INICCDatabyCountry HAIrates, Lengthofstay, Mortality, Microorganismprofile, AndbacterialresistanceinICU

.
HAI Rates, Length Of Stay, Mortality,

Microorganism Profile, And Bacterial
Resistance In ICU.
Data By Country:
Findings Of INICC Members
Dr. Victor D. Rosenthal, MD, MSC, CIC

INICC Founder and Chairman
victor_rosenthal@inicc.org
Peer Review Manuscripts
indexed in Pubmed,
published by INICC
Members from:
Latin America
Data collected by Hospital Team, using INICC Surveillance forms and methods, applying CDC NHSN Criteria for HAIs. Data analyzed by Dr.
Victor D. Rosenthal (VDR). Paper drafted by VDR, revised and approved by Hospital Team, and submitted to the journal by VDR
Table 1. Overall nosocomial infection rates by hospital.
Period of this Study: 1998-1999
Hospital Hospital Patients Patients Patient Number of NI per 1000

discharges with NI with NI (%) days NI patient days
(n)
A 23 10 43.0 293 20 68.0
B 101 18 17.8 527 26 49.3
C 89 29 53.9 602 82 136.21
Total 213 57 26.76 1422 128 90
Nosocomial infections in medical-surgical intensive care units in Argentina: attributable mortality and length of stay. Rosenthal
VD, Guzman S, Orellano PAm J Infect Control. 2003 Aug;31(5):291-5.
Table 2. Distribution of nosocomial infection sites
Infection Site N %
Central Line-associated bloodstream infection 41 32
Ventilator-associated pneumonia 32 25
Catheter-associated Urinary tract infection 29 22.6
Peripheral line-associated Phlebitis 2 1.6
Peripheral line-associated BSI 10 7.8

Non ventilator-associated Pneumonia 14 10.9
Total 128 100
Table 3. Site-specific nosocomial infection rates.
Infection site Device days NI Rate per 1000

device days
CR BSI 919 41 44.61
CAUTI 1286 29 22.55
VAP 629 32 50.87
Table 4. Attributable Mortality, Period of this Study:
and ALOS extra Days. 1998-1999
Infection site ALOS Attributable Mortality Attributable

extra days mortality
CR BSI 26.08 13.94 (15/24) 62.5 25.3
CAUTI 17.50 5.36 (6/14) 42.9 5.7
VAP 22.14 10.00 (10/14) 71.4 34.2
Control 12.14 - (16/43) 37.2 -
Table 1. Features of the consortium Period of this
Study: 2002-2004
hospitals and ICUs studied
hospital
Hospital A Hospital B Hospital C Hospital D Overall
Hospitals, n 1 1 1 1 4
Academic 1 0 0 0 1 (25%)
Teac
hing
Public 1 1 1 1 100 (100%)
Private 0 0 0 0 0 (0%)
Community
ICUs, n 2 1 1 1 5
Experience of ICP 5 2 5 7 4-5
(range), years
Patients n 656 289 270 142 1357
Patients-days n 5213 878 1952 839 8882
ASIS score, mean 3.92 (2569/654) 3.29 (861/261) 4.45 (24/107) 3.54 3.62
(297/119) (3834/1058)
Device-associated nosocomial infection rates in intensive care units in four Mexican public hospitals Ramirez Barba EJ,
Rosenthal VD, Higuera F, Oropeza MS, Hernndez HT, Lpez MS, Lona EL, Duarte P, Ruiz J, Hernandez RR, Chavez A,
Cerrato IP, Ramirez GE, Safdar N. Am J Infect Control. 2006 May;34(4):244-7.
Table 2. Device usage in the ICUs studied Period of this Study: 2002-2004
hospital
Total ICU days 5213 878 1952 839 8882
Ventilator-days 1743 67 1352 399 3561
Ventilator usage 0.33 0.08 0.69 0.48 0.40
CVC-days 5593 642 1785 686 8706
CVC usage 1.07 0.73 0.91 0.82 0.98
Urinary catheter- 3116 676 1709 729 6230

days
Catheter usage 0.60 0.77 0.88 0.87 0.70
Table 3. VAP in the participant ICUs Period of this Study: 2002-2004

VAP, no.of cases 40 0 27 2 69
Rate per 100 patients (%) 6.1 0.0 10.0 1.4 5.1 (69/1357)
Rate per 1000 ventilator-days 22.9 0.0 19.9 5.0 19.4 (69/3561)

Proportion of cases (%):
Acinetobacter spp 5.0 0.0 0.0 0.0 2.9
Candida spp. 2.5 0.0 3.7 0.0 2.9
E.Coli 8.0 0.0 0.0 100.0 7.2
Enterobacter 8.0 0.0 26.0 0.0 14.5
Klebsiella 12.5 0.0 3.7 0.0 8.7
Micrococo 5.0 0.0 0.0 0.0 2.9
Proteus 0.0 0.0 4.0 0.0 1.4
Pseudomonas aeruginosa 17.5 0.0 37.0 0.0 24.6
Staphylococcus aureus 12.5 0.0 14.8 0.0 13.0
Coagulase-negative staphylococci 2.5 0.0 3.7 0.0 2.9
Serratia 5.0 0.0 3.7 0.0 4.3
Table 4. CVC- related BSI in the Period of this Study: 2002-2004
participant ICUs
CVC-related BSI, no. of cases 100 4 27 16 147
Rate per 1000 CVC-days 17.9 6.2 15.1 23.3 16.9 (147/8706)

Alcaligenes 2.0 0.0 0.0 0.0 1.6
Candida spp. 0.0 0.0 23.8 0.0 4.1
Citrobacter 1.0 0.0 0.0 0.0 0.8
Criptococcus 1.0 0.0 0.0 0.0 0.8
E.Coli 0.0 0.0 4.8 0.0 0.8
Enterobacter 7.0 0.0 14.3 0.0 8.2
Klebsiella 2.0 0.0 0.0 100.0 2.5
Proteus 2.0 0.0 0.0 0.0 1.6
Staph Staphylococcus aureus 5.0 0.0 4.8 0.0 4.9
Serratia 1.0 0.0 0.0 0.0 0.8
Salmonella 1.0 0.0 0.0 0.0 0.8
Table 5. CAUTI in the participant ICUs Period of this Study: 2002-2004

CAUTI, no. of cases 30 3 31 2 66
Rate per 1000 catheter-days 9.6 4.4 18.1 2.7 10.6 (66/8882)

Candida spp. 3.3 0.0 61.3 0.0 32.8
E.Coli 20.0 100.0 3.2 0.0 12.5
Enterobacter 6.7 0.0 12.9 0.0 9.4
Klebsiella 3.3 0.0 0.0 0.0 1.6
Morgane 3.3 0.0 0.0 0.0 1.6
Proteus 3.3 0.0 0.0 0.0 1.6
Staphylococcus aureus 0.0 0.0 9.7 0.0 4.7
Serratia 23.3 0.0 0.0 0.0 10.9
Table 6. Mortality of device-associated Period of this Study: 2002-2004
nosocomial infections in the participants ICUs
Hospital A Hospital B Hospital C Hospital D Overall RR 95% CI P-value
Overall Crude 25.9 (126/487) 2.5 (7/280) 21.3 (45/211) 14.8 (18/122) 17.8 (196/1100) 1.0 - -
Mortality of patients
without
infection, %
Crude unadjusted 47.5 (19/40) 0.0 (0/0) 25.9 (7/27) 50 (1/2) 39.1 (27/69) 2.20 1.47 3.28 0.0000
attributable mortality
of patients with VAP,
%
Crude unadjusted 52.0 (52/100) 0.0 (0/4) 25.9 (7/27) 6.3 (1/16) 40.8 (60/147) 2.29 1.72 3.06 0.0000
of patients with CVC-
associated BSI, %
Crude unadjusted 36.7 (11/30) 0.0 (0/3) 29.0 (9/31) 0.0 (0/2) 30.3 (20/66) 1.70 1.07 2.69 0.0220
of patients with
CAUTI, %
Table 7. Comparison of device utilization and rates of
deviceassociated nosocomial infection in the ICUs Period of this Study:
of the consortium and in U.S. ICUs. 2002-2004
U.S. NNIS- These hospitals RR

1992-2004
Device utilization
Mechanical ventilator 0.35 0.43* 0.40 (0.08 0.69) + 0.93
Central vascular 0.49 - 0.56 0.98 (0.73 - 1.07) 1.75
catheter
Urinary catheter 0.78 0.82 0.70 (0.60 0.88) 0.85

Rates, per 1000 device-days
Ventilator-associated 4.6 5.1 19.4 (5.0 22.9) 3.8
pneumonia
CVC-associated 3.1 - 3.4 16.9 (6.2 23.3) 5.0
bloodstream infection
Catheter-associated 3.1- 3.3 10.6 (2.7 18.1) 3.2
urinary tract infection

Data collected by Hospital Team, using INICC Surveillance forms and methods, applying CDC NSHN Criteria for HAIs. Data analyzed by Dr.
TABLE 1. Features of three International Nosocomial Period of this Study:
Infection Control Consortium member hospitals in Brazil 2003-2006
Variable Hospital A Hospital B Hospital C Total
Hospitals, n 1 1 1 3
Academic teaching 0 1 0 1 (33.3%)
Public 1 0 0 1 (33.3%)
Private community 0 0 1 1 (33.3%)
Hospital beds, n 750 480 180 1410
Experience of infection 6 14 9 6-14
control practitioners, y
Intensive care units 3 1 1 5
(ICUs), n
ICU type Medical-surgical Medical-surgical Medical-surgical Medical-surgical
ICU beds, n 35 14 9 58
Surveillance period 10/03 to 10/04 4/03 to 6/03 6/04 to 2/06 4/03 to 2/06
Patients studied, n 705 142 184 1031
Total ICU days, d 7942 673 1678 10293
Male, % 55.3 52.8 50.5 54.1%
Mean age of patient, y 53.6 55.7 68.1 56.5
Mean ASISa 3.59 2.57 3.90 3.51
Device utilization (DU)b
Ventilator, d 5344 424 734 6502
Ratio of ventilator use 0.67 0.63 0.44 0.63
Central venous 7648 620 1226 9494
catheter, d
Ratio of central 0.96 0.92 0.73 0.92
venous catheter use
Urinary catheter, d 6768 619 1430 8817
Ratio of urinary 0.85 0.92 0.85 0.86
catheter use
Device-associated infection rates in intensive care units of Brazilian hospitals: findings of the International Nosocomial Infection Control Consortium Salomao R, Rosenthal
VD, Grimberg G, Nouer S, Blecher S, Buchner-Ferreira S, Vianna R, Maretti-da-Silva MA. Rev Panam Salud Publica. 2008 Sep;24(3):195-202.
TABLE 2. Device-associated infections per 1000 Period of this Study:
device-days in intensive care units of three 2003-2006
Brazilian INICC member hospitals
Infection Device Device- DAIs (n) Distribution Rate per Rate per
site type days (n) of DAIs (%) 100 1000
patients device-
daysa
VAP MV 6502 254 44.3 13.2 20.9
CVC-BSI CVC 9494 26 28.0 8.3 9.1
CAUTI UC 8817 27 27.7 8.2 9.6
Device-associated infection rates in intensive care units of Brazilian hospitals: findings of the International Nosocomial Infection
Control Consortium Salomao R, Rosenthal VD, Grimberg G, Nouer S, Blecher S, Buchner-Ferreira S, Vianna R, Maretti-da-Silva
MA. Rev Panam Salud Publica. 2008 Sep;24(3):195-202.
TABLE 3. Microbiological profile of DAIs in Period of this Study:
the intensive care units of three INICC 2003-2006
member hospitals in Brazil
Pathogen Proportion of cases (%)
Enterobacteriaceae 22.8
Pseudomonas spp. 22.6
Candida spp. 15.9
Acinetobacter spp. 14.6
Staphylococcus aureus 11.3
Coagulase-negative staphylococci 8.4
Enterococcus spp. 2.5
Stenotrophomonas spp. 0.8
Streptococcus spp. 0.8
TABLE 4. Resistance of pathogens in the intensive care Period of this Study:
units of three INICC member hospitals in Brazil 2003-2006
Bacteria Antibiotic used Percentage resistance

