ORCID Profile
0000-0001-9138-4801
Current Organisation
Leonard M. Miller School of Medicine, University of Miami
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Publisher: Elsevier BV
Date: 11-2008
DOI: 10.1016/J.AJIC.2008.06.003
Abstract: We have shown that intensive care units (ICUs) in countries with limited resources have rates of device-associated health care-associated infection (HAI), including central line-related bloodstream infection (CLAB), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infection (CAUTI), 3 to 5 times higher than rates reported from North American, Western European, and Australian ICUs. The International Nosocomial Infection Control Consortium (INICC) is an international ongoing collaborative HAI control program with a surveillance system based on that of the US National Healthcare Safety Network. The INICC was founded 10 years ago to promote evidence-based infection control in hospitals in limited-resource countries and in hospitals of developed countries without sufficient experience in HAI surveillance and control, through the analysis and feedback of surveillance data collected voluntarily by the member hospitals. It developed from a handful of South American hospitals in 1998 to a dynamic network of 98 ICUs in 18 countries, and is the only source of aggregate standardized international data on HAI epidemiology. Herein we report the criteria and mechanisms for gaining membership in INICC the training of personnel in INICC hospitals the INICC protocol for outcome surveillance of CLABs, VAPs, and CAUTIs in ICUs, microorganism profiles, bacterial resistance, antibiotic use, extra length of stay, extra costs, extra mortality, and risk factor analysis, and for process surveillance, including compliance rates for hand hygiene, vascular catheter care, urinary catheter care, and measures for prevention of VAP and the use of surveillance data feedback as a powerful weapon for control of HAIs. The INICC will continue to evolve in its quest to find more effective and efficient ways to assess patient risk and improve patient safety in hospitals.
Publisher: Cambridge University Press (CUP)
Date: 28-04-2023
DOI: 10.1017/ICE.2023.69
Abstract: To identify central-line (CL)–associated bloodstream infection (CLABSI) incidence and risk factors in low- and middle-income countries (LMICs). From July 1, 1998, to February 12, 2022, we conducted a multinational multicenter prospective cohort study using online standardized surveillance system and unified forms. The study included 728 ICUs of 286 hospitals in 147 cities in 41 African, Asian, Eastern European, Latin American, and Middle Eastern countries. In total, 278,241 patients followed during 1,815,043 patient days acquired 3,537 CLABSIs. For the CLABSI rate, we used CL days as the denominator and the number of CLABSIs as the numerator. Using multiple logistic regression, outcomes are shown as adjusted odds ratios (aORs). The pooled CLABSI rate was 4.82 CLABSIs per 1,000 CL days, which is significantly higher than that reported by the Centers for Disease Control and Prevention National Healthcare Safety Network (CDC NHSN). We analyzed 11 variables, and the following variables were independently and significantly associated with CLABSI: length of stay (LOS), risk increasing 3% daily (aOR, 1.03 95% CI, 1.03–1.04 P .0001), number of CL days, risk increasing 4% per CL day (aOR, 1.04 95% CI, 1.03–1.04 P .0001), surgical hospitalization (aOR, 1.12 95% CI, 1.03–1.21 P .0001), tracheostomy use (aOR, 1.52 95% CI, 1.23–1.88 P .0001), hospitalization at a publicly owned facility (aOR, 3.04 95% CI, 2.31–4.01 P .0001) or at a teaching hospital (aOR, 2.91 95% CI, 2.22–3.83 P .0001), hospitalization in a middle-income country (aOR, 2.41 95% CI, 2.09–2.77 P .0001). The ICU type with highest risk was adult oncology (aOR, 4.35 95% CI, 3.11–6.09 P .0001), followed by pediatric oncology (aOR, 2.51 % CI, 1.57–3.99 P .0001), and pediatric (aOR, 2.34 95% CI, 1.81–3.01 P .0001). The CL type with the highest risk was internal-jugular (aOR, 3.01 95% CI, 2.71–3.33 P .0001), followed by femoral (aOR, 2.29 95% CI, 1.96–2.68 P .0001). Peripherally inserted central catheter (PICC) was the CL with the lowest CLABSI risk (aOR, 1.48 95% CI, 1.02–2.18 P = .04). The following CLABSI risk factors are unlikely to change: country income level, facility ownership, hospitalization type, and ICU type. These findings suggest a focus on reducing LOS, CL days, and tracheostomy using PICC instead of internal-jugular or femoral CL and implementing evidence-based CLABSI prevention recommendations.
Publisher: Elsevier BV
Date: 06-2023
DOI: 10.1016/J.AJIC.2022.08.024
Abstract: The International Nosocomial Infection Control Consortium has found a high ICU mortality rate. Our aim was to identify all-cause mortality risk factors in ICU-patients. Multinational, multicenter, prospective cohort study at 786 ICUs of 312 hospitals in 147 cities in 37 Latin American, Asian, African, Middle Eastern, and European countries. Between 07/01/1998 and 02/12/2022, 300,827 patients, followed during 2,167,397 patient-days, acquired 21,371 HAIs. Following mortality risk factors were identified in multiple logistic regression: Central line-associated bloodstream infection (aOR:1.84 P<.0001) ventilator-associated pneumonia (aOR:1.48 P<.0001) catheter-associated urinary tract infection (aOR:1.18 P<.0001) medical hospitalization (aOR:1.81 P<.0001) length of stay (LOS), risk rises 1% per day (aOR:1.01 P<.0001) female gender (aOR:1.09 P<.0001) age (aOR:1.012 P<.0001) central line-days, risk rises 2% per day (aOR:1.02 P<.0001) and mechanical ventilator (MV)-utilization ratio (aOR:10.46 P<.0001). Coronary ICU showed the lowest risk for mortality (aOR: 0.34 P<.0001). Some identified risk factors are unlikely to change, such as country income-level, facility ownership, hospitalization type, gender, and age. Some can be modified Central line-associated bloodstream infection, ventilator-associated pneumonia, catheter-associated urinary tract infection, LOS, and MV-utilization. So, to lower the risk of death in ICUs, we recommend focusing on strategies to shorten the LOS, reduce MV-utilization, and use evidence-based recommendations to prevent HAIs.
