  RESULTS
  Central-line-associated bloodstream infection (CLA-BSI) rates in NICU patients were significantly lower in private than academic hospitals (10.8 vs. 14.3 CLA-BSI per 1,000 catheter-days; p < 0.03), but not different in public and academic hospitals (14.6 vs. 14.3 CLA-BSI per 1,000 catheter-days; p = 0.86). NICU patient CLA-BSI rates were significantly higher in low-income countries than in lower-middle-income countries or upper-middle-income countries [37.0 vs. 11.9 (p < 0.02) vs. 17.6 (p < 0.05) CLA-BSIs per 1,000 catheter-days, respectively]. Ventilator-associated-pneumonia (VAP) rates in NICU patients were significantly higher in academic hospitals than in private or public hospitals [13.2 vs. 2.4 (p < 0.001) vs. 4.9 (p < 0.001) VAPs per 1,000 ventilator days, respectively]. Lower-middle-income countries had significantly higher VAP rates than low-income countries (11.8 vs. 3.8 per 1,000 ventilator-days; p < 0.001), but VAP rates were not different in low-income countries and upper-middle-income countries (3.8 vs. 6.7 per 1,000 ventilator-days; p = 0.57). When examined by hospital type, overall crude mortality for NICU patients without DA-HAIs was significantly higher in academic and public hospitals than in private hospitals (5.8 vs. 12.5%; p < 0.001). In contrast, NICU patient mortality among those with DA-HAIs was not different regardless of hospital type or country socioeconomic level.
  
  
  CONCLUSIONS
  Hospital type and country socioeconomic level influence DA-HAI rates and overall mortality in developing countries.
authors: International Nosocomial Infection Control Consortium, Corrientes Ave #4580, Buenos Aires, Argentina. victor_rosenthal@inicc.org
authors: V D
authors: VD
authors: Rosenthal
authors: P
authors: P
authors: Lynch
authors: W R
authors: WR
authors: Jarvis
authors: I A
authors: IA
authors: Khader
authors: R
authors: R
authors: Richtmann
authors: N B
authors: NB
authors: Jaballah
authors: C
authors: C
authors: Aygun
authors: W
authors: W
authors: Villamil-Gómez
authors: L
authors: L
authors: Dueñas
authors: T
authors: T
authors: Atencio-Espinoza
authors: J A
authors: JA
authors: Navoa-Ng
authors: M
authors: M
authors: Pawar
authors: M
authors: M
authors: Sobreyra-Oropeza
authors: A
authors: A
authors: Barkat
authors: N
authors: N
authors: Mejía
authors: C
authors: C
authors: Yuet-Meng
authors: A
authors: A
authors: Apisarnthanarak
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D003428:Cross Infection / Q000097:blood / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D003906:Developing Countries; D004866:Equipment Contamination; D016304:Hospitals, Private / Q000145:classification; D006779:Hospitals, Public / Q000145:classification; D006784:Hospitals, Teaching / Q000145:classification; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000401:mortality*; D011446:Prospective Studies; D012959:Socioeconomic Factors; D012122:Ventilators, Mechanical / Q000009:adverse effects / Q000382:microbiology