title: Socioeconomic impact on device-associated infections in pediatric intensive care units of 16 limited-resource countries: international Nosocomial Infection Control Consortium findings.
abstract: OBJECTIVE
  We report the results of the International Nosocomial Infection Control Consortium prospective surveillance study from January 2004 to December 2009 in 33 pediatric intensive care units of 16 countries and the impact of being in a private vs. public hospital and the income country level on device-associated health care-associated infection rates. Additionally, we aim to compare these findings with the results of the Centers for Disease Control and Prevention National Healthcare Safety Network annual report to show the differences between developed and developing countries regarding device-associated health care-associated infection rates.
  
  
  METHODS
  A prospective cohort, active device-associated health care-associated infection surveillance study was conducted on 23,700 patients in International Nosocomial Infection Control Consortium pediatric intensive care units.
  
  
  METHODS
  The protocol and methodology implemented were developed by International Nosocomial Infection Control Consortium. Data collection was performed in the participating intensive care units. Data uploading and analyses were conducted at International Nosocomial Infection Control Consortium headquarters on proprietary software. Device-associated health care-associated infection rates were recorded by applying Centers for Disease Control and Prevention National Healthcare Safety Network device-associated infection definitions, and the impact of being in a private vs. public hospital and the income country level on device-associated infection risk was evaluated.
  
  
  METHODS
  None.
  
  
  RESULTS
  Central line-associated bloodstream infection rates were similar in private, public, or academic hospitals (7.3 vs. 8.4 central line-associated bloodstream infection per 1,000 catheter-days [p < .35 vs. 8.2; p < .42]). Central line-associated bloodstream infection rates in lower middle-income countries were higher than low-income countries or upper middle-income countries (12.2 vs. 5.5 central line-associated bloodstream infections per 1,000 catheter-days [p < .02 vs. 7.0; p < .001]). Catheter-associated urinary tract infection rates were similar in academic, public and private hospitals: (4.2 vs. 5.2 catheter-associated urinary tract infection per 1,000 catheter-days [p = .41 vs. 3.0; p = .195]). Catheter-associated urinary tract infection rates were higher in lower middle-income countries than low-income countries or upper middle-income countries (5.9 vs. 0.6 catheter-associated urinary tract infection per 1,000 catheter-days [p < .004 vs. 3.7; p < .01]). Ventilator-associated pneumonia rates in academic hospitals were higher than private or public hospitals: (8.3 vs. 3.5 ventilator-associated pneumonias per 1,000 ventilator-days [p < .001 vs. 4.7; p < .001]). Lower middle-income countries had higher ventilator-associated pneumonia rates than low-income countries or upper middle-income countries: (9.0 vs. 0.5 per 1,000 ventilator-days [p < .001 vs. 5.4; p < .001]). Hand hygiene compliance rates were higher in public than academic or private hospitals (65.2% vs. 54.8% [p < .001 vs. 13.3%; p < .01]).
  
  
  CONCLUSIONS
  Country socioeconomic level influence device-associated infection rates in developing countries and need to be considered when comparing device-associated infections from one country to another.
authors.affiliation: International Nosocomial Infection Control Consortium, Buenos Aires, Argentina. victor_rosenthal@inicc.org
authors.forename: Victor D
authors.initials: VD
authors.lastname: Rosenthal
authors.forename: William R
authors.initials: WR
authors.lastname: Jarvis
authors.forename: Silom
authors.initials: S
authors.lastname: Jamulitrat
authors.forename: Cristiane Pavanello Rodrigues
authors.initials: CP
authors.lastname: Silva
authors.forename: Bala
authors.initials: B
authors.lastname: Ramachandran
authors.forename: Lourdes
authors.initials: L
authors.lastname: Dueñas
authors.forename: Vaidotas
authors.initials: V
authors.lastname: Gurskis
authors.forename: Gulden
authors.initials: G
authors.lastname: Ersoz
authors.forename: María Guadalupe Miranda
authors.initials: MG
authors.lastname: Novales
authors.forename: Ilham Abu
authors.initials: IA
authors.lastname: Khader
authors.forename: Khaldi
authors.initials: K
authors.lastname: Ammar
authors.forename: Nayide Barahona
authors.initials: NB
authors.lastname: Guzmán
authors.forename: Josephine Anne
authors.initials: JA
authors.lastname: Navoa-Ng
authors.forename: Zeinab Salah
authors.initials: ZS
authors.lastname: Seliem
authors.forename: Teodora Atencio
authors.initials: TA
authors.lastname: Espinoza
authors.forename: Cheong Yuet
authors.initials: CY
authors.lastname: Meng
authors.forename: Kushlani
authors.initials: K
authors.lastname: Jayatilleke
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology*; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology; D003906:Developing Countries; D019983:Guideline Adherence; D006235:Hand Disinfection; D006801:Humans; D015278:Intensive Care Units, Pediatric; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology*; D011446:Prospective Studies; D012923:Social Class