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    Are Soap, Paper Towel and Alcohol-based Disinfectants Easily Accessible in Intensive Care Units in Turkey?: Results of the Phokai Study
    (Galenos Yayincilik, 2018) Uyan, Ayse; Durmus, Gul; Sezak, Nurbanu; Ozdemir, Burcu; Kaygusuz, Turkkan; Oztoprak, Nefise; Ozdemir, Keyser; Aksoy, Firdevs; Ozgultekin, Asu; Koc, Meliha Meric; Oncul, Ahsen; Cagan Aktas, Sabahat; Isik, Burcu; Celebi, Giiven; Evik, Guliiz; Ozger, Selcuk; Harman, Rezan; Dindar Demiray, Emine Kubra; Ozkoren Calik, Sebnem; Alkan Ceviker, Sevil; Yildiz, Ilknur Esen; Isik, Mehmet Emirhan; Senol, Gunes; Sari, Sema; Dogan, Mustafa; Ugurlu, Kenan; Arslan, Mustafa; Akgul, Fethiye; Koc, Filiz; Kurekci, Yeim; Caglayan, Derya; Ucar, Mehmet; Gozukucuk, Ramazan; Elmaslar Mert, Habibe Tulin; Alay, Handan; Erdogan, Haluk; Demirel, Aslihan; Dogan, Nilgun; Kocak, Funda; Guven, Emre; Unsal, Guieser; Sipahi, Hilal; Yamazhan, Tansu; Arda, Bilgin; Ulusoy, Sercan; Sipahi, Oguz Resat
    Introduction: Hand hygiene is one of the most effective infection control measures to prevent the spread of healthcare-associated infections (HCAI). Water, soap, paper towel and hand disinfectant must be available and adequate in terms of effective hand hygiene. The adequacy of hand hygiene products or keeping water-soap and paper towel is still a problem for many developing countries like Turkey. In this multicenter study, we analyzed the adequacy in number and availability of hand hygiene products. Materials and Methods: This study was performed in all intensive care units (ICUs) of 41 hospitals (27 tertiary-care educational, 10 state and four private hospitals) from 22 cities located in seven geographical regions of Turkey. We analyzed water, soap, paper towel and alcohol-based hand disinfectant adequacy on four different days, two of which were in summer during the vacation time (August, 27th and 31st 2016) and two in autumn (October, 12th and 15th 2016). Results: The total number of ICUs and intensive care beds in 41 participating centers were 214 and 2357, respectively. Overall, there was no soap in 3-11% of sinks and no paper towel in 10-18% of sinks while there was no alcohol-based hand disinfectant in 1-4.7% of hand disinfectant units on the observation days. When we compared the number of sinks with soap and/or paper towel on weekdays vs. weekends, there was no significant difference in summer. However, on autumn weekdays, the number of sinks with soap and paper towel was significantly lower on weekend days (p<0.0001, p<0.0001) while the number of hand disinfectant units with alcohol-based disinfectant was significantly higher (p<0.0001). Conclusion: There should be adequate and accessible hand hygiene materials for effective hand hygiene. In this study, we found that soap and paper towels were inadequate on the observation days in 3-11% and 10-18% of units, respectively. Attention should be paid on soap and paper towel supply at weekends as well.
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    International Nosocomial Infection Control Consortium (INICC) national report on device-associated infection rates in 19 cities of Turkey, data summary for 2003-2012
