Socioeconomic impact on device-associated infections in limited-resource neonatal intensive care units: findings of the INICC
- 422 Downloads
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.
KeywordsCentral 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
- 1.Zupan J, Aahman E (editors). Perinatal mortality for the year 2000: estimates developed by WHO. Geneva: World Health Organization; 2005.Google Scholar
- 7.World Health Organization (WHO). Proceedings of meeting of development partners: maternal and newborn health with a focus on country implementation. In: Millennium Development Goals. Stockholm: World Health Organization. 2006. Available at: http://www.who.org. Accessed 26 May 2008.
- 11.Rosenthal VD, Maki DG, Jamulitrat S, Medeiros EA, Todi SK, Gomez DY et al. International Nosocomial Infection Control Consortium (INICC) report. Data summary for 2003-2008, issued June 2009. Am J Infect Control. 38:95–104 e2. doi: 10.1016/j.ajic.2009.12.004.
- 14.Bank W. World Bank clasification of economies. 2007. Available at: http://web.worldbank.org/WBSITE/EXTERNAL/DATASTATISTICS/0,contentMDK:20421402~pagePK:64133150~piPK:64133175~theSitePK:239419,00.html. Accessed 5 Oct 2008.
- 17.National Nosocomial Infections Surveillance (NNIS) system report. Data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control. 2004;32:470–85.Google Scholar
- 19.Madani N, Rosenthal VD, Dendane T, Abidi K, Zeggwagh AA, Abouqal R. Health-care associated infections rates, length of stay, and bacterial resistance in an intensive care unit of morocco: findings of the International Nosocomial Infection Control Consortium (INICC). Int Arch Med. 2009;2:29.PubMedCrossRefGoogle Scholar
- 20.Leblebicioglu H, Rosenthal VD, Arikan OA, Ozgultekin A, Yalcin AN, Koksal I, et al. Device-associated hospital-acquired infection rates in Turkish intensive care units. Findings of the International Nosocomial Infection Control Consortium (INICC). J Hosp Infect. 2007;65:251–7.PubMedCrossRefGoogle Scholar
- 21.Mehta A, Rosenthal VD, Mehta Y, Chakravarthy M, Todi SK, Sen N, et al. Device-associated nosocomial infection rates in intensive care units of seven Indian cities. Findings of The International Nosocomial Infection Control Consortium (INICC). J Hosp Infect. 2007;67:168–74.PubMedCrossRefGoogle Scholar
- 22.Salomao R, Rosenthal VD, Grinberg G, Nouer S, Blecher S, Buchner-Ferreira S, et al. Device-associated infection rates in intensive care units of Brazilian hospitals: findings of the International Nosocomial Infection Control Consortium. Rev Panam Salud Publica. 2008;24:195–202.PubMedCrossRefGoogle Scholar
- 23.Cuellar LE, Fernandez-Maldonado E, Rosenthal VD, Castaneda-Sabogal A, Rosales R, Mayorga-Espichan MJ, et al. Device-associated infection rates and mortality in intensive care units of Peruvian hospitals: findings of the International Nosocomial Infection Control Consortium. Rev Panam Salud Publica. 2008;24:16–24.PubMedCrossRefGoogle Scholar
- 26.Rosenthal VD. Device-associated nosocomial infections in limited-resources countries: findings of the International Nosocomial Infection Control Consortium (INICC). Am J Infect Control. 2008;36:S171 e7–12.Google Scholar
- 29.Lynch P, Rosenthal VD, Borg MA, Eremin SR. Infection control in developing countries. In: Jarvis WR, editor. Bennett and Brachman’s hospital infections. Philadelphia: Lipppincott Williams & Wilkins; 2007. p. 255.Google Scholar
- 31.Moreno CA, Rosenthal VD, Olarte N, Gomez WV, Sussmann O, Agudelo JG, et al. Device-associated infection rate and mortality in intensive care units of 9 Colombian hospitals: findings of the International Nosocomial Infection Control Consortium. Infect Control Hosp Epidemiol. 2006;27:349–56.PubMedCrossRefGoogle Scholar