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J Infect Public Health. 2018 Sep - Oct;11(5):677-684. doi: 10.1016/j.jiph.2018.06.002. Epub 2018 Jun 23.

Impact of the International Nosocomial Infection Control Consortium (INICC)'s multidimensional approach on rates of ventilator-associated pneumonia in intensive care units in 22 hospitals of 14 cities of the Kingdom of Saudi Arabia.

Al-Abdely HM1, Khidir Mohammed Y1, Rosenthal VD2, Orellano PW3, ALazhary M4, Kaid E5, Al-Attas A5, Hawsawi G5, Kelany A6, Hussein B5, Esam B5, Altowerqi R7, Alkamaly MA8, Tawfic NA9, Cruzpero E9, Al Rashidi RM9, Thomas R9, Molano AM10, Al Enazy HA10, Al Adwani FM10, Casuyon Pahilanga AM10, Alatawi S10, Nakhla R10, Al Adwani FM10, Gasmin Aromin R11, Balon Ubalde E11, Hanafy Diab H12, Kader NA11, Hassan Assiry IY11, Sawan FA13, Ammari HE13, Mashiakhy AM13, Santiago EB13, Chua CMS13, Dalis IM13, Arishi HM13, Lozada R13, Al-Zaydani Asiri IAM14, Ahmed H14, Jarie A14, Al-Qathani ASM14, Al-Alkami HY14, AlDalaton M15, Alih SJB14, Alaliany MJ15, Helali NJ16, Sindayen G16, Malificio AA16, Al Dossari HB16, Algethami AG17, Mohamed D16, Yanne L16, Tan A16, Babu S16, Abduljabbar SM16, Rushdi H18, Fernandez J19, Hussain WM19, Rajavel RD19, Bukhari SZ19, Turkistani AA20, Mushtaq JJ20, Albeladi E21, Aboushoushah S21, Qushmaq N21, Shyrine L22, Philipose J22, Raees M22, AbdulKhalik NS22, Madco M23, Abdulghany M23, Manao A23, Acostan C23, Safwat R23, Halwani M23, Abdul Aal NAH23, Thomas A23, Abdulatif SM23, Ariola NC24, Mutwalli AH24, Ariola N24, Bohlega E25, Simon S25, Damlig E25, Elsherbini SG25, Krishne IT25, Abraham S25, Ali Karrar MA26, Gosn NA26, Al Hindi AA27, Jaha RN26, AlQahtani SM28, Abdul Aziz AO29, Demaisip NL29, Laungayan Cortez E29, Cabato AF29, Gonzales Celiz JM29, Al Raey MA29, Al Darani SA29, Aziz MR29, Manea BA29, Samy E29, Briones S30, Krishnan R30, Raees SSM30, Tabassum K30, Ghalilah KM31, Alradady M31, Al Qatri A31, Chaouali M31, Elsisi M31, Aldossary HA32, Al-Suliman S32, Al Talib AA33, Albaghly N32, Haqlre Mia ME32, Al-Gethamy MM34, Alamri DM34, Al-Saadi AS34, Ayugat EP35, Al Hazazi NA35, Al Hussain MI35, Caminade Y36, Santos AJ36, Abdulwahab MH36, Al-Garni BTA36.