Enterobacteriaceae Ceftriaxone 96.7
Enterobacteriaceae Ceftazidime 79.3
Enterobacteriaceae Piperacillin-tazobactam 85.7
Enterococci Vancomycin 0.0
P. aeruginosa Ciprofloxacin 71.3
P. aeruginosa Ceftazidime 75.5
P. aeruginosa Imipenem 27.7
P. aeruginosa Piperacillin-tazobactam 100
S. aureus Methicillin 95.7
Table 1. Features of the consortium Period of this Study:
hospitals and ICUs studied 2002-2005
Hospital
A B C D E F G H I Overall
Hospitals, n 1 1 1 1 1 1 1 1 1 9
Academic 1 0 1 0 0 0 0 0 0 2 (22.2%)
teaching
Public 0 0 0 0 0 1 0 1 1 3 (33.3%)
Private 0 1 0 1 1 0 1 0 0 4 (44.4%)
Community
ICUs, n 1 1 2 1 1 1 1 1 1 10
Experience of 8 5 8 15 4 4 30 4 5 4-30
ICP (range),
years
Patients n 478 154 578 291 239 58 52 26 296 2172
Patients-days n 3878 1127 3210 1497 1108 542 372 233 2636 14603
Sex % (male) 58.6 59.1 55.9 44.0 59.0 51.7 40.4 53.8 56.4 55.0
Device-associated infection rate and mortality in intensive care units of 9 Colombian hospitals: findings of the International
Nosocomial Infection Control Consortium.Moreno CA, Rosenthal VD, Olarte N, Gomez WV, Sussmann O, Agudelo JG, Rojas C,
Osorio L, Linares C, Valderrama A, Mercado PG, Bernate PH, Vergara GR, Pertuz AM, Mojica BE, Navarrete Mdel P, Romero AS,
Henriquez D. Infect Control Hosp Epidemiol. 2006 Apr;27(4):349-56.
Table 2. Overall microbiological profile and bacterial
resistance in the participant ICUs Period of this Study:
2002-2005
Acinetobacter 4.5
Alcaligenes 0.6
Candida 5.1
E.Coli 14.2
Enterobacter 7.4
Enterococcus 2.3
Haemophilius 2.3
Klebsiella 14.8
Proteus 1.1
Pseudomonas aeruginosa 11.4
Staphylococcus aureus 25.6
Coagulase-negative staphylococci 9.7
Serratia 0.6
Streptococcus 0.6

Susceptibility of microorganisms (% resistant):
S. aureus / methicillin (MRSA) 65.4 (17/26)
Enterobacteriaceae / ceftriaxone 40.0 (10/25)
Enterobacteriaceae / ceftazidima 28.3 (13/46)
Enterobacteriaceae / piperacilina tazobactma 37.5 (6/16)
P. aeruginosa / ciprofloxacina 40.0 (6/15)
P. aeruginosa / ceftazidima 50.0 (5/10)
P. aeruginosa / imipenem 19.0 (4/21)
P. aeruginosa / piperacilina tazobactma 33.3 (2/6)
Enterococci/ vancomycin 0.0
Table 3. Device associated infection rates in the
participant ICUs Period of this Study:
2002-2005
VAP, no. of cases 86

Rate per 100 patients (%) 4.0 (86/2172)
Rate per 1000 ventilator-days 10.0 (86/8593)
CVC-related BSI, no. of cases 126
Rate per 1000 CVC-days 11.3 (126/11110)
CAUTI, no. of cases 54
Rate per 1000 catheter-days 4.3 (54/12433)
Table 4. Extra Mortality of device-associated Period of this Study:
nosocomial infections in the participants ICUs 2002-2005
Crude Extra RR IC % P. value

Mortality mortality
Patients without 18.1 - 1.0
infection, %
Patients with VAP, % 35.0 16.9 1.93 1.24 3.00 0.0028
Patients with CVC- 36.6 18.5 2.02 1.42 2.87 0.0000

associated BSI, %
Patients with CAUTI, % 28.6 10.5 1.58 0.78 3.18 0.1987
Table 5. Comparison of device utilization and rates of device
associated nosocomial infection in the ICUs of the consortium and Period of this Study:
in U.S. ICUs. 2002-2005
U.S. NNIS- INICC Hospitals- RR
1992-2004 1 2002-2005
Device utilization
Mechanical ventilator 0.35 0.43* 0.59 1.37
Central vascular catheter 0.49 - 0.56 0.76 1.35
Urinary catheter 0.78 0.82 0.85 1.03

Ventilator-associated pneumonia 4.6 5.1 10.0 1.96
CVC-associated bloodstream infection 3.1 - 3.4 11.3 3.32
Catheter-associated urinary tract 3.1- 3.3 4.3 1.30
infection

Proportion (%) of device-associated infections
with resistance:
S.aureus / methicillin. 48.1 36.2 0.75

Enterobacteriaceae / ceftriaxone 17.4 36.2 2.08
Enterococci / vancomycin 13.6 0.0 -
Table 1. Features of the International Nosocomial Infection
Control Consortium Hospitals and Intensive Care Units* Period of this Study:
Hospitals A and B, Havana, Cuba. 2006-2009
Variable Medical Surgical ICU Trauma ICU Overall

ICUs, n 1 1 2
Hospitals, n (%) 1 1 2
Academic teaching 1 1 2 (100%)
Public 0 0 0
Private community 0 0 0
Patients studied, n 836 1,146 1,982
Total ICU days, d 4,762 9,750 14,512
Device use*
Ventilator days, d 1,902 4,515 6,417
Ventilator use, 0.40 0.46 0.44
CL days, d 3,028 6,863 9,891
CL use, 0.64 0.70 0.68
Urinary catheter days, d 3,867 6,822 10,689
Urinary catheter use, 0.81 0.70 0.74
Device-associated infection rates in adult intensive care units of Cuban university hospitals: International Nosocomial Infection
Control Consortium (INICC) findings. Guanche-Garcell H, Requejo-Pino O, Rosenthal VD, Morales-Prez C, Delgado-Gonzlez
O, Fernndez-Gonzlez D. Int J Infect Dis. 2011 May;15(5):e357-62.
Table 2. Device associated infections per 1000 devices
days: VAP, CLA-BSI, and CAUTI. Hospitals A and B, Period of this Study:
Havana, Cuba. 2006-2009
Infection site Device Device- DA-HAI Distribution of device Rate per Rate per
type days associated DA-HAI (%) 100 patients 1000 device-days
VAP (Overall rate) MV 6,417 337 76% 17.0% 52.5 (95% CI 47.2 58.3)
Trauma ICU MV 4,515 298 78% 26.0% 66.0 (95% CI 58.9 73.7)
Medical Surgical ICU MV 1,902 39 63% 4.7% 20.5 (95% CI 14.6 27.9)
CLA-BSI (Overall rate) CL 9,891 20 4% 1.0% 2.0 (95% CI 1.2 3.1)
Trauma ICU CL 6,863 13 3% 1.1% 1.9 (95% CI 1.0 3.3)
Medical Surgical ICU CL 3,028 7 11% 0.8% 2.3 (95% CI 0.9 4.8)
CAUTI (Overall rate) UC 10,689 87 20% 4.4% 8.1 (95% CI 6.5 10.0)
Trauma ICU UC 6,822 71 19% 6.2% 10.4 (95% CI 8.1 13.1)
Medical Surgical ICU UC 3,867 16 26% 1.9% 4.1 (95% CI 2.4 6.7)
Table 3.Hand Hygiene compliance in the participant ICUs. Period of this Study:
Comparison per stratum. Hospital A, Havana, Cuba. 2006-2009
Variable % ( # HH / Comparison RR 95% CI P.Value

# opportunities)
Gender Female 45.2% F vs M 1.15 0.83 - 1.58 0.3921
Male 51.9%
HCW Nurses 49.3% Ns vs Ph 1.48 0.21 - 10.57 0.6950
Physicians 43.3% Ns vs AS 1.14 0.64 - 2.01 0.6574
Ancillary Staff 33.3% Ph vs AS 1.30 0.17 - 9.94 0.7998
Procedure Non-invasive 46.3% NI vs I 1.15 0.82 - 1.61 0.4218
invasive 53.1%
Work Shift Morning 49.5% M vs A 1.05 0.76 - 1.46 0.7746
Afternoon 47.2%
Table 4. Extra Mortality of patients with device-associated Period of this Study:
nosocomial infections in the Medical-Surgical ICU. Hospital 2006-2009
A, Havana, Cuba.
Crude Extra
patients (n)* RR 95% CI P-value
Mortality Mortality
Patients
without 782 33.0% - 1.0
infection, %
Patients with
4 50.0% 17% 1.52 0.4 6.1 0.5552
CLA-BSI, %
Patients with
5 80.0% 47% 2.42 0.9 6.5 0.0693
VAP, %
Table 5. Extra Length of stay of patients with device-
Period of this Study:
associated nosocomial infections in the Medical-Surgical
2006-2009
ICU.Hospital A, Havana, Cuba.
Average Length Extra Length

95% CI RR
of Stay of Stay
Patients without infection, days 4.9 - 4.6 - 5.2 1.0
Patients with CLA-BSI, days 23.3 18.3 9.4 - 85.8 4.7
Patients with VAP, days 23.8 18.9 10.5 - 73.3 4.9
Table 6. Microorganism profile in the participant Period of this Study:
ICUs. Hospital A, Havana, Cuba. 2006-2009
Microorganism CLA-BSI related VAP related CAUTI related Overall %

related to DA-HAI
Acinetobacter spp. 33.3% 15.4% 0% 10.3%
Escherichia coli 33.3% 15.4% 53.8% 34.5%
Klebsiella spp. 0% 23.1% 15.4% 17.2%
Pseudomonas spp. 0% 30.8% 7.7% 17.2%
Pneumoccoccus spp. 0% 7.7% 0% 3.4%
coagulasa negative 33.3% 7.7% 23.1% 17.2%

Staphylococcus
Table 1. Features of the consortium hospitals, ICUs Period of this Study:
and patients studied 2003-2007
Overall
Hospital A Hospital B Hospital C
Hospitals, n 1 1 1 3
Academic Teaching 0 0 0 0
Public 1 0 1 2 (66.7%)
Private Community 0 1 0 1 (33.3%)
ICUs, n 1 1 1 3
Experience of ICP (range), years 8 2 8 6
Patients n 473 357 345 1175
Patients-days n 2129 1577 1935 5641
Sex % (male) 50.1 64.4 56.5 56.3 (662/5641)
Age 47.3 61.6 62.5 56.1
ASIS score, mean 2.76 2.28 3.17 2.70
Device-associated infection rates and mortality in intensive care units of Peruvian hospitals: findings of the International
Nosocomial Infection Control Consortium. Cuellar LE, Fernandez-Maldonado E, Rosenthal VD, Castaneda-Sabogal A, Rosales
R, Mayorga-Espichan MJ, Camacho-Cosavalente LA, Castillo-Bravo LI. Rev Panam Salud Publica. 2008 Jul;24(1):16-24.
Table 2. Global rates of health care associated 2003-2007
infection by 100 patients and by 1000 bed days
Hospital A Hospital B Hospital C Overall

