CARE BUNDLES FOR PREVENTING DEVICE ASSOCIATED INFECTION IN EMERGENCY INTENSIVE CARE UNIT AT ZAGAZIG UNIVERSITY HOSPITALS : EVALUATION OF PROCESS AND OUTCOME

Background: The intensive care unit (ICU) is considered as an epicentre of infections. A device-associated healthcare-associated infection is a hospital acquired infection in a patient with a (relevant) device within 48 hours either permanently or intermittently. It comprises ventilator associated pneumonia (VAP), Central line associated blood stream infection (CLABSI) and catheter associated urinary tract infection (CAUTI).Implementation of care bundles was shown to reduce the incidence of hospital acquired and device-associated infections. Substantial improvements in the rate of infection have been achieved by applying a basic educational program in infection control. Aim: the aims of this work are to asses compliance with device care bundle components and review its impact on the rates of DAI at the Emergency ICU, Zagazig university hospitals. Patients and Methods: This is a prospective surveillance, cohort study made on all the patients admitted, between May 2016 to October 2016 as regard device associated infection (DAI) .It was carried out in a 15 beds Emergency ICU Zagazig University Hospitals. All cases with invasive devices (endotracheal tube, central vascular catheter and urinary catheter) inserted in the emergency ICU and lasts more than 48 hrs over 6 months were included in the study. The bundle for preventing and controlling HAIs was evaluated based on Hospital Infection Control Measures, Guideline for Strengthening the Construction and Management of ICU in China (2006).Outcomes measured during the surveillance period included the incidence density of overall DAIs, VAPs, CAUTIs, and CLABSIs. Results :Incidence of device associated infections was 35.3/1000 device days and , Incidence of VAP was 68.2 /1000 ventilator-days with DUR 0.80 for 997 ventilator days , Incidence of CLABSI was 18.5/1000catheter-days with DUR 0.96 for 1190 central line days and Incidence of CAUTI was 24.9/1000catheter-days with DUR 0.99 for 1243 catheter days .Conclusion: the high rates of DAIs, device utilization ratios, mortality rate and levels of antimicrobial resistance of pathogens identified in this study and the low percentage of compliance of care bundle highlight the importance of developing a comprehensive care bundle education program. Keywords: intensive care unit , ventilator-associated pneumonia, catheter-associated urinary tract infection, central line-associated bloodstream infection, antimicrobial resistance ,care bundle .