Author information

1
General Directorate of Prevention and Infection Control, Ministry of Health, Riyadh, Saudi Arabia; King Fahad Hospital, Jeddah, Kingdom of Saudi Arabia; King Khalid Hospital, Hail, Kingdom of Saudi Arabia; King Khalid Hospital, Tabuk, Kingdom of Saudi Arabia; King Khalid Hospital, Najran, Kingdom of Saudi Arabia; King Fahad Central Hospital, Jizan, Kingdom of Saudi Arabia; Abha Maternity and Children Hospital, Assir, Kingdom of Saudi Arabia; King Abdulaziz Specialist Hospital, Taif, Kingdom of Saudi Arabia; Hera General Hospital, Makkah, Kingdom of Saudi Arabia; King Abdullah Medical Complex, Jeddah, Kingdom of Saudi Arabia; King Saud Hospital, Qassim, Kingdom of Saudi Arabia; King Fahad Hospital, Al Baha, Kingdom of Saudi Arabia; King Abdulaziz Hospital and Oncology Center, Jeddah, Kingdom of Saudi Arabia; King Salman Hospital, Riyadh, Kingdom of Saudi Arabia; Yanbou General Hospital, Madina, Kingdom of Saudi Arabia; Khamis Mushayt General Hospital, Assir, Kingdom of Saudi Arabia; Assir Central Hospital, Assir, Kingdom of Saudi Arabia; King Fahad Specialist Hospital, Qassim, Kingdom of Saudi Arabia; King Fahad Hospital, Madina, Kingdom of Saudi Arabia; Dammam Medical Complex, Dammam, Kingdom of Saudi Arabia; Al Noor Specialist, Makkah, Kingdom of Saudi Arabia; Al Jubail General Hospital, Al Jubail, Kingdom of Saudi Arabia; King Feisal Hospital, Taif, Kingdom of Saudi Arabia.
2
International Nosocomial Infection Control Consortium (INICC), Buenos Aires, Argentina. Electronic address: victor_rosenthal@inicc.org.
3
International Nosocomial Infection Control Consortium (INICC), Buenos Aires, Argentina; Universidad Tecnológica Nacional, Facultad Regional San Nicolás and Consejo Nacional de Investigaciones Científicas y Técnicas, San Nicolás, Argentina.
4
King Fahad Hospital, Jeddah, Kingdom of Saudi Arabia; King Khalid Hospital, Hail, Kingdom of Saudi Arabia; King Khalid Hospital, Tabuk, Kingdom of Saudi Arabia; King Khalid Hospital, Najran, Kingdom of Saudi Arabia; King Fahad Central Hospital, Jizan, Kingdom of Saudi Arabia; Abha Maternity and Children Hospital, Assir, Kingdom of Saudi Arabia; King Abdulaziz Specialist Hospital, Taif, Kingdom of Saudi Arabia; Hera General Hospital, Makkah, Kingdom of Saudi Arabia; King Abdullah Medical Complex, Jeddah, Kingdom of Saudi Arabia; King Saud Hospital, Qassim, Kingdom of Saudi Arabia; King Fahad Hospital, Al Baha, Kingdom of Saudi Arabia; King Abdulaziz Hospital and Oncology Center, Jeddah, Kingdom of Saudi Arabia; King Salman Hospital, Riyadh, Kingdom of Saudi Arabia; Yanbou General Hospital, Madina, Kingdom of Saudi Arabia; Khamis Mushayt General Hospital, Assir, Kingdom of Saudi Arabia; Assir Central Hospital, Assir, Kingdom of Saudi Arabia; King Fahad Specialist Hospital, Qassim, Kingdom of Saudi Arabia; King Fahad Hospital, Madina, Kingdom of Saudi Arabia; Dammam Medical Complex, Dammam, Kingdom of Saudi Arabia; Al Noor Specialist, Makkah, Kingdom of Saudi Arabia; Al Jubail General Hospital, Al Jubail, Kingdom of Saudi Arabia; King Feisal Hospital, Taif, Kingdom of Saudi Arabia.
5
King Fahad Hospital, Jeddah, Kingdom of Saudi Arabia.
6
King Fahad Hospital, Jeddah, Kingdom of Saudi Arabia; King Abdulaziz Specialist Hospital, Taif, Kingdom of Saudi Arabia; King Abdullah Medical Complex, Jeddah, Kingdom of Saudi Arabia; King Abdulaziz Hospital and Oncology Center, Jeddah, Kingdom of Saudi Arabia; King Feisal Hospital, Taif, Kingdom of Saudi Arabia.
7
King Fahad Hospital, Jeddah, Kingdom of Saudi Arabia; King Abdullah Medical Complex, Jeddah, Kingdom of Saudi Arabia; King Abdulaziz Hospital and Oncology Center, Jeddah, Kingdom of Saudi Arabia.
8
King Khalid Hospital, Hail, Kingdom of Saudi Arabia; King Saud Hospital, Qassim, Kingdom of Saudi Arabia; King Fahad Specialist Hospital, Qassim, Kingdom of Saudi Arabia.
9
King Khalid Hospital, Hail, Kingdom of Saudi Arabia.
10
King Khalid Hospital, Tabuk, Kingdom of Saudi Arabia.
11
King Khalid Hospital, Najran, Kingdom of Saudi Arabia.
12
King Khalid Hospital, Najran, Kingdom of Saudi Arabia; King Fahad Central Hospital, Jizan, Kingdom of Saudi Arabia.
13
King Fahad Central Hospital, Jizan, Kingdom of Saudi Arabia.
14
Abha Maternity and Children Hospital, Assir, Kingdom of Saudi Arabia.
15
Abha Maternity and Children Hospital, Assir, Kingdom of Saudi Arabia; Khamis Mushayt General Hospital, Assir, Kingdom of Saudi Arabia; Assir Central Hospital, Assir, Kingdom of Saudi Arabia.
16
King Abdulaziz Specialist Hospital, Taif, Kingdom of Saudi Arabia.
17
King Abdulaziz Specialist Hospital, Taif, Kingdom of Saudi Arabia; King Feisal Hospital, Taif, Kingdom of Saudi Arabia.
18
Hera General Hospital, Makkah, Kingdom of Saudi Arabia; Yanbou General Hospital, Madina, Kingdom of Saudi Arabia; King Fahad Hospital, Madina, Kingdom of Saudi Arabia; Al Noor Specialist, Makkah, Kingdom of Saudi Arabia.
19
Hera General Hospital, Makkah, Kingdom of Saudi Arabia.
20
Hera General Hospital, Makkah, Kingdom of Saudi Arabia; Al Noor Specialist, Makkah, Kingdom of Saudi Arabia.
21
King Abdullah Medical Complex, Jeddah, Kingdom of Saudi Arabia.
22
King Saud Hospital, Qassim, Kingdom of Saudi Arabia.
23
King Fahad Hospital, Al Baha, Kingdom of Saudi Arabia.
24
King Abdulaziz Hospital and Oncology Center, Jeddah, Kingdom of Saudi Arabia.
25
King Salman Hospital, Riyadh, Kingdom of Saudi Arabia.
26
Yanbou General Hospital, Madina, Kingdom of Saudi Arabia.
27
Yanbou General Hospital, Madina, Kingdom of Saudi Arabia; King Fahad Hospital, Madina, Kingdom of Saudi Arabia.
28
Khamis Mushayt General Hospital, Assir, Kingdom of Saudi Arabia.
29
Assir Central Hospital, Assir, Kingdom of Saudi Arabia.
30
King Fahad Specialist Hospital, Qassim, Kingdom of Saudi Arabia.
31
King Fahad Hospital, Madina, Kingdom of Saudi Arabia.
32
Dammam Medical Complex, Dammam, Kingdom of Saudi Arabia.
33
Dammam Medical Complex, Dammam, Kingdom of Saudi Arabia; Al Jubail General Hospital, Al Jubail, Kingdom of Saudi Arabia.
34
Al Noor Specialist, Makkah, Kingdom of Saudi Arabia.
35
Al Jubail General Hospital, Al Jubail, Kingdom of Saudi Arabia.
36
King Feisal Hospital, Taif, Kingdom of Saudi Arabia.

