Advertisement

Infection control bundles in intensive care: an international cross-sectional survey in low- and middle-income countries

      Summary

      Background

      In low- and middle-income countries (LMICs), the burden of healthcare-associated infections (HCAIs) is not known due to a lack of national surveillance systems, standardized infection definitions, and paucity of infection prevention and control (IPC) organizations and legal infrastructure.

      Aim

      To determine the status of IPC bundle practice and the most frequent interventional variables in LMICs.

      Methods

      A questionnaire was emailed to Infectious Diseases International Research Initiative (ID-IRI) Group Members and dedicated IPC doctors working in LMICs to examine self-reported practices/policies regarding IPC bundles. Responding country incomes were classified by World Bank definitions into low, middle, and high. Comparison of LMIC results was then made to a control group of high-income countries (HICs).

      Findings

      This survey reports practices from one low-income country (LIC), 16 middle-income countries (MICs) (13 European), compared to eight high-income countries (HICs). Eighteen (95%) MICs had an IPC committee in their hospital, 12 (63.2%) had an annual agreed programme and produced an HCAI report. Annual agreed programmes (87.5% vs 63.2%, respectively) and an annual HCAI report (75.0% vs 63.2%, respectively) were more common in HICs than MICs. All HICs had at least one invasive device-related surveillance programme. Seven (37%) MICs had no invasive device-related surveillance programme, six (32%) had no ventilator-associated pneumonia prevention bundles, seven (37%) had no catheter-associated urinary tract infection prevention bundles, and five (27%) had no central line-associated bloodstream infection prevention bundles.

      Conclusion

      LMICs need to develop their own bundles with low-cost and high-level-of-evidence variables adapted to the limited resources, with further validation in reducing infection rates.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hospital Infection
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Pittet D.
        Infection control and quality health care in the new millenium.
        Am J Infect Control. 2005; 33: 258-267
        • Alp E.
        • Damani N.
        Healthcare-associated infections in intensive care units: epidemiology and infection control in low-to-middle income countries.
        J Infect Dev Ctries. 2015; 9: 1040-1045
        • Rosenthal V.D.
        • Maki D.G.
        • Mehta Y.
        • Leblebicioglu H.
        • Memish Z.A.
        • Al-Mousa H.H.
        • et al.
        International Nosocomial Infection Control Consortium (INICC) report, data summary of 43 countries for 2007–2012. Device-associated module.
        Am J Infect Control. 2014; 42: 942-956
        • Iwuafor A.A.
        • Ogunsola F.T.
        • Oladele R.O.
        • Oduyebo O.O.
        • Desalu I.
        • Egwuatu C.C.
        • et al.
        Incidence, clinical outcome and risk factors of ıntensive care unit ınfections in the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria.
        PLoS One. 2016; 11e0165242
        • Rosenthal V.D.
        • Maki D.G.
        • Graves N.
        The International Nosocomial Infection Control Consortium (INICC): goals and objectives, description of surveillance methods, and operational activities.
        Am J Infect Control. 2008; 36: e1-e12
        • Rosenthal V.D.
        • Maki D.G.
        • Salomao R.
        • Moreno C.A.
        • Mehta Y.
        • Higuera F.
        • et al.
        International Nosocomial Infection Control Consortium. Device-associated nosocomial infections in 55 intensive care units of 8 developing countries.
        Ann Intern Med. 2006; 145: 582-591
        • Rosenthal V.D.
        • Maki D.G.
        • Jamulitrat S.
        • Medeiros E.A.
        • Todi S.K.
        • Gomez D.Y.
        • et al.
        • INICC Members
        International Nosocomial Infection Control Consortium (INICC) report, data summary for 2003–2008, issued June 2009.
        Am J Infect Control. 2010; 38: 95-104
        • Rosenthal V.D.
        • Lynch P.
        • Jarvis W.R.
        • Khader I.A.
        • Richtmann R.
        • Jaballah N.B.
        • et al.
        International Nosocomial Infection Control Consortium members. Socioeconomic impact on device-associated infections in limited-resource neonatal intensive care units: findings of the INICC.
        Infection. 2011; 39: 439-450
        • Andreessen L.
        • Wilde M.H.
        • Herendeen P.
        Preventing catheter-associated urinary tract infections in acute care.
        J Nurs Care Qual. 2012; 27: 209-217
        • Clarke K.
        • Tong D.
        • Pan Y.
        • Easley K.A.
        • Norrick B.
        • Ko C.
        • et al.
        Reduction in catheter-associated urinary tract infections by bundling interventions.
        Int J Qual Health Care. 2013; 25: 43-49
        • Crolla R.M.P.H.
        • van der Laan L.
        • Veen E.J.
        • Hendriks Y.
        • vanSchendel C.
        • Kluytmans J.
        Reduction of surgical site infections after implementation of a bundle of care.
        PLoS One. 2012; 7e44599
        • Rosenthal V.D.
        • Desse J.
        • Maurizi D.M.
        • Chaparro G.J.
        • Orellano P.W.
        • Chediack V.
        • et al.
        Impact of the International Nosocomial Infection Control Consortium (INICC)’s multidimensional approach on rates of central line-associated bloodstream ınfection in 14 ıntensive care units in 11 hospitals of 5 cities in Argentina.
        Infect Control Hosp Epidemiol. 2018; 39: 445-451
        • Rosenthal V.D.
        • Desse J.
        • Maurizi D.M.
        • Chaparro G.J.
        • Orellano P.W.
        • Chediack V.
        • et al.
        Impact of the International Nosocomial Infection Control Consortium’s multidimensional approach on rates of ventilator-associated pneumonia in 14 intensive care units in 11 hospitals of 5 cities within Argentina.
        Am J Infect Control. 2018; (pii: S0196-6553(17)31290-31297)
        • Álvarez-Moreno C.A.
        • Valderrama-Beltrán S.L.
        • Rosenthal V.D.
        • Mojica-Carreño B.E.
        • Valderrama-Márquez I.A.
        • Matta-Cortés L.
        • et al.
        Multicenter study in Colombia: impact of a multidimensional International Nosocomial Infection Control Consortium (INICC) approach on central line-associated blood stream infection rates.
        Am J Infect Control. 2016; 44: e235-e241
        • Navoa-Ng J.A.
        • Berba R.
        • Rosenthal V.D.
        • Villanueva V.D.
        • Tolentino M.C.
        • Genuino G.A.
        • et al.
        Impact of an International Nosocomial Infection Control Consortium multidimensional approach on catheter-associated urinarytract infections in adult intensive care units in the Philippines: International Nosocomial Infection Control Consortium (INICC) findings.
        J Infect Public Health. 2013; 6: 389-399
        • Pulcini C.
        • Leibovici L.
        CMI guidance for authors of surveys.
        Clin Microbiol Infect. 2016; 22: 901-902
        • Alp E.
        • Cookson B.
        • Erdem H.
        • Rello J.
        Infection control bundles in low-middle income countries: an international cross-sectional survey (study protocol).
        J Emerg Crit Care Med. 2018; 2: 40
      1. World Bank Data Team. New country classifications by income level: 2016–2017. Available at: https://blogs.worldbank.org/opendata/trade/new-country-classifications-2016 [last accessed August 2018].