Number of HCAI 46 48 38 132
Number of patients 473 357 345 1175
HCAI (%) 9.7 13.4 11.0 11.2
Bed days 2129 1577 1935 5641
HCAI per 1000 21.6 30.4 19.6 23.4

bed days
Table 3. Proportion of Health care associated 2003-2007
infections in the ICU studied
Total NI 46 48 38 132
Proportion of
69.6 47.9 65.8 60.6
VAP (%)
Proportion of
CVC-related BSI 13.0 29.2 26.3 22.7
(%)
Proportion of
17.4 22.9 7.9 16.7
CAUTI (%)
Table 4. Device usage in the ICUs studied 2003-2007

Total ICU days 2129 1577 1935 5641
Ventilator-days 964 552 1184 2700

Ventilator usage 0.45 0.35 0.61 0.48
CVC-days 1310 1063 1458 3831

CVC usage 0.62 0.67 0.75 0.68
Urinary 1733 936 1830 4499

catheter-days
Catheter usage 0.81 0.59 0.95 0.80
Table 5. Overall microbiological profile and bacterial Period of this Study:
resistance in the participant ICUs 2003-2007
Acinetobacter 7.5 (3/40) 0 8.0 (2/25) 4.7 (5/107)
Candida spp. 10.0 (4/40) 33.3 (14/42) 0 16.8 (18/107)
Citrobacter 0 0 4.0 (1/25) 0.9 (1/107)
E.Coli 10.0 (4/40) 11.9 (5/107) 8.0 (2/25) 10.3 (11/107)
Enterobacter 10.0 (4/40) 19.0 (8/42) 4.0 (1/25) 12.1 (13/107)
Enterococcus 7.5 (3/40) 0 4.0 (1/25) 3.7 (4/107)
Klebsiella 5.0 (2/40) 2.4 (1/42) 16.0 (4/25) 6.5 (7/107)
Pseudomonas aeruginosa 12.5 (5/40) 14.3 (6/42) 20.0 (5/25) 15.0 (16/107)
Staphylococcus aureus 20.0 (8/40) 11.9 (5/42) 32.0 (8/25) 19.6 (21/107)
Coagulase-negative staphylococci 15.0 (6/40) 0 4.0 (1/25) 6.5 (7/107)
Streptococcus sp 0 7.1 (3/42) 0 2.8 (3/107)
Stenotropomonas 2.5 (1/40) 0 0 0.9 (1/107)
Susceptibility of microorganisms
(% resistant):
S. aureus / methicillin (MRSA) 90.0 (9/10) 33.3 (3/9) 94.7 (18/19) 78.9 (30/38)
Enterobacteriaceae / ceftriaxone 0.0 (0/2) 6.8 (3/44) 71.4 (20/28) 31.1 (23/74)
Enterobacteriaceae / ceftazidima 50.0 (2/4) 5.1 (2/39) 70.8 (17/24) 31.3 (21/67)
Enterobacteriaceae / piperacillin 0.0 (0/1) 0.0 (0/4) 34.6 (9/26) 29.0 (9/31)
tazobactam
P. aeruginosa / ciprofloxacina 60.0 (3/5) 42.9 (3/7) 82.4 (14/17) 69.0 (20/29)
P. aeruginosa / ceftazidima 57.1 (4/7) 46.2 (6/13) 77.8 (14/18) 63.2 (24/38)
P. aeruginosa / imipenem 0.0 (0/3) 50.0 (1/2) 52.9 (9/17) 45.5 (10/22)
P. aeruginosa / piperacilin tazobactam 0 0.0 (0/1) 33.3 (6/18) 31.6 (6/19)
Enterococci/ vancomycin 0 0 0 0.0 (0/0)
Acinetobacter / piperacilin tazobactam 0 0 75.0 (3/4) 75.0 (3/4)
VAP, no.of cases 32 23 25 80
Rate per 100 patients (%) 6.8 6.4 7.2 6.8 (80/1175)
Rate per 1000 ventilator-days 33.2 41.7 21.1 29.6 (80/2700)

Acinetobacter 7.1 (2/28) 0 5.0 (1/20) 4.2 (3/71)
Candida spp. 7.1 (2/28) 21.7 (5/23) 0 9.9 (7/71)
E.Coli 7.1 (2/28) 0 10.0 (2/20) 5.6 (4/71)
Enterobacter 7.1 (2/28) 26.1 (6/23) 0 11.3 (8/71)
Enterococcus 3.6 (1/28) 0 5.0 (1/20) 2.8 (2/71)
Klebsiella 7.1 (2/28) 4.3 (1/23) 20.0 (4/20) 9.9 (7/71)
Pseudomonas aeruginosa 14.3 (4/28) 21.7 (5/23) 25.0 (5/20) 19.7 (14/71)
Coagulase-negative staphylococci 17.9 (5/28) 0 5.0 (1/20) 8.5 (6/71)
Stenotropomonas 3.6 (1/28) 0 0 1.4 (1/71)
Streptococcus sp 0 13.0 (3/23) 0 4.2 (3/71)
(% resistant):
S. aureus / methicillin (MRSA) 90.0 (9/10) 28.6 (2/7) 92.9 (13/14) 77.4 (24/31)
Enterobacteriaceae / ceftriaxone 0.0 (0/2) 5.3 (1/19) 75.0 (9/12) 30.3 (10/33)
Enterobacteriaceae / ceftazidima 50.0 (2/4) 5.6 (1/18) 72.7 (8/11) 33.3 (11/33)
Enterobacteriaceae / piperacillin tazobactam 0.0 (0/1) 0.0 (0/3) 42.9 (6/14) 33.3 (6/18)
P. aeruginosa / ciprofloxacina 60.0 (3/5) 33.3 (2/6) 82.4 (14/17) 67.9 (19/28)
P. aeruginosa / ceftazidima 66.7 (4/6) 46.2 (6/13) 77.8 (14/18) 64.9 (24/37)
P. aeruginosa / imipenem 0.0 (0/2) 50.0 (1/2) 52.9 (9/17) 47.6 (10/21)
P. aeruginosa / piperacilin tazobactam 0 0.0 (0/1) 33.3 (6/18) 31.6 (6/19)
Enterococci/ vancomycin 0 0 0 0.0 (0/0)
Acinetobacter / piperacilin tazobactam 0 0 75.0 (3/4) 75.0 (3/4)
Table 7. CVC- related BSI in the participant ICUs Period of this Study: 2003-2007

CVC-related BSI, no. of cases 6 14 10 30
Rate per 1000 CVC-days 4.6 13.2 6.9 7.8 (30/3831)

Acinetobacter spp 0 0 33.3 (1/3) 6.3 (1/16)
Candida spp. 40.0 (2/5) 37.5 (3/8) 0 31.3 (5/16)
Enterobacter 20.0 (1/5) 25.0 (2/8) 0 18.8 (3/16)
Pseudomonas aeruginosa 0 12.5 (1/8) 0 6.3 (1/16)
Coagulase-negative staphylococci 20.0 (1/5) 0 0 6.3 (1/16)
(% resistant):
S. aureus / methicillin (MRSA) 0 50.0 (1/2) 100.0 (5/5) 85.7 (6/7)
Enterobacteriaceae / ceftriaxone 0 20.0 (1/5) 80.0 (4/5) 50.0 (5/10)
Enterobacteriaceae / ceftazidima 0 0.0 (0/2) 100.0 (2/2) 50.0 (2/4)
Enterobacteriaceae / piperacillin tazobactam 0 0.0 (0/1) 14.3 (1/7) 12.5 (1/8)
P. aeruginosa / ciprofloxacina 0 100.0 (1/1) 0 100.0 (1/1)

P. aeruginosa / ceftazidima 0 0 0 0 (0/0)
P. aeruginosa / imipenem 0 0 0 0 (0/0)
P. aeruginosa / piperacillin tazobactam 0 0 0 0 (0/0)
Enterococci / vancomycin 0 0 0 0 (0/0)

Acinetobacter / piperacillin tazobactam 0 0 0 0 (0/0)

CAUTI, no. of cases 8 11 3 22
Rate per 1000 catheter-days 4.6 11.8 1.6 4.9 (30/4499)

Acinetobacter 14.3 (1/7) 0 0 5.0 (1/20)
Candida spp. 0 54.5 (6/11) 0 30.0 (6/20)
Citrobacter 0 0 50.0 (1/2) 5.0 (1/20)
E.Coli 28.6 (2/7) 45.5 (5/11) 0 35.0 (7/20)
Enterobacter 14.3 (1/7) 0 50.0 (1/2) 10.0 (2/20)
Enterococcus 28.6 (2/17) 0 0 10.0 (2/20)
Pseudomonas aeruginosa 14.3 (1/7) 0 0 5.0 (1/20)
(% resistant):
S. aureus / methicillin (MRSA) 0 0 0 0.0 (0/0)
Enterobacteriaceae / ceftriaxone 0 5.0 (1/20) 63.6 (7/11) 25.8 (8/31)
Enterobacteriaceae / ceftazidima 0 5.3 (1/19) 63.6 (7/11) 26.7 (8/30)
Enterobacteriaceae / piperacillin tazobactam 0 0 40.0 (2/5) 40.0 (2/5)
P. aeruginosa / ciprofloxacina 0 0 0 0.0 (0/0)
P. aeruginosa / ceftazidima 0.0 (0/1) 0 0 0.0 (0/1)
P. aeruginosa / imipenem 0.0 (0/1) 0 0 0.0 (0/1)
P. aeruginosa / piperacillin tazobactam 0 0 0 0.0 (0/0)
Enterococci / vancomycin 0 0 0 0.0 (0/0)
Acinetobacter / piperacillin tazobactam 0 0 0 0.0 (0/0)
Table 9. Mortality of device-associated Period of this Study:
infections in the participants ICUs 2003-2007
Attributable
Hospital A Hospital B Hospital C Overall RR IC % P. value
mortality
Overall Crude Mortality of

13.8
patients without infection, 15.3 (65/425) 7.0 (22/313) 18.9 (57/302) 1.0
(144/1040)
%
Crude unadjusted
2.4 1.51
attributable mortality of 40.0 (10/25) 21.4 (3/14) 33.3 (7/21) 33.3 (20/60) 19.5 0.0001
1 3.84
patients with VAP, %
Crude unadjusted
attributable mortality of 2.1 0.96
50.0 (1/2) 20.0 (2/10) 37.5 (3/8) 30.0 (6/20) 16.2 0.0571
patients with CVC- 7 4.90
associated BSI, %
Crude unadjusted
1.1 0.28
attributable mortality of 20.0 (1/5) 0.0 (0/6) 50.0 (1/2) 15.4 (2/13) 1.6 0.8823
1 4.49
patients with CAUTI, %
Table 10. Comparison of device utilization and rates of device Period of this Study:
associated health care associated infection in the ICUs of 2003-2007
Peru and in U.S. ICUs.
U.S. NNIS- Hospitals RR

1992-2004
Device utilization
Mechanical ventilator 0.35 0.43* 0.48 (0.35 0.61) + 1.11
Central vascular catheter 0.49 - 0.56 0.68 (0.62 0.75) 1.21
Urinary catheter 0.78 0.82 0.80 (0.59 0.95) 0.97

Ventilator-associated pneumonia 4.6 5.1 29.6 (21.1 41.7) 5.80
CVC-associated bloodstream infection 3.1 - 3.4 7.8 (4.6 13.2) 2.29
Catheter-associated urinary tract infection 3.1- 3.3 4.9 (4.6 11.8) 1.48
Proportion (%) of device-associated infections with resistance:
S.aureus / methicillin. 48.1 78.9 (30/38) 1.64

