title: Findings of the International Nosocomial Infection Control Consortium (INICC), part III: effectiveness of a multidimensional infection control approach to reduce central line-associated bloodstream infections in the neonatal intensive care units of 4 developing countries.
abstract: OBJECTIVE
  To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach to reduce central line-associated bloodstream infection (CLABSI) rates.
  
  
  METHODS
  Four neonatal intensive care units (NICUs) of INICC member hospitals from El Salvador, Mexico, Philippines, and Tunisia.
  
  
  METHODS
  A total of 2,241 patients hospitalized in 4 NICUs for 40,045 bed-days.
  
  
  METHODS
  We conducted a before-after prospective surveillance study. During Phase 1 we performed active surveillance, and during phase 2 the INICC multidimensional infection control approach was implemented, including the following practices: (1) central line care bundle, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of CLABSI rates, and (6) performance feedback of infection control practices. We compared CLABSI rates obtained during the 2 phases. We calculated crude stratified rates, and, using random-effects Poisson regression to allow for clustering by ICU, we calculated the incidence rate ratio (IRR) for each follow-up time period compared with the 3-month baseline.
  
  
  RESULTS
  During phase 1 we recorded 2,105 CL-days, and during phase 2 we recorded 17,117 CL-days. After implementation of the multidimensional approach, the CLABSI rate decreased by 55%, from 21.4 per 1,000 CL-days during phase 1 to 9.7 per 1,000 CL-days during phase 2 (rate ratio, 0.45 [95% confidence interval, 0.33-0.63]). The IRR was 0.53 during the 4-12-month period and 0.07 during the final period of the study (more than 45 months).
  
  
  CONCLUSIONS
  Implementation of a multidimensional infection control approach was associated with a significant reduction in CLABSI rates in NICUs.
authors: International Nosocomial Infection Control Consortium, Buenos Aires, Argentina. victor_rosenthal@inicc.org
authors: Victor Daniel
authors: VD
authors: Rosenthal
authors: Lourdes
authors: L
authors: Dueñas
authors: Martha
authors: M
authors: Sobreyra-Oropeza
authors: Khaldi
authors: K
authors: Ammar
authors: Josephine Anne
authors: JA
authors: Navoa-Ng
authors: Ana Concepción Bran
authors: AC
authors: de Casares
authors: Lilian
authors: L
authors: de Jesús Machuca
authors: Nejla
authors: N
authors: Ben-Jaballah
authors: Asma
authors: A
authors: Hamdi
authors: Victoria D
authors: VD
authors: Villanueva
authors: María Corazon V
authors: MC
authors: Tolentino
mesh_terms: D062905:Central Venous Catheters / Q000009:adverse effects*; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D003906:Developing Countries / Q000706:statistics & numerical data*; D004544:El Salvador / Q000453:epidemiology; D005246:Feedback; D063373:Hand Hygiene / Q000592:standards; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods / Q000592:standards; D007363:Intensive Care Units, Neonatal / Q000592:standards; D008800:Mexico / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D010679:Philippines / Q000453:epidemiology; D016012:Poisson Distribution; D018805:Sepsis / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D014416:Tunisia / Q000453:epidemiology