Major Article
International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2012-2017: Device-associated module

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Highlights

  • We report INICC device-associated module data of 45 countries from 2012-2015.

  • We collected prospective data from 532,483 patients in 523 ICUs for 2,197,304 days.

  • DA-HAI rates and bacterial resistance were higher in INICC ICUs than in CDC-NHSN's.

  • Device utilization ratio in the INICC ICUs was similar to CDC-NHSN's.

Background

We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2012 to December 2017 in 523 intensive care units (ICUs) in 45 countries from Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.

Methods

During the 6-year study period, prospective data from 532,483 ICU patients hospitalized in 242 hospitals, for an aggregate of 2,197,304 patient days, were collected through the INICC Surveillance Online System (ISOS). The Centers for Disease Control and Prevention-National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care–associated infection (DA-HAI) were applied.

Results

Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the medical-surgical ICUs, the pooled central line-associated bloodstream infection rate was higher (5.05 vs 0.8 per 1,000 central line-days); the ventilator-associated pneumonia rate was also higher (14.1 vs 0.9 per 1,000 ventilator-days,), as well as the rate of catheter-associated urinary tract infection (5.1 vs 1.7 per 1,000 catheter-days). From blood cultures samples, frequencies of resistance, such as of Pseudomonas aeruginosa to piperacillin-tazobactam (33.0% vs 18.3%), were also higher.

Conclusions

Despite a significant trend toward the reduction in INICC ICUs, DA-HAI rates are still much higher compared with CDC-NHSN's ICUs representing the developed world. It is INICC's main goal to provide basic and cost-effective resources, through the INICC Surveillance Online System to tackle the burden of DA-HAIs effectively.

Section snippets

METHODS

The DA module data were collected using the ISOS platform,2 which applies CDC/NHSN's latest criteria and reported methods for calculation of HAI rates and DU ratios, and DA-HAI definitions that include laboratory and clinical criteria.5, 6 For this report, definitions of HAI used during surveillance were those published by CDC in 2008,5 and their subsequent updates, until 2017.19

This report includes ventilator-associated pneumonia (VAP) rates for adults, and for pediatric and neonatal units,

RESULTS

From January 1, 2012, to December 31, 2017, we conducted a multicenter prospective cohort surveillance study of DA-HAIs in 523 ICUs in 242 hospitals in 45 countries from Latin America, Europe, Eastern Mediterranean, South East Asia, and Western Pacific World Health Organization regions, currently participating in INICC. Of all the hospitals, 30% were academic, 27% were public, and the remaining 43% were private. As stated in the INICC charter, the identity of patients and hospitals are kept

DISCUSSION

In this report, the DU ratios identified in INICC ICUs are similar or even lower to the DU reported of US ICUs by the CDC's NHSN system; however, all DA-HAI rates found in INICC ICUs are higher than in US ICU rates.21

The antimicrobial resistance rates identified in INICC ICUs in blood samples for isolates of Staphylococcus aureus, Pseudomonas, and Enterococcus faecalis were higher than the CDC's NHSN rates identified in the last published report 2011-2014.20 Whereas the resistance rates found

Acknowledgments

The authors would like to thank the many health care professionals who assisted with the conduct of surveillance in their hospital, including Débora López Burgardt, who works at International Nosocomial Infection Control Consortium headquarters in Buenos Aires, and the International Nosocomial Infection Control Consortium Advisory Board, Country Directors, and Secretaries (Hail M. Alabdaley, Yassir Khidir Mohamed, Safaa Abdul Aziz AlKhawaja, Amani Ali El-Kholy, Vineya Rai, Souha S. Kanj, Yatin

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    Funding/support: Funding for the design, development, maintenance, technical support, data validation, and report generation of the International Nosocomial Infection Control Consortium Surveillance Online System, and the activities carried out at the International Nosocomial Infection Control headquarters were provided by Victor D. Rosenthal, and the Foundation to Fight against Nosocomial Infections.

    Conflicts of interest: None to report.

    Ethics approval and consent to participate: Every hospital's Institutional Review Board agreed to the study protocol, and patient confidentiality was protected by codifying the recorded information, making it only identifiable to the infection control team.

    Author contributions: V.D.R. was responsible for study conception and design, drafting of the manuscript, software development, technical support, report generation, data validation, data assembly, data interpretation, epidemiologic, and statistical analysis. All authors were involved in provision of study patients, critical revision of the manuscript for important intellectual content, and final approval of the manuscript.

    Additional authors from the International Nosocomial Infection Control Consortium are listed in the Appendix.

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