Enterobacteriaceae / ceftriaxone 17.4 31.1 (23/74) 1.78
Enterococci / vancomycin 29.1 0.0 (0/0) -
Table 1. Features of the pediatric and neonatal Intensive
2007-2009
Care Units
Variable pediatric ICU neonatal ICU Overall

ICUs, n 1 1
Patients studied, n 1,145 1,270 2,415
Total ICU days, d 9,517 30,663 40,180
Device use*
Ventilator days, d 7,709 8,634 16,343
Ventilator use 0.81 0.28 0.41
Central line days, d 6,344 15,819 22,163
Central line use 0.67 0.52 0.55
Urinary catheter days, d 3,437 - 3,437
Urinary catheter use** 0.36 - 0.36
Device-associated infections rates in pediatrics and neonatal intensive care units in El Salvador: findings of the INICC. Dueas
L, Bran de Casares A, Rosenthal VD, Jess Machuca L. J Infect Dev Ctries. 2011 Jul 4;5(6):445-51.
Table 2. Device-associated infections per 1000 devices days:
2007-2009
VAP, CLA-BSI, and CAUTI in pediatric and neonatal ICU
ICU Infection Device Device- DA- Distribution of device Rate per Rate per
site type days HAI associated HAI (%) 100 patients (%) 1000 device-days*
PICU VAP MV 7,709 93 53 8.1 12.1 (95% CI 9.7 14.8)

CLA-BSI CL 6,344 64 36 5.6 10.1 (95% CI 7.8 12.8)
CAUTI UC 3,437 20 11 1.7 5.8 (95% CI 3.6 9.0)
NICU VAP MV 8,634 139 47 10.9 16.1 (95% CI 13.5 19.0)
CLA-BSI CL 15,819 157 53 12.4 9.9 (95% CI 8.4 11.6)
Table 3. Extra mortality of patients with device-
associated nosocomial infections in the pediatric Period of this Study:
and neonatal ICUs 2007-2009
ICU Patient infection site number of Crude Extra RR 95% CI P-value

patients* Mortality Mortality (%)
PICU no HAI, % 994 13.6% - 1.0 11.5 15.9

CLA-BSI 40 25.0% 11.4 1.84 0.97 - 3.50 0.0586
VAP 63 19.0% 5.5 1.4 0.78 - 2.53 0.2592
CAUTI 11 18.2% 4.6 1.34 0.33 - 5.41 0.681
NICU no HAI 962 12.3% - 1.0

CLA-BSI 108 38.0% 25.7 3.09 2.17 - 4.42 0.0001
VAP 100 23.0% 10.7 1.88 1.20 - 2.93 0.0050
Table 4. Extra length of stay of patients with Period of this Study:
device-associated nosocomial infections in the 2007-2009
pediatric and neonatal ICUs.
Average Extra
ICU Patient infection site* RR 95% CI
Length of Stay Length of Stay
no HAI 6.2 - 6.2 5.8 - 6.5
PICU CLA-BSI 19.1 12.9 19.1 14.1 - 26.5

VAP 18.6 12.4 18.6 11.8 - 24.0
CAUTI 13.5 7.4 13.5 7.8 - 26.8
no HAI 16.7 16.7 15.7 - 17.8

NICU
CLA-BSI 37.7 21.0 37.7 31.3 - 45.9

VAP 42.3 25.5 42.3 34.8 - 51.9
Table 5. Microorganism distribution in the Period of this Study:
participant ICUs 2007-2009
Microorganism
CLA-BSI related (%) VAP related (%) CAUTI related (%) Overall (%)
related to DA-HAI
Candida sp. 37.5 0.0 36.3 28.0
Pseudomonas sp. 12.5 66.6 18.2 28.0
Escherichia coli 12.5 16.7 9.1 12.0
Klebsiella sp. 12.5 0.0 18.2 12.0

Coagulase Nega8ve
25.0 0.0 9.1 12.0
Staphylococci
Acinetobacter sp. 0.0 16.7 - 4.0
Citrobacter sp. 0.0 0.0 9.1 4.0
indexed in Pubmed,
published by INICC
Members from:
Europe
Table I. Features of the consortium hospitals Period of this Study:
and patients studied ICUs 2002-2005
Hospital
A B C D E F G H I J K L Overall
Hospitals, n 1 1 1 1 1 1 1 1 1 1 1 1 12
ICUs, n 1 2 1 1 1 1 1 1 1 1 1 1 13
Experience 3 13 5 5 7 3 12 3 8 4 6 3 3-13
of ICP
(range),
years
Surveillan 10/03 to 9/03 to 6/04 to 1/04 to 1/04 to 8/03 to 1/04 to 5/05 to 1/04 to 9/05 to 2/04 to 10/05 to 8/03 to
ce period 04/06 12/05 4/06 1/06 1/06 10/04 2/06 1/06 8/04 12/05 5/04 3/06 04/06
Patients n 656 479 412 343 337 317 310 220 53 34 21 106 3,288
Patients- 6,512 6,543 6,154 3,190 4,313 3,230 4,106 1,427 620 490 393 653 37,631
days n
ASIS score, 4.47 2.46 3.61 2.55 3.11 4.11 3.59 3.44 3.68 3.47 3.10 3.27 3.47
mean
Sex (male), 61.4 56.3 73.2 62.2 64.2 53.9 53.0 65.5 50.9 67.6 52.4 61.3 61.0
%
Age (years), 51.9 52.5 42.1 49.2 47.9 59.0 46.1 39.7 58.1 57.5 65.6 59.06 49.86
mean
Device-associated hospital-acquired infection rates in Turkish intensive care units. Findings of the International Nosocomial
Infection Control Consortium (INICC). Leblebicioglu H, Rosenthal VD, Arikan OA, Ozgltekin A, Yalcin AN, Koksal I, Usluer G,
Sardan YC, Ulusoy S; Turkish Branch of INICC. J Hosp Infect. 2007 Mar;65(3):251-7.
Table II. Device associated infections per 1000 devices Period of this Study:
days: VAP, CVC- BSI, and CAUTI. 2002-2005
Infection Device Device- Device HAI Distribution of Rate per Rate per 1000
site type days utilization device associated 100 patients device-days
HAI (%)
VAP MV 23,520 0.63 623 47.4 18.9 26.5
CVC-BSI CVC 22,782 0.61 400 30.4 12.2 17.6
CAUTI UC 35,237 0.94 291 22.2 8.9 8.3
Table III. Overall susceptibility of microorganisms Period of this Study:
(% resistant): 2002-2005
Susceptibility of microorganisms % resistant
S. aureus / methicillin (MRSA) 89.2

Enterobacteriaceae / ceftriaxone 48.2
Enterobacteriaceae / ceftazidima 52.0
Enterobacteriaceae / piperacillin tazobactam 33.2
P. aeruginosa / ciprofloxacina 51.1
P. aeruginosa / ceftazidima 50.7
P. aeruginosa / imipenem 38.7
P. aeruginosa / piperacilin tazobactam 30.0
Enterococci/ vancomycin 1.9
Acinetobacter / piperacilin tazobactam 87.1
Table 1. Characteristics of the Intensive Care Period of this Study:
Unit 2007-2010
Patients studied, n 847

Total ICU days, d 9,386
Device use*
Ventilator days, d 7,089
Ventilator use, 0.76
CL days, d 8,725
CL use, * 0.93
Urinary catheter days, d 8,720
Urinary catheter use, 0.93
Device-associated infection rates and extra length of stay in an intensive care unit of a university hospital in Wroclaw, Poland:
International Nosocomial Infection Control Consortium's (INICC) findings. Kbler A, Duszynska W, Rosenthal VD, Fleischer M,
Kaiser T, Szewczyk E, Barteczko-Grajek B. J Crit Care. 2012 Feb;27(1):105.e5-10.
Table 2. Device associated infections rates (VAP, CLA-BSI, Period of this Study:
and CAUTI 2007-2010
Infection site Device Device- DA- Distribution Rate per 100 Rate per 1000
type days HAI of DA-HAI patients device-days
(%)
VAP MV 7,089 129 62.6% 15.2% 18.2 (15.5 21.6)
CLA-BSI CL 8,725 35 17.0% 4.1% 4.01 (2.8 5.6)
CAUTI UC 8,720 42 20.4% 0.5% 4.8 (3.5 6.5)
Table 3. Excess length of stay of patients with device- Period of this Study:
associated infections 2007-2010
Average Length Extra Length of

95% CI RR
of Stay Stay
Patients without
6.9 - 5.8 8.5 1.0
infection, days
Patients with
10.0 3.1 3.2 87.7 1.4
CLA-BSI, days
Patients with
15.5 8.6 6.4 56.9 2.2
VAP, days
Patients with
15.0 8.1 4.5 132.6 2.2
CAUTI, days
indexed in Pubmed,
published by INICC
Members from:
Asia
Table 1. Features of the participant Hospitals and patients. 2004-2007
Hospital A B C D E F G Overall
ICUs, n 1 3 4 1 1 1 1 12
Surveillance Period 7/04 to 7/05 9/04 to 5/06 4/06 to 3/07 7/05 to 3/07 1/05 to 3/06 1.07 to 3/07 2/06 to 3/06 7/04 to 3/07
Experience of the 17 17 2 2 20 2 1 1-20

infection control
practitioner, y
Patients studied, n 3,052 2,655 2,151 2,032 751 151 43 10,835
Total ICU days, d 15,302 14,681 8,121 10,532 2,873 791 218 52,518
Men, % 84.0 81.3 62.8 66.1 69.2 79.5 74.4 74.6
Mean age, y 58.2 57.6 55.76 56.37 43.46 49.32 42.7 56.0
Mean ASIS 2.34 2.10 3.15 2.51 3.69 3.99 2.70 2.60
Device use
Ventilator days, d 3,632 680 2,846 4,060 1,903 228 132 13,481
Ventilator use, 0.24 0.05 0.35 0.39 0.66 0.29 0.61 0.26
proportion
CVC days, d 17,960 5,030 3,054 7,081 3,196 30 196 36,857
CVC use, 1.17 0.34 0.38 0.67 1.11 0.43 0.90 0.70
proportion
Urinary catheter 9,213 3,748 5,289 8,519 2,824 662 209 30,464
days, d
Urinary catheter 0.60 0.26 0.65 0.81 0.98 0.84 0.96 0.58
use, proportion
Device-associated nosocomial infection rates in intensive care units of seven Indian cities. Findings of the International Nosocomial Infection Control Consortium
(INICC). Mehta A, Rosenthal VD, Mehta Y, Chakravarthy M, Todi SK, Sen N, Sahu S, Gopinath R, Rodrigues C, Kapoor P, Jawali V, Chakraborty P, Raj JP, Bindhani D,
Ravindra N, Hegde A, Pawar M, Venkatachalam N, Chatterjee S, Trehan N, Singhal T, Damani N. J Hosp Infect. 2007 Oct;67(2):168-74.
Table 2. HAIs per 1000 devices days: VAP, Period of this Study:
CVC-BSI, and CAUTI. 2004-2007
Infection Device Device- Device HAI Distribution Rate per Rate per
site type days utilization of HAI (%) 100 1000
patients device-
days
VAP MV 13,481 0.26 141 29.6% 1.3% 10.46
CVC-BSI CVC 36,857 0.70 292 61.3% 2.7% 7.92
CAUTI UC 30,464 0.58 43 9.0% 0.4% 1.41
Device-associated nosocomial infection rates in intensive care units of seven Indian cities. Findings of the International
Nosocomial Infection Control Consortium (INICC). Mehta A, Rosenthal VD, Mehta Y, Chakravarthy M, Todi SK, Sen N, Sahu
S, Gopinath R, Rodrigues C, Kapoor P, Jawali V, Chakraborty P, Raj JP, Bindhani D, Ravindra N, Hegde A, Pawar M,
Venkatachalam N, Chatterjee S, Trehan N, Singhal T, Damani N. J Hosp Infect. 2007 Oct;67(2):168-74.
Table 3. Comparison of DAI rates (per 1000 device-days) in the studied
ICUs, in ICUs of the International Nosocomial Infection Control Consortium Period of this Study:
(INICC) and the U.S. National Healthcare Safety Network (NHSN). 2004-2007
Studied ICUs INICC U.S. NHSN