    (Bmc, 2014) Leblebicioglu, Hakan; Erben, Nurettin; Rosenthal, Victor Daniel; Atasay, Begum; Erbay, Ayse; Unal, Serhat; Senol, Gunes; Willke, Ayse; Ozgultekin, Asu; Altin, Nilgun; Bakir, Mehmet; Oncul, Oral; Ersoz, Gulden; Ozdemir, Davut; Yalcin, Ata Nevzat; Ozdemir, Halil; Yildizdas, Dincer; Koksal, Iftihar; Aygun, Canan; Sirmatel, Fatma; Sener, Alper; Tuna, Nazan; Akan, OTzay Arikan; Turgut, Huseyin; Demiroz, A. Pekcan; Kendirli, Tanil; Alp, Emine; Uzun, Cengiz; Ulusoy, Sercan; Arman, Dilek; Ozgunes, Ilhan; Usluer, Gaye; Kilic, Atila; Arsan, Saadet; Cabadak, Hatice; Sen, Suha; Gelebek, Yasemin; Zengin, Humeyra; Topeli, Arzu; Alper, Yusuf; Meric, Meliha; Azak, Emel; Inan, Asuman; Turan, Guldem; Haznedaroglu, Tuncer; Gorenek, Levent; Acar, Ali; Cesur, Salih; Engin, Aynur; Kaya, Ali; Kuyucu, Necdet; Geyik, Mehmet Faruk; Aydin, Ozlem Cetinkaya; Erdogan, Nurse Selvi; Turhan, Ozge; Gunay, Nurgul; Gumus, Eylul; Dursun, Oguz; Esen, Saban; Ulger, Fatma; Dilek, Ahmet; Yilmaz, Hava; Sunbul, Mustafa; Gokmen, Zeynel; Ozdemir, Sonay Incesoy; Horoz, Ozden Ozgur; Yylmaz, Gurdal; Kaya, Selcuk; Ulusoy, Hulya; Kucukoduk, Sukru; Ustun, Cemal; Baysal, Abant Izzet; Otkun, Metin; Tulunay, Melek; Oral, Mehmet; Unal, Necmettin; Cengiz, Mustafa; Yilmaz, Leyla; Sacar, Suzan; Sungurtekin, Hulya; Ugurcan, Dogac; Yetkin, M. Arzu; Bulut, Cemal; Erdinc, F. Sebnem; Hatipoglu, Cigdem Ataman; Ince, Erdal; Ciftci, Ergin; Odek, Caglar; Yaman, Ayhan; Karbuz, Adem; Aldemir, Bilge; Kilic, Aysegul Ulu; Arda, Bilgin; Bacakoglu, Feza; Hizel, Kenan
    Background: Device-associated healthcare-acquired infections (DA-HAI) pose a threat to patient safety, particularly in the intensive care unit (ICU). We report the results of the International Infection Control Consortium (INICC) study conducted in Turkey from August 2003 through October 2012. Methods: A DA-HAI surveillance study in 63 adult, paediatric ICUs and neonatal ICUs (NICUs) from 29 hospitals, in 19 cities using the methods and definitions of the U.S. NHSN and INICC methods. Results: We collected prospective data from 94,498 ICU patients for 647,316 bed days. Pooled DA-HAI rates for adult and paediatric ICUs were 11.1 central line-associated bloodstream infections (CLABSIs) per 1000 central line (CL)-days, 21.4 ventilator-associated pneumonias (VAPs) per 1000 mechanical ventilator (MV)-days and 7.5 catheter-associated urinary tract infections (CAUTIs) per 1000 urinary catheter-days. Pooled DA-HAI rates for NICUs were 30 CLABSIs per 1000 CL-days, and 15.8 VAPs per 1000 MV-days. Extra length of stay (LOS) in adult and paediatric ICUs was 19.4 for CLABSI, 8.7 for VAP and 10.1 for CAUTI. Extra LOS in NICUs was 13.1 for patients with CLABSI and 16.2 for patients with VAP. Extra crude mortality was 12% for CLABSI, 19.4% for VAP and 10.5% for CAUTI in ICUs, and 15.4% for CLABSI and 10.5% for VAP in NICUs. Pooled device use (DU) ratios for adult and paediatric ICUs were 0.54 for MV, 0.65 for CL and 0.88 for UC, and 0.12 for MV, and 0.09 for CL in NICUs. The CLABSI rate was 8.5 per 1,000 CL days in the Medical Surgical ICUs included in this study, which is higher than the INICC report rate of 4.9, and more than eight times higher than the NHSN rate of 0.9. Similarly, the VAP and CAUTI rates were higher compared with U. S. NHSN (22.3 vs. 1.1 for VAP; 7.9 vs. 1.2 for CAUTI) and with the INICC report (22.3 vs. 16.5 in VAP; 7.9 vs. 5.3 in CAUTI). Conclusions: DA-HAI rates and DU ratios in our ICUs were higher than those reported in the INICC global report and in the US NHSN report.