        • Alp E.
        • Leblebicioglu H.
        • Doganay M.
        • Voss A.
        Infection control practice in countries with limited resources.
        Ann Clin Microbiol Antimicrob. 2011; 10: 36
        • Vandijck D.
        • Cleemput I.
        • Hellings J.
        • Vogelaers D.
        Infection prevention and control strategies in the era of limited resources and quality improvement: a perspective paper.
        Aust Crit Care. 2013; 26: 154-157
        • Vincent J.L.
        • Rello J.
        • Marshall J.
        • Silva E.
        • Anzueto A.
        • Martin C.D.
        • et al.
        EPIC II Group of Investigators. International study of the prevalence and outcomes of infection in intensive care units.
        JAMA. 2009; 302: 2323-2329
        • Alp E.
        • Altun D.
        • Cevahir F.
        • Ersoy S.
        • Cakir O.
        • McLaws M.L.
        Evaluation of the effectiveness of an infection control program in adult intensive care units: a report from a middle-income country.
        Am J Infect Control. 2014; 42: 1056-1061
        • Azab S.F.
        • Sherbiny H.S.
        • Saleh S.H.
        • Elsaeed W.F.
        • Elshafiey M.M.
        • Siam A.G.
        • et al.
        Reducing ventilator-associated pneumonia in neonatal intensive care unit using “VAP prevention bundle”: a cohort study.
        BMC Infect Dis. 2015; 15: 314
        • Hugonnet S.
        • Chevrolet J.C.
        • Pittet D.
        The effect of workload on infection risk in critically ill patients.
        Crit Care Med. 2007; 35: 76-81