The impact of the International Nosocomial Infection Control Consortium (INICC) multicenter, multidimensional hand hygiene approach in two cities of India.

The fundamental tool for preventing and controlling healthcare-acquired infections is hand hygiene (HH). Nonetheless, adherence to HH guidelines is often low. Our goal was to assess the effect of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene Approach (IMHHA) in three intensive care units of three INICC member hospitals in two cities of India and to analyze the predictors of compliance with HH. From August 2004 to July 2011, we carried out an observational, prospective, interventional study to evaluate the implementation of the IMHHA, which included the following elements: (1) administrative support, (2) supplies availability, (3) education and training, (4) reminders in the workplace, (5) process surveillance and (6) performance feedback. The practices of health care workers were monitored during randomly selected 30-min periods. We observed 3612 opportunities for HH. Overall adherence to HH increased from 36.9% to 82% (95% CI 79.3-84.5; P=0.0001). Multivariate analysis indicated that certain variables were significantly associated with poor HH adherence: nurses vs. physicians (70.5% vs. 74%; 95% CI 0.62-0.96; P=0.018), ancillary staff vs. physicians (43.6% vs. 74.0%; 95% CI 0.48-0.72; P<0.001), ancillary staff vs. nurses (43.6% vs. 70.5%; 95% CI 0.51-0.75; P<0.001) and private vs. academic hospitals (74.2% vs. 66.3%; 95% CI 0.83-0.97; P<0.001). It is worth noticing that in India, the HH compliance of physicians is higher than in nurses. Adherence to HH was significantly increased by implementing the IMHHA. Programs targeted at improving HH are warranted to identify predictors of poor compliance.

Impact of an international nosocomial infection control consortium multidimensional approach on central line-associated bloodstream infection rates in adult intensive care units in eight cities in India.

OBJECTIVE: To evaluate the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach on central line-associated bloodstream infection (CLABSI) rates in eight cities of India. METHODS: This was a prospective, before-and-after cohort study of 35650 patients hospitalized in 16 adult intensive care units of 11 hospitals. During the baseline period, outcome surveillance of CLABSI was performed, applying the definitions of the CDC/NHSN (US Centers for Disease Control and Prevention/National Healthcare Safety Network). During the intervention, the INICC approach was implemented, which included a bundle of interventions, education, outcome surveillance, process surveillance, feedback on CLABSI rates and consequences, and performance feedback. Random effects Poisson regression was used for clustering of CLABSI rates across time periods. RESULTS: During the baseline period, 9472 central line (CL)-days and 61 CLABSIs were recorded; during the intervention period, 80898 CL-days and 404 CLABSIs were recorded. The baseline rate was 6.4 CLABSIs per 1000 CL-days, which was reduced to 3.9 CLABSIs per 1000 CL-days in the second year and maintained for 36 months of follow-up, accounting for a 53% CLABSI rate reduction (incidence rate ratio 0.47, 95% confidence interval 0.31-0.70; p=0.0001). CONCLUSIONS: Implementing the six components of the INICC approach simultaneously was associated with a significant reduction in the CLABSI rate in India, which remained stable during 36 months of follow-up.

Hospital acquired infection is inversely related to utilization of isopropyl alcohol and tissue paper pulls--a prospective observational study.

INTRODUCTION: Healthcare associated infections not only cause morbidity and mortality, but also drain the resources in the hospitals across the globe. It has been shown repeatedly that practicing hand hygiene is a deterrent to hospital acquired infection. It is essential for the infection control committee and the hospital administrators to have a fair idea of the prevailing hand hygiene practice in the healthcare facility. This is commonly obtained direct observation, self-reporting by healthcare workers and indirect calculation based on hand hygiene disinfectant product usage. AIMS: This study was planned to assess the indirect surrogates of hand hygiene among healthcare workers in an Indian hospital. METHODS: We presumed that the tools used to perform hand hygiene, the alcoholic hand rub and the tissue paper towel may throw light on the prevailing hand hygiene practice. An analysis of the quantity of alcohol hand rub and the number of tissue paper towel usage against the incidence of hospital acquired infection was made. OBSERVATION: The mean incidence of HAI during the period of study was 8.5 +/- 6.7 (range 2 to 27) per month. There was a decrease in the HAI rates with increasing of alcoholic hand rub and tissue paper towels. It was predicted using the regression graphs that if the quantity of alcoholic hand rub usage increased to 2620 Ltrs/ month, the HAI would be '0'. Similarly if 427,0000 tissue paper towel pulls were used, the HAI would be '0'. CONCLUSION: Studying the incidence consumption of the quantity of tissue paper rolls and isopropyl alcohol may be used as a surrogate of hand hygiene practice among healthcare workers.