20022007 20022007 2005- 2006
Pooled Mean Pooled Mean (Interquartile range, Pooled Mean (Interquartile
25%-75%) range, 25%-75%)
Coronary ICU
CLAB 9.9 9.9 (0.0 11.8) 2.8 (0.0 - 4.2)
CAUTI 6.4 6.4 (0.0 13.3) 4.6 (2.8 - 5.5)
VAP 20.2 20.2 (7.3 33.2) 2.8 (0.0 - 4.5)

Medical-surgical ICU
CLAB 8.9 8.9 (3.7 16.5) 2.4 (0.6 3.1)
CAUTI 6.6 6.6 (2.5 8.3) 3.4 (1.9 - 4.5)
VAP 19.8 19.8 (9.6 24.1) 3.6 (1.3 - 5.1)

Pediatric ICU
CLAB 6.9 6.9 (7.9 19.2) 5.3 (1.1 - 6.5)
CAU 4.0 4.0 (0.0 3.3) 5.2 (0.0 - 6.0)
VAP 7.9 7.9 (3.0 14.2) 2.5 (0,0 - 2.8)

Newborn ICU (1501-2500 g)
CLAB 15.2 15.2 (0.0 21.8) 4.2 (0.0 4.1)

VAP 6.68 6.68 (0.0 4.2) 1.1 (0.0 0.2)
Table 4. Comparison of antimicrobial resistance rates (%)in the studied
ICUs, in the ICUs of the International Nosocomial Infection Control Period of this Study:
Consortium (INICCC) and the U.S. National Nosocomial Surveillance 2004-2007
System (NNIS).
Pooled mean (range) Pooled mean (range) Pooled mean (range)

(Interquartile range, 25%-75%) (Interquartile range, 25%-75%) (Interquartile range, 25%-75%)
Antimicrobial-resistant pathogen Studied ICUs INICC 20022007 U.S. NNIS 1992- 2004
20022007

Methicillin-resistant Staph aureus (MRSA) 80.8 80.8 (50.0 100.0) 52.9 (32.7-603)
Methicillin-resistant coagulase-negative 75.2 75.2 (64.0 100.0) 76.6 (69.4-83.8)
staphylococci
Vancomycin-resistant enterococcus spp 9.4 9.4 (0.0 6.3) 13.9 (5- 24.3)
Ciprofloxacin/ofloxacin-resistant 52.4 52.4 (40.0 75.0) 34.8 (17.4-41.3)
Pseudomonas aeruginosa
Imipenem-resistant P aeruginosa 53.8 53.8 (0.0 100.0) 19.1 (8.3-25.5)
Ceftazidime-reisistant P aeruginosa 36.6 36.6 (0.0 52.4) 13.9 (5-16.9)
Piperacillin-resistant P aeruginosa 51.7 51.7 (33.3 72.7) 17.50 (7.5-19.5)
Ceph3-resistant Enterobacter spp 50.8 50.8 (36.4 75.0) 27.70 (17.4-36.4)
Carbapenem-resistant Enterobacter spp 59.8 59.8 (48.1 93.9) 0.70 (0.0-0.0)
Ceph3-resistant Klebsiella pneumoniae 7.8 7.8 (0.0-81.3) 6.20 (0.0-8.0)
Ceph3-resistant Escherichia coli 68.8 68.8 (25.0 90.3) 1.3 (0.0-2.6)
Ciprofloxacin/ofloxacin-resistant E coli 52.6 52.6 (0.0 75.1) 7.30 (0.0-8.2)
Table 1. Features of the participating Period of this Study:
2004-2009
hospitals
Variable Hospital, n (%) 70 (100%)
Type of Hospital Academic, n (%) 33 (47%)
Public, n (%) 37 (53%)
Complexity Level Complexity level 2, n (%) 36 (51%)
Complexity level 3, n (%) 34 (49%)
Number of ICP 1 ICP, n (%) 34 (49%)
2-3 ICPs, n (%) 28 (40%)
More tan 3 ICPs, n (%) 8 (11%)
Device-associated infection rates in 398 intensive care units in Shanghai, China: International Nosocomial Infection Control
Consortium (INICC) findings. Tao L, Hu B, Rosenthal VD, Gao X, He L. Int J Infect Dis. 2011 Nov;15(11):e774-80.
Table 2. Pooled means and 95% CI of the distribution of
central line-associated blood stream infection rates (per 1000 Period of this Study:
central line-days) and central line utilization ratios by type of 2004-2009
adult and pediatric ICUs:
Type of ICU No of No of No of CL-days Pooled 95% CI
ICUs patients CLABSI mean
CLABSI rate
Burn ICU 8 169 0 351 0.0 -
Cardiothoracic ICU 48 61189 332 166943 2.0 1.8 - 2.2
Coronary Care ICU 59 88287 190 59337 3.2 2.7 - 3.7
General ICU 47 64707 719 198871 3.6 3.4 - 3.9
Medical ICU 53 24664 164 38207 4.3 3.7 - 5.0
Neuro-Surgical ICU 43 26944 145 64521 2.2 1.9 - 2.6
Pediatric ICU 19 17365 68 19462 3.5 2.7 - 4.4
Respiratory ICU 48 10668 84 30598 2.7 2.2 - 3.4
Surgical ICU 64 95491 870 251631 3.5 3.2 - 3.7
Trauma ICU 9 2043 6 5394 1.1 0.4 - 2.4
Overall 398 391,527 2,578 835,313 3.1 3.0 3.2
central line-associated blood stream infection rates (per Period of this Study:
1000 central line-days) and central line utilization ratios by 2004-2009
type of adult and pediatric ICUs:
Type of ICU No of ICUs Central line- Patient days Pooled mean 95% CI
days DUR
Burn ICU 8 351 663 0.53 0.49 - 0.57
Cardiothoracic ICU 48 166943 416574 0.40 0.39 - 40.1
Coronary Care ICU 59 59337 691444 0.09 0.08 - 0.09
General ICU 47 198871 655734 0.30 0.30 - 0.30
Medical ICU 53 38207 213547 0.18 0.18 - 0.18
Neuro-Surgical ICU 43 64521 235930 0.27 0.27 - 0.28
Pediatric ICU 19 19462 195671 0.10 0.09 - 0.10
Respiratory ICU 48 30598 123524 0.25 0.24 - 0.25
Surgical ICU 64 251631 699138 0.36 0.36 - 0.36
Trauma ICU 9 5394 13019 0.41 0.41 - 0.43
Overall 398 835,313 3,245,243 0.26 0.26 0.26
Table 3. Pooled means and 95% CI of the distribution of Ventilator
Associated Pneumonia rates (per 1000 mechanical ventilator-days) Period of this Study:
and mechanical ventilator utilization ratios by type of adult and 2004-2009
Type of ICU No of No of No of MV days Pooled 95% CI

ICUs patients VAP mean
VAP rate
Burn ICU 8 169 1 134 7.5 0.1 - 40.9
General ICU 47 64707 4103 165007 24.9 24.1 - 25.6
Medical ICU 53 24664 535 25219 21.2 19.5 - 23.1
Pediatric ICU 19 17365 220 20806 10.6 9.2 - 12.1
Respiratory ICU 48 10668 676 31186 21.7 20.0 - 23.4
Surgical ICU 64 95491 2626 126230 20.8 20.2 - 21.6
Trauma ICU 9 2043 164 4186 39.2 33.5 - 45.5
Overall 398 391,527 11,224 540,535 20.8 20.4 - 21.1
Ventilator Associated Pneumonia rates (per 1000 mechanical Period of this Study:
ventilator-days) and mechanical ventilator utilization ratios 2004-2009
by type of adult and
Type of ICU No of ICUs MV-days Patient days Pooled mean DUR 95% CI
Burn ICU 8 134 663 0.20 0.17 0.23
Cardiothoracic ICU 48 78901 416574 0.19 0.18 0.19
Coronary Care ICU 59 25507 691444 0.04 0.04 0.04
General ICU 47 165007 655734 0.25 0.25 0.25
Medical ICU 53 25219 213547 0.12 0.11 0.12
Neuro-Surgical ICU 43 63360 235930 0.27 0.27 0.27
Pediatric ICU 19 20806 195671 0.11 0.10 0.11
Respiratory ICU 48 31186 123524 0.25 0.25 0.25
Surgical ICU 64 126230 699138 0.18 0.18 0.18
Trauma ICU 9 4186 13019 0.32 0.31 0.33
Overall 398 540,535 3,245,243 0.17 0.17 0.17
Table 4. Pooled means and 95% CI of the distribution of catheter-
associated urinary tract infection rates (per 1000 urinary catheter -days) Period of this Study:
and urinary catheter utilization ratios by type of adult and pediatric 2004-2009
Type of ICU No of No of No of UC-days Pooled 95% CI

ICUs patients CAUTI mean
CAUTI rate
Burn ICU 8 169 0 452 0.0 -
General ICU 47 64707 2596 297760 8.7 8.4 - 9.1
Medical ICU 53 24664 637 67243 9.5 8.7 - 10.2
Pediatric ICU 19 17365 39 14742 2.6 1.9 - 3.6
Respiratory ICU 48 10668 331 41392 8.0 7.2 - 8.9
Surgical ICU 64 95491 1550 312618 5.0 4.7 - 5.2
Trauma ICU 9 2043 70 7707 9.1 7.1 - 11.5
Overall 398 391,527 7,064 1,098,013 6.4 6.3 - 6.6
catheter-associated urinary tract infection rates (per 1000 Period of this Study:
urinary catheter -days) and urinary catheter utilization ratios 2004-2009
by type of adult and pediatric
Type of ICU No of ICUs UC-days Patient days Pooled mean 95% CI

DUR
Burn ICU 8 452 663 0.68 0.65 - 0.72
Cardiothoracic ICU 48 144694 416574 0.35 0.35 - 0.35
Coronary Care ICU 59 82220 691444 0.12 0.12 - 0.12
General ICU 47 297760 655734 0.45 0.45 - 0.46
Medical ICU 53 67243 213547 0.31 0.31 - 0.32
Neuro-Surgical ICU 43 129187 235930 0.55 0.55 - 0.56
Pediatric ICU 19 14742 195671 0.08 0.07 - 0.08
Respiratory ICU 48 41392 123524 0.34 0.33 - 0.34
Surgical ICU 64 312618 699138 0.45 0.45 - 0.45
Trauma ICU 9 7707 13019 0.59 0.58 - 0.60
Overall 398 1,098,013 3,245,243 0.34 0.34 - 0.34
Table 5. Pooled means and 95% CI of the distribution of device-
associated infection rates (per 1000 invasive device-days) by Period of this
hospital size Study: 2004-2009
Hospital Size No of CLAB rate VAP rate CAUTI rate

patients (95% CI) (95% CI) (95% CI)

