, 39:439 | Cite as

Socioeconomic impact on device-associated infections in limited-resource neonatal intensive care units: findings of the INICC

  • V. D. Rosenthal
  • P. Lynch
  • W. R. Jarvis
  • I. A. Khader
  • R. Richtmann
  • N. B. Jaballah
  • C. Aygun
  • W. Villamil-Gómez
  • L. Dueñas
  • T. Atencio-Espinoza
  • J. A. Navoa-Ng
  • M. Pawar
  • M. Sobreyra-Oropeza
  • A. Barkat
  • N. Mejía
  • C. Yuet-Meng
  • A. Apisarnthanarak
  • INICC members
Clinical and Epidemiological Study



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).


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.


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.


Hospital type and country socioeconomic level influence DA-HAI rates and overall mortality in developing countries.


Central line associated blood stream infection Ventilator associated pneumonia Catheter associated urinary tract infection Intensive care unit Health care acquired infection International nosocomial infection control consortium 



The authors thank the many healthcare professionals at each INICC member hospital who assisted/participated in the surveillance program in their hospital, including the surveillance nurses, clinical microbiology personnel, and the physicians and nurses providing care for the patients during the study, without whose cooperation and generous assistance this surveillance system would not be possible. The authors also thank the INICC country coordinators (Altaf Ahmed, Carlos A. Álvarez Moreno, Anucha Apisarnthanarak, Luis E. Cuéllar, Eduardo A. Medeiros, Bijie Hu, Hakan Leblebicioglu, Lul Raka, Toshihiro Mitsuda, Virgilio Bonilla Sanchez, and Yatin Mehta), and The INICC Advisory Board (Carla J. Alvarado, Gary L. French, Nicholas Graves, Dennis G Maki, Russell N Olmsted, Didier Pittet, William Rutala, and Wing Hong Seto), who have so generously supported this unique international infection control network.

Conflict of interest



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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • V. D. Rosenthal
    • 1
  • P. Lynch
    • 2
  • W. R. Jarvis
    • 3
  • I. A. Khader
    • 4
  • R. Richtmann
    • 5
  • N. B. Jaballah
    • 6
  • C. Aygun
    • 7
  • W. Villamil-Gómez
    • 8
  • L. Dueñas
    • 9
  • T. Atencio-Espinoza
    • 10
  • J. A. Navoa-Ng
    • 11
  • M. Pawar
    • 12
  • M. Sobreyra-Oropeza
    • 13
  • A. Barkat
    • 14
  • N. Mejía
    • 15
  • C. Yuet-Meng
    • 16
  • A. Apisarnthanarak
    • 17
  • INICC members
  1. 1.International Nosocomial Infection Control Consortium (INICC)Buenos AiresArgentina
  2. 2.Epidemiology AssociatesRedmondUSA
  3. 3.Jason and Jarvis Associates, LLCHilton Head IslandUSA
  4. 4.Jordan University HospitalAmmanJordan
  5. 5.Hospital e Maternidade Santa JoanaSao PauloBrazil
  6. 6.Hôpital d’EnfantsTunisTunisia
  7. 7.Ondokuz Mayis UniversitySamsunTurkey
  8. 8.Clínica Santa MaríaSucreColombia
  9. 9.Hospital Nacional de Niños Benjamin BloomSan SalvadorEl Salvador
  10. 10.Hospital Regional de PucallpaPucallpaPeru
  11. 11.St. Luke’s Medical CenterQuezonPhilippines
  12. 12.Pushpanjali Crosslay HospitalGhaziabadIndia
  13. 13.Hospital de la MujerMexicoMexico
  14. 14.Children Hôspital of RabatRabatMorocco
  15. 15.Hospital General de la Plaza de la Salud/Universidad IberoamericanaSanto DomingoDominican Republic
  16. 16.Sunway Medical Centre Berhad and Monash University Sunway CampusPetaling JayaMalaysia
  17. 17.Thammasat University HospitalPratumthaniThailand

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