• Victor Daniel Rosenthal, Lourdes Dueñas, Martha Sobreyra-Oropeza, Khaldi Ammar, Josephine Anne Navoa-Ng, Ana Concepción Bran de Casares, Lilian de Jesús Machuca, Nejla Ben-Jaballah, Asma Hamdi, Victoria D Villanueva, and María Corazon V Tolentino.
• International Nosocomial Infection Control Consortium, Buenos Aires, Argentina. victor_rosenthal@inicc.org
• Infect Control Hosp Epidemiol. 2013 Mar 1; 34 (3): 229-37.

ObjectiveTo analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach to reduce central line-associated bloodstream infection (CLABSI) rates.SettingFour neonatal intensive care units (NICUs) of INICC member hospitals from El Salvador, Mexico, Philippines, and Tunisia.PatientsA total of 2,241 patients hospitalized in 4 NICUs for 40,045 bed-days.MethodsWe conducted a before-after prospective surveillance study. During Phase 1 we performed active surveillance, and during phase 2 the INICC multidimensional infection control approach was implemented, including the following practices: (1) central line care bundle, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of CLABSI rates, and (6) performance feedback of infection control practices. We compared CLABSI rates obtained during the 2 phases. We calculated crude stratified rates, and, using random-effects Poisson regression to allow for clustering by ICU, we calculated the incidence rate ratio (IRR) for each follow-up time period compared with the 3-month baseline.ResultsDuring phase 1 we recorded 2,105 CL-days, and during phase 2 we recorded 17,117 CL-days. After implementation of the multidimensional approach, the CLABSI rate decreased by 55%, from 21.4 per 1,000 CL-days during phase 1 to 9.7 per 1,000 CL-days during phase 2 (rate ratio, 0.45 [95% confidence interval, 0.33-0.63]). The IRR was 0.53 during the 4-12-month period and 0.07 during the final period of the study (more than 45 months).ConclusionsImplementation of a multidimensional infection control approach was associated with a significant reduction in CLABSI rates in NICUs.

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