200 to 500 beds 51,854 3.4 (3.0 3.7) 20.2 (19.1 21.4) 8.0 (7.5 8.6)
501 to 800 beds 144,669 2.2 (2.0 2.4) 20.9 (20.2 21.6) 7.5 (7.2 7.7)
801 beds or bigger 194,877 3.5 (3.4 3.7) 20.8 (20.3 21.3) 5.6 (5.4 5.7)
Table 6. Pooled means and 95% CI of the distribution of Period of this Study:
device-associated infection rates (per 1000 invasive device - 2004-2009
days) by year
Year No of CLAB rate (95% CI) VAP rate (95% CI) CAUTI rate (95% CI)
patients
2004 18,335 3.0 (2.4 3.6) 26.0 (24.0 28.2) 7.4 (6.7 8.2)
2005 65,080 2.5 (2.3 2.8) 23.2 (22.2 24.2) 7.2 (6.8 7.6)
2006 69,010 2.8 (2.5 3.1) 23.6 (22.7 24.7) 7.4 (7.0 7.8)
2007 80,841 2.7 (2.2 3.0) 22.3 (21.5 23.2) 6.4 (6.1 6.7)
2008 78,021 4.3 (4.0 4.6) 19.0 (18.1 19.8) 6.4 (6.1 6.7
2009 80,249 3.0 (2.7 3.2) 15.8 (15.1 16.5) 4.9 (4.6 5.2)
Table 7. Comparison of DA-HAI rates (per 1000 device-days) in the
ICUs of the International Nosocomial Infection Control Consortium Period of this Study:
(INICC) Shanghai hospitals and the U.S. National Healthcare Safety 2004-2009
Network.
INICC Shanghai, China INICC 2004- 2009 U.S. NHSN

20042009 Pooled Mean (95% CI) 2006- 2008
Pooled Mean (95% CI) Pooled Mean (95% CI)
Medical ICU
CLABSI 4.3 (3.7 5.0) 14.7 (13.8 15.6) 1.9 (1.8 2.0)
CAUTI 9.5 (8.7 10.2) 6.3 (5.8 6.8) 3.9 (3.7 4.2)
VAP 21.2 (19.5 23.1) 7.7 (7.1 8.3) 2.2 (2.0 2.4)
Surgical ICU
CLABSI 3.5 (3.2 3.7) 5.0 (4.7 5.4) 2.3 (2.2 2.4)
CAUTI 5.0 (4.7 5.2) 5.0 (4.7 5.4) 4.3 (4.1 4.5)
VAP 20.8 (20.2 21.6) 16.3 (15.7 17.0) 4.9 (4.6 5.1)
Pediatric ICU
CLABSI 3.5 (2.7 4.4) 10.7 (9.9 11.5) 3.0 (2.8 3.2 )
CAUTI 2.6 (1.9 3.6) 4.7 (4.1 5.5) 4.2 (3.8 4.7)
VAP 10.6 (9.2 12.1) 6.5 (5.9 7.1) 1.8 (1.6 2.1)
Table 8. Distribution of pathogens involved in
device-associated health care associated infections.
2004-2009
Microorganism related to DA-HAI CLABSI related VAP related CAUTI related Overall
(n: 845) (n: 6,151) (n: 2,047) (n: 9,043)
Acinetobacter baumanii 12.3% 25.4% 3.0% 19.1%
Pseudomonas aeruginosa 5.1% 23.5% 3.3% 17.2%
Klebsiella pneumoniae 6.9% 14.6% 5.8% 11.9%
Staphylococcus aureus 15.9% 15.0% 1.2% 11.9%
Candida spp. 14.0% 1.4% 35.7% 10.4%
Enterococcus faecium 1.7% 0.0% 13.3% 3.2%
Stenotrophomonas spp. 1.9% 4.2% 0.1% 3.1%
Enterobacter spp. 3.3% 2.6% 2.4% 2.6%
Enterococcus faecalis 5.1% 0.0% 8.5% 2.4%
Other Staphylococcus 14.1% 0.2% 2.6% 2.0%
Other Gram negative 2.2% 1.9% 1.3% 1.8%
Other Pseudomonas 1.3% 1.7% 0.7% 1.4%
Proteus spp. 0.6% 1.2% 1.1% 1.1%
Flavobacterium spp. 0.5% 0.9% 0.1% 0.7%
Streptococcus spp. 1.7% 0.0% 0.7% 0.3%
Other pathogens 3.3% 2.1% 1.1% 2.2%
Table 1. Demographics of Patient Population and Device Period of this Study:
Use by Intensive Care Unit 2008-2010
Hospital 1 Hospital 2 Hospital 3 Hospital 4
All Medical- Medical- Medical- Medical- Neurological Medical-Cardiac Surgical

Cardiac Surgical Surgical Surgical
Contribution to study
Study period Aug-08/Jul-10 Aug-09 /Jul-10 Aug-09/Jun-10 Jul-09/ Jun-10 Jul-09/ Jun-10 Jul-09 /Jun-10 Aug-08/Jul-09 Aug-08/ Jul-09
ICU 2631 157 294 277 155 113 889 746

Admissions
during study
period
Bed days 17359 953 1869 2689 1849 1695 4090 4214
contributed
Hospital characteristics
Hospital size 1380 1565 1200 1700

(beds)
ICP 1 to 3 years 18 years 17 years 20 years
experience
Patient Characteristics
Age, 60 (1 - 100) 62 (31 - 82) 64 (15 - 98) 55 (1 - 98) 58 (11 - 94) 63 (18 - 85) 57 (3 - 99) 62 (6- 100)
median(range
)
Male, n(%) 1721 (65) 108 (69) 189 (64) 173 (62) 95 (61) 71 (63) 563 (63) 513 (69)
Apache score, 9 (0 - 54) 7 (1 - 16) 21 (0 - 51) 14 (0 - 43) 12 (0 - 46) 12 (0 - 42) 5 (0 - 54) 11 (2 - 37)
median
(range)
Device Use
DUR (CL) 0.71(0.70-0.73) 1.24 0.15 0.57(0.54-0.6) 0.7(0.66-0.74) 0.58 (0.55-0.62) 0.91(0.88-0.94) 0.81(0.78-0.84)
(1.17-1.31) (0.13-0.16)
DUR (MV) 0.43(0.42-0.44) 0.5(0.47-0.53) 0.13(0.12-0.15) 0.47(0.45-0.49) 0.49(0.47-0.51) 0.23(0.21-0.25) 0.4 (0.38-0.41) 0.61(0.59-0.62)
DUR (UC) 0.76 0.99(0.98-0.99) 0.4(0.38-0.42) 0.7(0.68-0.71) 0.8(0.78-0.82) 0.61(0.59-0.64) 0.9 (0.89-0.91) 0.81(0.8-0.83)
(0.75-0.77)
Device-associated infection rates, device use, length of stay, and mortality in intensive care units of 4 Chinese hospitals: International
Nosocomial Control Consortium findings. Hu B, Tao L, Rosenthal VD, Liu K, Yun Y, Suo Y, Gao X, Li R, Su D, Wang H, Hao C, Pan W,
Saunders CL. Am J Infect Control. 2013 Apr;41(4):301-6.
Table 2. Hand Hygiene Compliance and Central Line
Care Monitoring by Intensive Care Unit 2008-2010
Hospital 1 Hospital 2 Hospital 3 Hospital 4
All Medical- Medical - Medical- Medical- Neurological Medical-

Cardiac Surgical Surgical Surgical Cardiac
Hand Hygiene 51% 77% 37% 47% 40% 59% -

compliance
Date in the 95.6% - 95.2% 93.7% 99.7% 100.0% 100.0%

intravascular
device
administration set
Presence of 99.9% - 99.5% 100.0% 100.0% 100.0% 100.0%
Sterile Gauze
Sterile Gauze in 93.7% - 87.4% 92.0% 99.7% 100.0% 100.0%

Good condition
Table 3. Stratified Mortality, Length of Stay and Device- Period of this Study:
Associated Healthcare Associated Infection Rate 2008-2010
N Mortality, N LOS, median CLA-BSI CLABSI rate/ VAP VAP rate/1000 CA-UTI CAUTI rate/
(%) (range) (Lab diagnosed) 1000 CL MV days 1000 UC days
days(95%CI) (95%CI) (95% CI)
All 2631 142 (5.4) 3 (1-231) 95 (64) 7.66 (4.41-15.45) 78 10.46 (5.5-19.4) 17 1.29 (.73-2.35)
Apache Score
1 to 10 1396 27 (1.93) 3 (1-108) 37 (26) 7.18 (3.6-22.08) 18 8.7 (4.71-16.47) 6 1.16 (.56-3.78)
11 to 20 644 51 (7.92) 4 (1-89) 36 (25) 9.04 (3.84-23.54) 35 11.67 3 .69 (.24-2.3)

(6.16-22.37)
21 325 47 (14.46) 5 (1-99) 16 (9) 9.26 (5.97-16.16) 11 8.47 (4.95-14.52) 7 3.35 (1.6-8.26)
Missing 266 17 6 14 1
LOS
1 to 5 1834 53 (2.89) 2 6 (1) 1.63 (.62-6.54) 0 0 (.-.) 0 0 (.-.)
6 to 10 405 31 (7.65) 7 23 (16) 12.21 6 5.42 (.55-216.09) 2 1.01 (.27-6.15)

(3.89-57.17)
11 392 58 (14.80) 18 66 (47) 9.65 (5.96-17.21) 72 14.42 15 2.05 (1.34-3.26)
(9.66-21.05)
ICU 2631 142 (5.4) 3 (1-231) 95 (64) 7.66 (4.41-15.45) 78 10.46 (5.5-19.4) 17 1.29 (.73-2.35)
Hospital 1 - 157 3 (1.9) 5 (1-60) 4 (3) 3.38 (1.27-9.02) 5 10.5 (4.37-25.24) 0 0 (.-.)
Medical Cardiac
Hospital 2 294 29 (9.8) 4 (1-44) 3 (1) 11.03 (3.56-34.2) 6 24.19 2 2.66 (.67-0.65)
Medical-Surgical (10.87-53.85)
Hospital 2 - 277 38 (13.7) 6 (1-108) 8 (6) 5.23 (2.62-10.46) 26 20.7 (14.09-30.4) 4 2.13 (.8-5.68)
Medical-Surgical
Hospital 3 - 155 23 (14.8) 7 (1-76) 14 (6) 10.84 9 9.97 (5.19-19.16) 4 2.69 (1.01-.18)
Medical-Surgical (6.42-18.31)
Hospital 3 - 113 4 (3.5) 10 (1-99) 4 (1 4.05 (1.52-10.79) 7 18.13 1 .96 (.14-6.83)
Neurological (8.65-38.04)
Hospital 4 - 889 23 (2.6) 2 (1-91) 46 (37) 12.34 13 7.99 (4.64-13.75) 5 1.36 (.57-3.27)
Medical Cardiac (9.24-16.47)
Hospital 4 - 746 22 (3.0) 3 (1-231) 16 (10) 4.7 (2.88-7.67) 12 4.69 (2.67-8.26) 1 .29 (.04-2.07)
Surgical
Table 1. Features of the International Nosocomial Infection Control Period of this Study:
Consortium Hospitals and Intensive Care Units*. Hospitals A, B, C. 2005-2009
Variable Burn ICU Surgical ICU Coronary ICU Medical Neurosurgical Pediatric ICU Newborn ICU Overall
Surgical ICU ICU
ICUs, n 1 1 1 2 1 1 2 9
Hospital type
Academic 0 0 1 2 1 1 1 6
Private 1 1 0 0 0 0 1 3
Patients studied, n 191 225 847 1,331 293 252 1,813 4,952
Total ICU days, d 2,156 1,503 2,210 7,588 1,548 1,638 24,090 40,733
Device use*
Ventilator days, d 135 1,246 596 4,513 881 391 2,279 10,041
Ventilator use 0.06 0.83 0.27 0.59 0.57 0.24 0.09 0.25
CL days, d 9 84 739 3,025 268 486 625 5,236
CL use 0.001 0.06 0.33 0.40 0.17 0.30 0.03 0.13
Urinary catheter days, d 402 1,397 1,236 4,886 1,924 214 - 10,093
Urinary catheter use 0.19 0.93 0.56 0.64 0.99 0.13 - 0.25
Device-associated infections rates in adult, pediatric, and neonatal intensive care units of hospitals in the Philippines:
International Nosocomial Infection Control Consortium (INICC) findings Navoa-Ng JA, Berba R, Galapia YA, Rosenthal VD,
Villanueva VD, Tolentino MC, Genuino GA, Consunji RJ, Mantaring JB 3rd. Am J Infect Control. 2011 Sep;39(7):548-54.
Table 2. Device associated infections per 1000 devices days: Period of this Study:
VAP, CLAB, and CAUTI in the participating ICUs. Hospitals 2005-2009
A, B, and C.
Type of Infection Device Device- DA- Distribution of Rate per Rate per 1000
ICU site type days HAI DA-HAI (%) 100 patients device-days
(n)
Adult VAP MV 7,371 123 67.2 4.3 16.7 (95% CI 14.0 20.0)
Adult CLAB CL 4,125 19 10.4 0.7 4.6 (95% CI 2.7 7.2)
Adult CAUTI UC 9,845 41 22.4 0.4 4.2 (95% CI 3.0 5.7)
Pediatric VAP MV 391 5 55.6 2.0 12.8 (95% CI 4.1 29.6)
Pediatric CLAB CL 486 4 44.4 1.6 8.2 (95% CI 2.2 20.1)
Pediatric CAUTI UC 214 0 0 0 0
Neonatal VAP MV 2,279 1 14.3 0.1 0.44 (95% CI 0.01 2.45)
Neonatal CLAB CL 625 6 85.7 0.3 9.60 (95% CI 3.5 20.8)
Table 3. Crude Extra Mortality of patients with device-associated health Period of this Study:
care associated infections in the participating ICUs. Hospitals A and B. 2005-2009
Type of ICU Type of patient Patients Crude Crude Extra RR 95% CI P-value
Mortality Mortality
Adult Patients without DA-HAI, 2291 6.8% - - 5.8 7.9

