The data was collected prospectively over 300,000 patients hospitalized across the consortium's ICUs. Despite reporting that the use of invasive devices was similar to that of US ICUs, the rates of hospital acquired infections were significantly higher. When compared to the CDC NHSN , the pooled rate of central line-associated bloodstream infection in the INICC ICUs was 6.8 per 1,000 central line-days vs. 2.0 per 1,000 central line-days reported in comparable US ICUs. Similar disparities were seen in ventilator-associated pneumonias (15.8 vs 3.3 per 1,000 ventilator-days) and catheter-associated urinary tract infection (6.3 vs. 3.3 per 1,000 catheter-days). The frequencies of drug resistant pathogens was higher also Pseudomonas aeruginosa isolates to imipenem (47.2% vs 23.0%), Klebsiella pneumoniae isolates to ceftazidime (76.3% vs 27.1%), Escherichia coli isolates to ceftazidime (66.7% vs 8.1%), Staphylococcus aureus isolates to methicillin (84.4% vs 56.8%).
These are important findings. On one level, the results suggest that, in developing countries, invasive devices are used with similar frequency as in the USA. Patient acuity, theoretically, is similar. Infection control outcomes are clearly different. In developing countries,
there are no legally enforceable rules or mandates to comply with infection prevention best practices. Absent this oversight in standards and safety, implementation of known risk reduction practices, even inexpensive interventions such as hand hygiene, will be erratic and suboptimal.
This underscores the ongoing need for research on practical interventions and implementation strategies to reduce hospital acquired infections. These must have universal applicability with minimal cost and resource barriers.
