Infection control bundles in intensive care: an international cross-sectional survey in low- and middle-income countries.


Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Erciyes University, Kayseri, Turkey; European Study Group of Nosocomial Infections, Basel, Switzerland. Electronic address: [Email]


BACKGROUND : In low- and middle-income countries (LMICs), the burden of healthcare-associated infections (HCAIs) is not known due to a lack of national surveillance systems, standardized infection definitions, and paucity of infection prevention and control (IPC) organizations and legal infrastructure.
OBJECTIVE : To determine the status of IPC bundle practice and the most frequent interventional variables in LMICs.
METHODS : A questionnaire was emailed to Infectious Diseases International Research Initiative (ID-IRI) Group Members and dedicated IPC doctors working in LMICs to examine self-reported practices/policies regarding IPC bundles. Responding country incomes were classified by World Bank definitions into low, middle, and high. Comparison of LMIC results was then made to a control group of high-income countries (HICs).
RESULTS : This survey reports practices from one low-income country (LIC), 16 middle-income countries (MICs) (13 European), compared to eight high-income countries (HICs). Eighteen (95%) MICs had an IPC committee in their hospital, 12 (63.2%) had an annual agreed programme and produced an HCAI report. Annual agreed programmes (87.5% vs 63.2%, respectively) and an annual HCAI report (75.0% vs 63.2%, respectively) were more common in HICs than MICs. All HICs had at least one invasive device-related surveillance programme. Seven (37%) MICs had no invasive device-related surveillance programme, six (32%) had no ventilator-associated pneumonia prevention bundles, seven (37%) had no catheter-associated urinary tract infection prevention bundles, and five (27%) had no central line-associated bloodstream infection prevention bundles.
CONCLUSIONS : LMICs need to develop their own bundles with low-cost and high-level-of-evidence variables adapted to the limited resources, with further validation in reducing infection rates.


Bundles,Healthcare-associated infection,Infection control,Low and middle income,Prevention,Ventilator-associated pneumonia,