title: Impact of a multidimensional infection control approach on central line-associated bloodstream infections rates in adult intensive care units of 8 cities of Turkey: findings of the International Nosocomial Infection Control Consortium (INICC).
abstract: BACKGROUND
  Central line-associated bloodstream infections (CLABs) have long been associated with excess lengths of stay, increased hospital costs and mortality attributable to them. Different studies from developed countries have shown that practice bundles reduce the incidence of CLAB in intensive care units. However, the impact of the bundle strategy has not been systematically analyzed in the adult intensive care unit (ICU) setting in developing countries, such as Turkey. The aim of this study is to analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach to reduce the rates of CLAB in 13 ICUs of 13 INICC member hospitals from 8 cities of Turkey.
  
  
  METHODS
  We conducted active, prospective surveillance before-after study to determine CLAB rates in a cohort of 4,017 adults hospitalized in ICUs. We applied the definitions of the CDC/NHSN and INICC surveillance methods. The study was divided into baseline and intervention periods. During baseline, active outcome surveillance of CLAB rates was performed. During intervention, the INICC multidimensional approach for CLAB reduction was implemented and included the following measures: 1- bundle of infection control interventions, 2- education, 3- outcome surveillance, 4- process surveillance, 5- feedback of CLAB rates, and 6- performance feedback on infection control practices. CLAB rates obtained in baseline were compared with CLAB rates obtained during intervention.
  
  
  RESULTS
  During baseline, 3,129 central line (CL) days were recorded, and during intervention, we recorded 23,463 CL-days. We used random effects Poisson regression to account for clustering of CLAB rates within hospital across time periods. The baseline CLAB rate was 22.7 per 1000 CL days, which was decreased during the intervention period to 12.0 CLABs per 1000 CL days (IRR 0.613; 95% CI 0.43 - 0.87; P 0.007). This amounted to a 39% reduction in the incidence rate of CLAB.
  
  
  CONCLUSIONS
  The implementation of multidimensional infection control approach was associated with a significant reduction in the CLAB rates in adult ICUs of Turkey, and thus should be widely implemented.
authors: Ondokuz Mayis University Medical School, Samsun, Turkey.
authors: Hakan
authors: H
authors: Leblebicioglu
authors: Recep
authors: R
authors: Öztürk
authors: Victor Daniel
authors: VD
authors: Rosenthal
authors: Özay Arıkan
authors: ÖA
authors: Akan
authors: Fatma
authors: F
authors: Sirmatel
authors: Davut
authors: D
authors: Ozdemir
authors: Cengiz
authors: C
authors: Uzun
authors: Huseyin
authors: H
authors: Turgut
authors: Gulden
authors: G
authors: Ersoz
authors: Iftíhar
authors: I
authors: Koksal
authors: Asu
authors: A
authors: Özgültekin
authors: Saban
authors: S
authors: Esen
authors: Fatma
authors: F
authors: Ulger
authors: Ahmet
authors: A
authors: Dilek
authors: Hava
authors: H
authors: Yilmaz
authors: Yalim
authors: Y
authors: Dikmen
authors: Gökhan
authors: G
authors: Aygún
authors: Melek
authors: M
authors: Tulunay
authors: Mehmet
authors: M
authors: Oral
authors: Necmettin
authors: N
authors: Ünal
authors: Mustafa
authors: M
authors: Cengiz
authors: Leyla
authors: L
authors: Yilmaz
authors: Mehmet Faruk
authors: MF
authors: Geyik
authors: Ahmet
authors: A
authors: Şahin
authors: Selvi
authors: S
authors: Erdogan
authors: Suzan
authors: S
authors: Sacar
authors: Hülya
authors: H
authors: Sungurtekin
authors: Doğaç
authors: D
authors: Uğurcan
authors: Ali
authors: A
authors: Kaya
authors: Necdet
authors: N
authors: Kuyucu
authors: Gürdal
authors: G
authors: Yýlmaz
authors: Selçuk
authors: S
authors: Kaya
authors: Hülya
authors: H
authors: Ulusoy
authors: Asuman
authors: A
authors: İnan
mesh_terms: D000328:Adult; D000368:Aged; D055499:Catheter-Related Infections / Q000097:blood / Q000517:prevention & control; D003428:Cross Infection / Q000097:blood* / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D063373:Hand Hygiene; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods* / Q000458:organization & administration / Q000592:standards; D007362:Intensive Care Units / Q000592:standards*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D014421:Turkey / Q000453:epidemiology
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