• Hakan Leblebicioglu, Recep Öztürk, Victor Daniel Rosenthal, Özay Arıkan Akan, Fatma Sirmatel, Davut Ozdemir, Cengiz Uzun, Huseyin Turgut, Gulden Ersoz, Iftíhar Koksal, Asu Özgültekin, Saban Esen, Fatma Ulger, Ahmet Dilek, Hava Yilmaz, Yalim Dikmen, Gökhan Aygún, Melek Tulunay, Mehmet Oral, Necmettin Ünal, Mustafa Cengiz, Leyla Yilmaz, Mehmet Faruk Geyik, Ahmet Şahin, Selvi Erdogan, Suzan Sacar, Hülya Sungurtekin, Doğaç Uğurcan, Ali Kaya, Necdet Kuyucu, Gürdal Yýlmaz, Selçuk Kaya, Hülya Ulusoy, and Asuman İnan.
• Ondokuz Mayis University Medical School, Samsun, Turkey.
• Ann. Clin. Microbiol. Antimicrob. 2013 Jan 1;12:10.

BackgroundCentral line-associated bloodstream infections (CLABs) have long been associated with excess lengths of stay, increased hospital costs and mortality attributable to them. Different studies from developed countries have shown that practice bundles reduce the incidence of CLAB in intensive care units. However, the impact of the bundle strategy has not been systematically analyzed in the adult intensive care unit (ICU) setting in developing countries, such as Turkey. The aim of this study is to analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach to reduce the rates of CLAB in 13 ICUs of 13 INICC member hospitals from 8 cities of Turkey.MethodsWe conducted active, prospective surveillance before-after study to determine CLAB rates in a cohort of 4,017 adults hospitalized in ICUs. We applied the definitions of the CDC/NHSN and INICC surveillance methods. The study was divided into baseline and intervention periods. During baseline, active outcome surveillance of CLAB rates was performed. During intervention, the INICC multidimensional approach for CLAB reduction was implemented and included the following measures: 1- bundle of infection control interventions, 2- education, 3- outcome surveillance, 4- process surveillance, 5- feedback of CLAB rates, and 6- performance feedback on infection control practices. CLAB rates obtained in baseline were compared with CLAB rates obtained during intervention.ResultsDuring baseline, 3,129 central line (CL) days were recorded, and during intervention, we recorded 23,463 CL-days. We used random effects Poisson regression to account for clustering of CLAB rates within hospital across time periods. The baseline CLAB rate was 22.7 per 1000 CL days, which was decreased during the intervention period to 12.0 CLABs per 1000 CL days (IRR 0.613; 95% CI 0.43 - 0.87; P 0.007). This amounted to a 39% reduction in the incidence rate of CLAB.ConclusionsThe implementation of multidimensional infection control approach was associated with a significant reduction in the CLAB rates in adult ICUs of Turkey, and thus should be widely implemented.

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