Abstract

BACKGROUND:

To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Approach (IMA) and use of INICC Surveillance Online System (ISOS) on ventilator-associated pneumonia (VAP) rates in Saudi Arabia from September 2013 to February 2017.

METHODS:

A multicenter, prospective, before-after surveillance study on 14,961 patients in 37 intensive care units (ICUs) of 22 hospitals. During baseline, we performed outcome surveillance of VAP applying the definitions of the CDC/NHSN. During intervention, we implemented the IMA and the ISOS, which included: (1) a bundle of infection prevention practice interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback on VAP rates and consequences and (6) performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using generalized linear mixed models to estimate the effect of intervention.

RESULTS:

The baseline rate of 7.84 VAPs per 1000 mechanical-ventilator (MV)-days-with 20,927 MV-days and 164 VAPs-, was reduced to 4.74 VAPs per 1000 MV-days-with 118,929 MV-days and 771 VAPs-, accounting for a 39% rate reduction (IDR 0.61; 95% CI 0.5-0.7; P 0.001).

CONCLUSIONS:

Implementing the IMA was associated with significant reductions in VAP rates in ICUs of Saudi Arabia.

KEYWORDS:

Healthcare-acquired infection; Hospital infection; Hospital-acquired pneumonia; Limited-resource countries; Nosocomial pneumonia; Surveillance

PMID:
29945849
DOI:
10.1016/j.jiph.2018.06.002
[Indexed for MEDLINE]
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