%
Adult Patients with CLA-BSI, % 10 10.0% 3.2% 1.48 0.21 - 10.56 0.695
Adult Patients with VAP, % 72 9.7% 3.0% 1.44 0.67 - 3.06 0.3454
Adult Patients with CAUTI, % 26 3.8% -2.9% 0.57 0.08 - 4.06 0.5683
Pediatric Patients without infection, 240 3.8% - - 1.7 7.0

%
Pediatric Patients with CLA-BSI, % 4 50.0% 46.3% 13.3 2.88 - 61.71 0.0001
Pediatric Patients with VAP, % 3 0.0% -3.8% undefined undefined 0.7373
Pediatric Patients with CAUTI, % 0 -
Neonatal Patients without infection, 1,729 5.6% - 4.6 6.8

%
Neonatal Patients with CLA-BSI, % 4 25.0% 19.4% 4.46 0.62 32.0 0.1033
Neonatal Patients with VAP, % 0 - - - - -
Table 4. Crude Extra Length of stay of patients with
2005-2009
device-associated health care associated infections in the
participating ICUs. Hospitals A and B
Type of ICU Type of patient Average Length Crude Extra Length 95% CI RR
of Stay (days) of Stay (days)
Adult Patients without DA-HAI, 4.3 - 4.1 - 4.4 -
Adult Patients with CLA-BSI 16.2 11.9 9.0 - 33.5 3.79
Adult Patients with VAP, 12.4 8.2 9.9 - 15.8 2.91
Adult Patients with CAUTI 11.9 7.7 8.3 - 18.0 2.79
Pediatric Patients without DA-HAI, 5.6 - 5.0 - 6.3
Pediatric Patients with CLA-BSI 17.0 11.4 6.9 - 62.5 3.03
Pediatric Patients with VAP, 10.7 5.1 4.0 - 52.1 1.90
Pediatric Patients with CAUTI 0.0 0.0 0.0 -
Neonatal Patients without DA-HAI, 12.6 - 12.1 - 13.2 -
Neonatal Patients with CLA-BSI 28.0 15.4 11.2 - 104.2 2.21
Neonatal Patients with VAP, 0 0.0 -
Table 5. Microorganism profile in the participating Period of this Study:
ICUs. Hospitals A and B 2005-2009
Microorganism related CLA-BSI related VAP related CAUTI related Overall %

to DA-HAI
Acinetobacter spp. 18.2% 25.5% 11.1% 21.1%
Pseudomonas spp. 9.1% 27.7% 5.6% 19.7%
Klebsiella spp. 9.1% 14.9% 11.1% 13.2%
Candida spp. 0.0% 0.0% 27.8% 6.6%
coagulasa negative Staphylococcus 18.2% 2.1% 5.6% 5.3%
Staphylococcus aureus 9.1% 4.3% 0.0% 3.9%
Stenotrophomonas 9.1% 0.0% 11.1% 3.9%
Enterococcus spp. 9.1% 2.1% 0.0% 2.6%
indexed in Pubmed,
published by INICC
Members from:
Middle East and Africa
Data collected by Hospital Team, using INICC Surveillance forms and
methods, applying CDC NSHN Criteria for HAIs. Data analyzed by Dr.
Victor D. Rosenthal (VDR). Paper drafted by VDR, revised and approved
by Hospital Team, and submitted to the journal by VDR
Table 1. Characteristics of the Intensive Care Unit, member
of the International Nosocomial Infection Control Period of this Study:
Consortium 2007-2010
Variable Overall
Number of hospital beds 320
Number of ICU beds 8
ICUs, n 1
ICU type Medical Surgical
Surveillance Period 11/2007 to 03/2010
Range of experience of the infection control practitioner, y 15
Number of medical staff 4
Patients studied, n 666
Total ICU days, d 5,506
Device use*
Ventilator days, d 3,561
Ventilator use, 0.65
Central line days, d 2,691
Central line use, 0.49
Urinary catheter days, d 5,340
Urinary catheter use, 0.97
International nosocomial infection control consortium findings of device-associated infections rate in an intensive care unit of a lebanese
university hospital. Kanj S, Kanafani Z, Sidani N, Alamuddin L, Zahreddine N, Rosenthal V. J Glob Infect Dis. 2012 Jan;4(1):15-21.
Table 2. Device associated infections rates Period of this Study:
2007-2010
(VAP, CLA-BSI, and CAUTI)
Infection Device Device- DA- Distribution Rate per Rate per

site type days HAI of DA-HAI (%) 100 patients 1000 device-days*
VAP MV 3,561 29 45% 4.35% 8.1 (95% CI 5.5 11.7)
CLA-BSI CL 2,691 14 22% 2.10% 5.2 (95% CI 2.8 8.7)
CAUTI UC 5,340 22 34% 3.30% 4.1 (95% CI 2.6 6.2)
Table 3. Excess mortality of patients with Period of this Study:
2007-2010
device-associated infections
Crude Extra
RR 95% CI P-value
Mortality Mortality
Patients without DA-HAI, % 19.1%
Patients with CLA-BSI, % 60.0% 40.9% 3.14 1.38 - 7.13 0.0039
Patients with VAP, % 15.0% - 0.78 0.25 - 2.47 0.6780
Patients with CAUTI, % 12.5% - 0.65 0.16 - 2.65 0.5487
Table 4. Excess length of stay of patients with Period of this Study:
device-associated infections 2007-2010
Average Length Extra Length

95% CI RR
of Stay of Stay
Patients without
7.3 6.8 - 7.9
DA-HAI, %
Patients with
13.8 6.5 7.7 - 28.4 1.88
CLA-BSI, %
Patients with
18.8 11.4 12.3 - 30.5 2.56
VAP, %
Patients with
15.8 8.5 9.9 - 27.4 2.16
CAUTI, %
Table 5. Distribution of pathogens involved in Period of this Study:
device-associated infections 2007-2010
CLA-BSI VAP CAUTI

Microorganism related to DA-HAI Overall %
related related related
Acinetobacter spp. 27.3% 37.5% 20.0% 29.1%
Candida spp. 0.0% 0.0% 25.0% 9.1%
Klebsiella spp. 0.0% 12.5% 5.0% 7.3%
coagulase negative staphylococci 27.3% 4.2% 0.0% 7.3%
Stenotrophomonas spp. 0.0% 8.3% 5.0% 5.5%
Pseudomonas spp. 0.0% 8.3% 0.0% 3.6%
Enterococcus spp. 0.0% 0.0% 5.0% 1.8%
Table 1. Features of the consortium hospitals, Period of this Study:
ICUs and patients studied 2004-2008
Hospitals, n 1 1
Academic Teaching 1 1 (100%)
Public 0 0%
Private Community 0 0%
ICUs, n 1 1
Experience of ICP (range), years 16 16
Patients n 269 269
Patients-days n 1818 1818
Sex % (male) 48.0 (129/269) 48.0 (129/269)
Age 43.1 43.1
ASIS score, mean 3.77 3.77
Health-care associated infections rates, length of stay, and bacterial resistance in an intensive care unit of Morocco: findings of
the International Nosocomial Infection Control Consortium (INICC). Madani N, Rosenthal VD, Dendane T, Abidi K, Zeggwagh AA,
Abouqal R. Int Arch Med. 2009 Oct 7;2(1):29.
Table 2. Global rates of health care associated Period of this Study:
2004-2008
infection by 100 patients and by 1000 bed days
Number of HCAI 52 52
Number of patients 269 269
HCAI (%) 19.3 19.3
Bed days 1818 1818
HCAI per 1000 bed days 28.6 28.6
Table 3. Proportion of Health care Period of this Study:
2004-2008
associated infections in the ICU studied
Total NI 52 52
Proportion of VAP (%) 53.8 53.8

Proportion of CVC-related
13.5 13.5
BSI (%)
Proportion of CAUTI (%) 32.7 32.7
Table 4. Device usage in the ICUs studied 2004-2008
Total ICU days 1818 1818
Ventilator-days 573 573

Ventilator usage 0.32 0.32
CVC-days 414 414

CVC usage 0.23 0.23
Urinary catheter-days 1321 1321

Catheter usage 0.73 0.73
Table 5. Overall microbiological profile and Period of this Study:
bacterial resistance in the participant ICUs 2004-2008

Acinetobacter 31.9 (15/47) 31.9 (15/47)
Candida spp. 4.3 (2/47) 4.3 (2/47)
E.Coli 10.6 (5/47) 10.6 (5/47)
Enterobacter 4.3 (2/47) 4.3 (2/47)
Klebsiella 12.8 (6/47) 12.8 (6/47)
Pseudomonas aeruginosa 27.7 (13/47) 27.7 (13/47)
Staphylococcus aureus 6.4 (3/47) 6.4 (3/47)
Coagulase-negative staphylococci 2.1 (1/47) 2.1 (1/47)
(% resistant):
S. aureus / methicillin (MRSA) 0.0 (0/8) 0.0 (0/8)
Enterobacteriaceae / ceftriaxone 71.7 (38/53) 71.7 (38/53)
Enterobacteriaceae / ceftazidima 61.1 (33/54) 61.1 (33/54)
Enterobacteriaceae / piperacillin tazobactam 58.8 (10/17) 58.8 (10/17)
P. aeruginosa / ciprofloxacina 0 0
P. aeruginosa / ceftazidima 28.6 (6/21) 28.6 (6/21)
P. aeruginosa / imipenem 9.5 (2/21) 9.5 (2/21)
P. aeruginosa / piperacilin tazobactam 0.0 (0/4) 0.0 (0/4)
Enterococci/ vancomycin 0.0 (0/0) 0.0 (0/0)
Acinetobacter / piperacilin tazobactam 100.0 (5/5) 100.0 (5/5)
VAP, no.of cases 28 28

