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Leblebicioglu H, Koksal I, Rosenthal VD, Akan ÖA, Özgültekin A, Kendirli T, Erben N, Yalcin AN, Ulusoy S, Sirmatel F, Ozdemir D, Alp E, Yıldızdaş D, Esen S, Ulger F, Dilek A, Yilmaz H, Yýlmaz G, Kaya S, Ulusoy H, Tulunay M, Oral M, Ünal N, Turan G, Akgün N, İnan A, Ince E, Karbuz A, Çiftçi E, Taşyapar N, Güneş M, Ozgunes I, Usluer G, Turhan O, Gunay N, Gumus E, Dursun O, Arda B, Bacakoglu F, Cengiz M, Yilmaz L, Geyik MF, Şahin A, Erdogan S, Kılıc AU, Horoz OO. Impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene Approach, over 8 years, in 11 cities of Turkey. J Infect Prev 2014; 16:146-154. [PMID: 28989420 DOI: 10.1177/1757177414560249] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 10/19/2014] [Indexed: 12/12/2022] Open
Abstract
AIMS To evaluate the effectiveness of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene Approach in Turkey and analyse predictors of poor hand hygiene compliance. DESIGN An observational, prospective, interventional, before-and-after study was conducted from August 2003 to August 2011 in 12 intensive care units (ICU) of 12 hospitals in 11 cities. The study was divided into a baseline and a follow-up period and included random 30-minute observations for hand hygiene compliance in ICU. The hand hygiene approach included administrative support, supplies availability, education and training, reminders in the workplace, process surveillance, and performance feedback. RESULTS We observed 21,145 opportunities for hand hygiene. Overall hand hygiene compliance increased from 28.8% to 91% (95% CI 87.6-93.0, p 0.0001). Multivariate and univariate analyses showed that several variables were significantly associated with poor hand hygiene compliance: males vs. females (39% vs. 48%; 95% CI 0.79-0.84, p 0.0001), ancillary staff vs. physicians (35% vs. 46%, 95% CI 0.73-0.78, p 0.0001), and adult vs. pediatric ICUs (42% vs. 74%, 95% CI 0.54-0.60, p 0.0001). CONCLUSIONS Adherence to hand hygiene was significantly increased with the INICC Hand Hygiene Approach. Specific programmes should be directed to improve hand hygiene in variables found to be predictors of poor hand hygiene compliance.
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Affiliation(s)
| | - Iftihar Koksal
- Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Victor D Rosenthal
- International Nosocomial Infection Control Consortium (INICC), Buenos Aires, Argentina
| | - Özay Arıkan Akan
- Ankara University School of Medicine, Ibni-Sina Hospital, Ankara, Turkey
| | - Asu Özgültekin
- Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - Tanil Kendirli
- Department of Pediatric Critical Care Medicine, Ankara University School of Medicine, Ankara, Turkey
| | | | | | | | | | - Davut Ozdemir
- Duzce University Medical School Infectious Diseases and Clinical Microbiology, Duzce, Turkey
| | - Emine Alp
- Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | | | - Saban Esen
- Ondokuz Mayis University Medical School, Samsun, Turkey
| | - Fatma Ulger
- Ondokuz Mayis University Medical School, Samsun, Turkey
| | - Ahmet Dilek
- Ondokuz Mayis University Medical School, Samsun, Turkey
| | - Hava Yilmaz
- Ondokuz Mayis University Medical School, Samsun, Turkey
| | - Gürdal Yýlmaz
- Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Selçuk Kaya
- Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Hülya Ulusoy
- Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Melek Tulunay
- Ankara University School of Medicine, Ibni-Sina Hospital, Ankara, Turkey
| | - Mehmet Oral
- Ankara University School of Medicine, Ibni-Sina Hospital, Ankara, Turkey
| | - Necmettin Ünal
- Ankara University School of Medicine, Ibni-Sina Hospital, Ankara, Turkey
| | - Güldem Turan
- Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - Nur Akgün
- Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - Asuman İnan
- Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - Erdal Ince
- Department of Pediatric Critical Care Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Adem Karbuz
- Department of Pediatric Critical Care Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Ergin Çiftçi
- Department of Pediatric Critical Care Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Nevin Taşyapar
- Department of Pediatric Critical Care Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Melek Güneş
- Department of Pediatric Critical Care Medicine, Ankara University School of Medicine, Ankara, Turkey
| | | | - Gaye Usluer
- Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | | | | | | | - Bilgin Arda
- Ege University Medical Faculty, Izmir, Turkey
| | | | - Mustafa Cengiz
- Harran University, Faculty of Medicine, Sanliurfa, Turkey
| | - Leyla Yilmaz
- Harran University, Faculty of Medicine, Sanliurfa, Turkey
| | - Mehmet Faruk Geyik
- Duzce University Medical School Infectious Diseases and Clinical Microbiology, Duzce, Turkey
| | - Ahmet Şahin
- Duzce University Medical School Infectious Diseases and Clinical Microbiology, Duzce, Turkey
| | - Selvi Erdogan
- Duzce University Medical School Infectious Diseases and Clinical Microbiology, Duzce, Turkey
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Leblebicioglu H, Öztürk R, Rosenthal VD, Akan ÖA, Sirmatel F, Ozdemir D, Uzun C, Turgut H, Ersoz G, Koksal I, Özgültekin A, Esen S, Ulger F, Dilek A, Yilmaz H, Dikmen Y, Aygún G, Tulunay M, Oral M, Ünal N, Cengiz M, Yilmaz L, Geyik MF, Şahin A, Erdogan S, Sacar S, Sungurtekin H, Uğurcan D, Kaya A, Kuyucu N, Yýlmaz G, Kaya S, Ulusoy H, İnan A. Impact of a multidimensional infection control approach on central line-associated bloodstream infections rates in adult intensive care units of 8 cities of Turkey: findings of the International Nosocomial Infection Control Consortium (INICC). Ann Clin Microbiol Antimicrob 2013; 12:10. [PMID: 23641950 PMCID: PMC3674978 DOI: 10.1186/1476-0711-12-10] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 02/23/2013] [Indexed: 02/07/2023] Open
Abstract
Background Central 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. Methods We 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. Results During 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. Conclusions The 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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