CLABSI rates in low-middle income countries
Abstract:
Background: Central line (CL)-associated bloodstream infections (CLABSIs) occurring in the ICU are common and associated with a high burden.
Methods: We implemented a multidimensional approach, incorporating an 11-element bundle, education, surveillance of CLABSI rates and clinical outcomes, monitoring compliance with bundle components, feedback of CLABSI rates and clinical outcomes, and performance feedback in 316 ICUs across 30 low- and middle-income countries (LMICs). Our dependent variables were CLABSI per 1,000-CL-days and in-ICU all-cause mortality rates. These variables were measured at baseline and during the intervention, specifically during the 2nd month, 3rd month, 4-16 months, and 17-29 months. Comparisons were conducted using a two-sample t-test. To explore the exposure-outcome relationship, we used a generalized linear mixed model with a Poisson distribution to model the number of CLABSIs.
Results: During 1,837,750 patient-days, 283,087 patients, used 1,218,882 CL-days. CLABSI per 1,000 CL-days rates decreased from 15.34 at the baseline period to 7.97 in the 2nd month (RR=0.52; 95% CI=0.48-0.56; P<0.001), 5.34 in the 3rd month (RR=0.35; 95% CI= 0.32-0.38; P<0.001), and 2.23 in the 17-29 months (RR=0.15; 95% CI=0.13-0.17; P<0.001). In-ICU all-cause mortality rate decreased from 16.17% at baseline to 13.68% (RR=0.84; p=0.0013) at 17-29 months.
Conclusions: The implemented approach was effective, and a similar intervention could be applied in other ICUs of LMICs to reduce CLABSI and in-ICU all-cause mortality rates.
Reference:
Rosenthal VD, Jin Z, Brown EC, Dongol R, De Moros DA, Alarcon-Rua J, Perez V, Stagnaro JP, Alkhawaja S, da Jimenez-Alvarez LF, Cano-Medina YA, Valderrama-Beltran SL, Henao-Rodas CM, Zuniga-Chavarria MA, El-Kholy A, Agha H, Sahu S, Mishra SB, Bhattacharyya M, Kharbanda M, Poojary A, Nair PK, Myatra SN, Chawla R, Sandhu K, Mehta Y, Rajhans P, Abdellatif-Daboor M, Chian-Wern T, Chin Seng G, Mat Nor MB, Aguirre-Avalos G, Hernandez-Chena BE, Sassoe-Gonzalez A, Villegas-Mota I, Aleman-Bocanegra MC, Bat-Erdene I, Carreazo NY, Castaneda-Sabogal A, Janc J, Hlinkova S, Yildizdas D, Havan M, Koker A, Sungurtekin H, Dinleyici EC, Guclu E, Tao L, Memish ZA, Yin R. Decreasing Central Line-Associated Bloodstream Infections Rates in Intensive Care Units in Low- and Middle- Income Countries: An INICC Approach. Am J Infect Control. 2023 Dec 26:S0196-6553(23)00871-4. doi: 10.1016/j.ajic.2023.12.010. Epub ahead of print. PMID: 38154739.