Rate per 100 patients (%) 10.4 10.4 (28/269)
Rate per 1000 ventilator-days 48.9 48.9 (28/573)

Acinetobacter 45.8 (11/24) 45.8 (11/24)
E.Coli 4.2 (1/24) 4.2 (1/24)
Enterobacter 4.2 (1/24) 4.2 (1/24)
Klebsiella 4.2 (1/24) 4.2 (1/24)
(% resistant):
P. aeruginosa / ciprofloxacina 0.0 (0/0) 0.0 (0/0)
P. aeruginosa / piperacilin tazobactam 0.0 (0/2) 0.0 (0/2)
Enterococci/ vancomycin 0.0 (0/0) 0.0 (0/0)
Acinetobacter / piperacilin tazobactam 100.0 (4/4) 100.0 (4/4)
Table 7. CVC- related BSI in the participant ICUs Period of this Study: 2004-2008
CVC-related BSI, no. of cases 7 7
Rate per 100 patients (%) 2.6 (7/269) 2.6 (7/269)
Rate per 1000 CVC-days 16.9 (7/414) 16.9 (7/414)

Acinetobacter spp 14.3 (1/7) 14.3 (1/7)
Candida spp. 14.3 (1/7) 14.3 (1/7)
Enterobacter 14.3 (1/7) 14.3 (1/7)
Coagulase-negative staphylococci 14.3 (1/7) 14.3 (1/7)
(% resistant):
P. aeruginosa / piperacillin tazobactam 0.0 (0/1) 0.0 (0/1)
Enterococci / vancomycin 0.0 (0/0) 0.0 (0/0)
Acinetobacter / piperacillin tazobactam 100.0 (1/1) 100.0 (1/1)
CAUTI, no. of cases 17 17

Rate per 100 patients (%) 6.3 (17/269) 6.3 (17/269)
Rate per 1000 catheter-days 12.9 (17/1321) 12.9 (17/1321)

Acinetobacter 18.8 (3/16) 18.8 (3/16)
Candida spp. 6.3 (1/16) 6.3 (1/16)
E.Coli 25.0 (4/16) 25.0 (4/16)
Klebsiella 31.3 (5/16) 31.3 (5/16)
Staphylococcus Aureus 6.3 (1/16) 6.3 (1/16)
(% resistant):
S. aureus / methicillin (MRSA) 0 0
P. aeruginosa / piperacillin tazobactam 0.0 (0/1) 0.0 (0/1)
Enterococci / vancomycin 0.0 (0/0) 0.0 (0/0)
Acinetobacter / piperacillin tazobactam 0.0 (0/0) 0.0 (0/0)
Table 9. Mortality of device-associated Period of this Study: 2004-2008
infections in the participants ICUs
Hospital Overall Attributable RR IC % P. value

mortality
Overall Crude Mortality of 25.1 (57/227) 25.1 (57/227) 1.0
patients without infection, %
Crude unadjusted attributable 62.5 (10/16) 62.5 (10/16) 37.4 2.49 1.27 4.87 0.0059
mortality of patients with VAP, %
mortality of patients with CVC-
associated BSI, %
mortality of patients with CAUTI,
%
Table 10. Comparison of device utilization and rates of
deviceassociated health care associated infection in Period of this Study: 2004-2008
the ICUs of Morocco and in U.S. ICUs.
U.S. NNIS- Hospital RR

1992-2004
Device utilization
Mechanical ventilator 0.35 0.43* 0.32 0.74
Central vascular catheter 0.49 - 0.56 0.23 0.41
Urinary catheter 0.78 0.82 0.73 0.89

Ventilator-associated pneumonia 4.6 5.1 48.9 9.58
CVC-associated bloodstream infection 3.1 - 3.4 16.9 4.97
Catheter-associated urinary tract infection 3.1- 3.3 12.9 3.90
Proportion (%) of device-associated infections with resistance:
S.aureus / methicillin. 48.1 0.0 (0/8) -

Enterobacteriaceae / ceftriaxone 17.4 71.7 (38/53) 4.12
Enterococci / vancomycin 29.1 0.0 (0/0) -
Table 1. Features of the International Nosocomial Infection Period of this Study:
Control Consortium Hospitals and Intensive Care Units 2009-2010
Variable Hospital A Hospital B Hospital C Overall

Hospitals, n (%) 1 1 1 3
Academic teaching 1 0 1 2 (66%)
Public 0 1 0 1 (33%)
Private community 0 0 0 0
Hospital number of beds 400 150 1000 400-1000
ICUs, n 1 1 1 3
ICU type PICU PICU RICU PICU & RICU
Surveillance Period 04/2009 to 09/2009 06/2010 to 07/2010 12/2008 to 12/2009 12/2008 to 07/2010
Range of experience of the 1 3 2 1-3
infection control practitioner, y
Patients studied, n 119 24 473 616
Total ICU days, d 1,274 261 2,930 6,000
Device use*
Ventilator days, d 510 57 1,077 1,644
Ventilator use, 0.40 0.22 0.37 0.27
Central Line days, d 794 112 1,021 1,927
Central Line use, 0.62 0.43 0.35 0.32
Urinary catheter days, d 466 67 1,551 2,084
Urinary catheter use, 0.37 0.26 0.53 0.35
Device-associated infection rates in adult and pediatric intensive care units of hospitals in Egypt. International Nosocomial Infection Control
Consortium (INICC) findings. Rasslan O, Seliem ZS, Ghazi IA, El Sabour MA, El Kholy AA, Sadeq FM, Kalil M, Abdel-Aziz D, Sharaf HY,
Saeed A, Agha H, El-Abdeen SA, El Gafarey M, El Tantawy A, Fouad L, Abel-Haleim MM, Muhamed T, Saeed H, Rosenthal VD. J Infect
Public Health. 2012 Dec;5(6):394-402.
Table 2. Device-associated health care associated infections per 1000
devices days: ventilator-associated pneumonia, central line-associated Period of this Study:
blood stream infection, and catheter-associated urinary tract infection 2009-2010
in the pediatric and respiratory intensive care unit.
Type of Infection Device Device- DA- Distribution of Rate per 100 patients (%) Rate per 1000 device-days*
ICU site type days HAI DA-HAI (%)
PICU VAP MV 567 18 51.4 12.6 31.7 (95% CI 19.9 49.8)
PICU CLABSI CL 906 15 48.6 11.9 18.8 (95% CI 10.9 29.9)
PICU CAUTI UC 533 0 0.0 0.0 0.0
RICU VAP MV 1,077 79 51% 16.7 73.4 (95% CI 58.5 90.6)
RICU CLABSI CL 1,021 23 15% 4.9 22.5 (95% CI 14.3 33.6)
RICU CAUTI UC 1,551 53 34% 11.2 34.2 (95% CI 25.7 44.5)
Device-associated infection rates in adult and pediatric intensive care units of hospitals in Egypt. International Nosocomial Infection Control
Consortium (INICC) findings. Rasslan O, Seliem ZS, Ghazi IA, El Sabour MA, El Kholy AA, Sadeq FM, Kalil M, Abdel-Aziz D, Sharaf HY,
Saeed A, Agha H, El-Abdeen SA, El Gafarey M, El Tantawy A, Fouad L, Abel-Haleim MM, Muhamed T, Saeed H, Rosenthal VD. J Infect
Public Health. 2012 Dec;5(6):394-402.
Thank you very much
Contact us by email:
online@inicc.org
Contact us in our Web Page:

www.INICC.org
Follow us :
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INICCDatabyCountry HAIrates, Lengthofstay, Mortality, Microorganismprofile, AndbacterialresistanceinICU

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HAI Rates, Length Of Stay, Mortality,

Dr. Victor D. Rosenthal, MD, MSC, CIC

Hospital Hospital Patients Patients Patient Number of NI per 1000

B 101 18 17.8 527 26 49.3

C 89 29 53.9 602 82 136.21

Total 213 57 26.76 1422 128 90

Central Line-associated bloodstream infection 41 32

Catheter-associated Urinary tract infection 29 22.6

Peripheral line-associated Phlebitis 2 1.6

Peripheral line-associated BSI 10 7.8

Total 128 100

Infection site Device days NI Rate per 1000

CAUTI 1286 29 22.55

VAP 629 32 50.87

Infection site ALOS Attributable Mortality Attributable

CAUTI 17.50 5.36 (6/14) 42.9 5.7

VAP 22.14 10.00 (10/14) 71.4 34.2

Control 12.14 - (16/43) 37.2 -

Hospital A Hospital B Hospital C Hospital D Overall

Total ICU days 5213 878 1952 839 8882

Ventilator-days 1743 67 1352 399 3561

Ventilator usage 0.33 0.08 0.69 0.48 0.40

CVC-days 5593 642 1785 686 8706

CVC usage 1.07 0.73 0.91 0.82 0.98

Urinary catheter- 3116 676 1709 729 6230

Catheter usage 0.60 0.77 0.88 0.87 0.70

Hospital A Hospital B Hospital C Hospital D Overall

Serratia 5.0 0.0 3.7 0.0 4.3

Hospital A Hospital B Hospital C Hospital D Overall

Hospital A Hospital B Hospital C Hospital D Overall RR 95% CI P-value

U.S. NNIS- These hospitals RR

CVC-BSI CVC 9494 26 28.0 8.3 9.1

CAUTI UC 8817 27 27.7 8.2 9.6

Bacteria Antibiotic used Percentage resistance

VAP, no. of cases 86

Crude Extra RR IC % P. value

Patients with VAP, % 35.0 16.9 1.93 1.24 3.00 0.0028

Patients with CVC- 36.6 18.5 2.02 1.42 2.87 0.0000

Patients with CAUTI, % 28.6 10.5 1.58 0.78 3.18 0.1987

S.aureus / methicillin. 48.1 36.2 0.75

Variable Medical Surgical ICU Trauma ICU Overall

CLA-BSI (Overall rate) CL 9,891 20 4% 1.0% 2.0 (95% CI 1.2 3.1)

Trauma ICU CL 6,863 13 3% 1.1% 1.9 (95% CI 1.0 3.3)

Trauma ICU UC 6,822 71 19% 6.2% 10.4 (95% CI 8.1 13.1)

Variable % ( # HH / Comparison RR 95% CI P.Value

Average Length Extra Length

Patients without infection, days 4.9 - 4.6 - 5.2 1.0

Patients with CLA-BSI, days 23.3 18.3 9.4 - 85.8 4.7

Patients with VAP, days 23.8 18.9 10.5 - 73.3 4.9

Microorganism CLA-BSI related VAP related CAUTI related Overall %

Acinetobacter spp. 33.3% 15.4% 0% 10.3%

Escherichia coli 33.3% 15.4% 53.8% 34.5%

Klebsiella spp. 0% 23.1% 15.4% 17.2%

Pseudomonas spp. 0% 30.8% 7.7% 17.2%

Pneumoccoccus spp. 0% 7.7% 0% 3.4%

coagulasa negative 33.3% 7.7% 23.1% 17.2%

Hospital A Hospital B Hospital C Overall

Number of patients 473 357 345 1175

HCAI (%) 9.7 13.4 11.0 11.2

Bed days 2129 1577 1935 5641

HCAI per 1000 21.6 30.4 19.6 23.4

Hospital A Hospital B Hospital C Overall