Publisher: Cambridge University Press (CUP)
Date: 11-2010
DOI: 10.1086/656593
Abstract: To estimate the excess length of stay in an intensive care unit (ICU) due to a central line-associated bloodstream infection (CLABSI), using a multistate model that accounts for the timing of infection. A cohort of 3,560 patients followed up for 36,806 days in ICUs. Eleven ICUs in 3 Latin American countries: Argentina, Brazil, and Mexico. All patients admitted to the ICU during a defined time period with a central line in place for more than 24 hours. The average excess length of stay due to a CLABSI increased in 10 of 11 ICUs and varied from -1.23 days to 4.69 days. A reduction in length of stay in Mexico was probably caused by an increased risk of death due to CLABSI, leading to shorter times to death. Adjusting for patient age and Average Severity of Illness Score tended to increase the estimated excess length of stays due to CLABSI. CLABSIs are associated with an excess length of ICU stay. The average excess length of stay varies between ICUs, most likely because of the case-mix of admissions and differences in the ways that hospitals deal with infections.
Publisher: Cambridge University Press (CUP)
Date: 2023
DOI: 10.1017/ASH.2022.339
Abstract: Rates of ventilator-associated pneumonia (VAP) in low- and middle-income countries (LMIC) are several times above those of high-income countries. The objective of this study was to identify risk factors (RFs) for VAP cases in ICUs of LMICs. Prospective cohort study. This study was conducted across 743 ICUs of 282 hospitals in 144 cities in 42 Asian, African, European, Latin American, and Middle Eastern countries. The study included patients admitted to ICUs across 24 years. In total, 289,643 patients were followed during 1,951,405 patient days and acquired 8,236 VAPs. We analyzed 10 independent variables. Multiple logistic regression identified the following independent VAP RFs: male sex (adjusted odds ratio [aOR], 1.22 95% confidence interval [CI], 1.16–1.28 P .0001) longer length of stay (LOS), which increased the risk 7% per day (aOR, 1.07 95% CI, 1.07–1.08 P .0001) mechanical ventilation (MV) utilization ratio (aOR, 1.27 95% CI, 1.23–1.31 P .0001) continuous positive airway pressure (CPAP), which was associated with the highest risk (aOR, 13.38 95% CI, 11.57–15.48 P .0001) tracheostomy connected to a MV, which was associated with the next-highest risk (aOR, 8.31 95% CI, 7.21–9.58 P .0001) endotracheal tube connected to a MV (aOR, 6.76 95% CI, 6.34–7.21 P .0001) surgical hospitalization (aOR, 1.23 95% CI, 1.17–1.29 P .0001) admission to a public hospital (aOR, 1.59 95% CI, 1.35-1.86 P .0001) middle-income country (aOR, 1.22 95% CI, 15–1.29 P .0001) admission to an adult-oncology ICU, which was associated with the highest risk (aOR, 4.05 95% CI, 3.22–5.09 P .0001), admission to a neurologic ICU, which was associated with the next-highest risk (aOR, 2.48 95% CI, 1.78–3.45 P .0001) and admission to a respiratory ICU (aOR, 2.35 95% CI, 1.79–3.07 P .0001). Admission to a coronary ICU showed the lowest risk (aOR, 0.63 95% CI, 0.51–0.77 P .0001). Some identified VAP RFs are unlikely to change: sex, hospitalization type, ICU type, facility ownership, and country income level. Based on our results, we recommend focusing on strategies to reduce LOS, to reduce the MV utilization ratio, to limit CPAP use and implementing a set of evidence-based VAP prevention recommendations.
Publisher: BMJ
Date: 06-09-2011
Publisher: Cambridge University Press (CUP)
Date: 24-10-2022
DOI: 10.1017/ICE.2022.245
Abstract: To identify risk factors for mortality in intensive care units (ICUs) in Asia. Prospective cohort study. The study included 317 ICUs of 96 hospitals in 44 cities in 9 countries of Asia: China, India, Malaysia, Mongolia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, and Vietnam. Patients aged >18 years admitted to ICUs. In total, 157,667 patients were followed during 957,517 patient days, and 8,157 HAIs occurred. In multiple logistic regression, the following variables were associated with an increased mortality risk: central-line-associated bloodstream infection (CLABSI aOR, 2.36 Some variables associated with an increased mortality risk are unlikely to change, such as age, sex, national economy, hospitalization type, and ICU type. Some other variables can be modified, such as LOS, central-line use, urinary catheter use, and mechanical ventilation as well as and acquisition of CLABSI, VAE, or CAUTI. To reduce mortality risk, we shall focus on strategies to reduce LOS strategies to reduce central-line, urinary catheter, and mechanical ventilation use and HAI prevention recommendations.
Location: No location found
Location: United States of America
No related grants have been discovered for VICTOR DANIEL ROSENTHAL.