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    Time-dependent analysis of extra length of stay and mortality due to ventilator-associated pneumonia in intensive-care units of ten limited-resources countries: findings of the International Nosocomial Infection Control Consortium (INICC)
    (Cambridge Univ Press, 2011) Rosenthal, V. D.; Udwadia, F. E.; Munoz, H. J.; Erben, N.; Higuera, F.; Abidi, K.; Medeiros, E. A.; Fernandez Maldonado, E.; Kanj, S. S.; Gikas, A.; Barnett, A. G.; Graves, N.; Guzman, Sandra; Flynn, Luis Pedro; Rausch, Diego; Spagnolo, Alejandro; Benchetrit, Guillermo; Bonaventura, Claudio; de los Angeles Caridi, Maria; Messina, Adriana; Ricci, Beatriz; Frias, Maria Laura; Churruarin, Griselda; Sztokhamer, Daniel; Soroka, Luisa C.; Forciniti, Silvia; Blasco, Marta; Lezcano, Carmen B.; Lastra, Carlos Esteban; Viegas, Monica; Di Nubila, Beatriz Marta Alicia; Lanzetta, Diana; Fernandez, Leonardo J.; Rossetti, Maria Adelaida; Romani, Adriana; Migazzi, Claudia; Barolin, Clarisa; Martinez, Estela; Kobylarz, Alicia; Grinberg, Gorki; Ferreira, Iselde Buchner; Cechinel, Raquel Bauer; Angelieri, Daniela Bicudo; Nouer, Simone; Vianna, Rosa; Machado, Ana Lucia; Gama, Elaine; Blanquet, Doris; Zanandrea, Bruna Boaria; Rohnkohl, Carolina; Regalin, Marcos; Salomao, Reinaldo; Maretti da Silva, Maria Angela; de Jesus Silva, Clelia Heloisa; Vilins, Margarete; Blecher, Sergio; Spessatto, Jamile Leda; Pasini, Ricardo Scopel; Ferla, Shaline; Grinberg, Gorki; Sussmann, Otto; Mojica, Beatriz Eugenia; Villamil Gomez, Wilmer; Ruiz Vergara, Guillermo; Arrieta, Patrick; Rojas, Catherine; Beltran, Humberto; Paez, Jerson; Sussmann, Otto; Torres Navarrete, Maria del Pilar; Dajud, Luis; Mendoza, Mariela; Arrieta, Patrick; Alvarez Moreno, Carlos; Linares, Claudia; Osorio, Laline; Barahona Guzman, Nayide; Rodriguez Ferrer, Marena; Sarmiento Villa, Guillermo; Lagares Guzman, Alfredo; Olarte, Narda; Valderrama, Alberto; Garzon Agudelo, Julio; Rodriguez Calderon, Maria Eugenia; Chaniotaki, Kalliopi; Tsioutis, Constantinos; Bampalis, Dimitris; Todi, Subhash Kumar; Bhakta, Arpita; Bhattacharjee, Mahuya; Kumar, R. Krishna; Radhakrishnan, Kavitha; Ansari, Reshma; Poojary, Aruna; Koppikar, Geeta; Bhandarkar, Lata; Jadhav, Shital; Sen, Nagamani; Subramani, Kandasamy; Karlekar, Anil; Rodrigues, Camilla; Hegd, Ashit; Kapadia, Farahad; Sahu, Samir; Gopinath, Ramachadran; Ravindra, Nallagonda; Myatra, Sheila Nainan; Divatia, J. V.; Kelkar, Rohini; Biswas, Sanjay; Raut, Sandhya; Sampat, Sulochana; Kumar, Rishi; Chakravarthy, Murali; Gokul, B. N.; Sukanya, R.; Pushparaj, Leema; Dwivedy, Arpita; Shetty, Suvin; Binu, Sheena; Zahreddine, Nada; Sidani, Nisreen; Jurdi, Lamia Alamaddni; Kanafani, Zeina; Sanchez Lopez, Martha; Torres Hernandez, Hector; Chavez Gomez, Amalia; Morales, Jaime Rivera; Valero Rodriguez, Julian Enrique; Sobreyra Oropeza, Martha; Sigfrido Rangel-Frausto, Manuel; Martinez Soto, Jose; Armas Ruiz, Alberto; Campuzano, Roberto; Mena Brito, Jorge; Abouqal, Redouane; Madani, Naoufel; Zeggwagh, Amine Ali; Dendane, Tarek; Barkat, Amina; Bouazzaoui, Naima Lamdouar; Meryem, Kabiri; Cuellar, Luis; Rosales, Rosa; Castillo Bravo, Luis Isidro; Linares Caceres, Maria; Atencio Espinoza, Teodora; Sarmiento Lopez, Favio; Mayorga Espichan, Manuel Jesus; Echenique, Liliana; Castaneda Sabogal, Alex; Paredes Goicochea, Iliana; Arroyo Sanchez, Abel; Rios Alva, Guillermo; Garcia Ventura, Jorge; Ramrez Aguilar, Miguel; Segura Plasencia, Niler; Rodriguez, Teofilo; Yalcin, A. Nevzat; Turhan, Ozge; Keskin, Sevim; Gumus, Eylul; Dursun, Oguz; Ozdemir, Davut; Guclu, Ertugrul; Erdogan, Selvi; Ulusoy, Sercan; Arda, Bilgin; Bacakoglu, Feza; Alp, Emine; Aygen, Bilgehan; Arman, Dilek; Hizel, Kenan; Ozdemir, Kesver; Uzun, Cengiz; Sardan, Yesim Cetinkaya; Yildirim, Gonul; Topeli, Arzu; Sirmatel, Fatma; Cengiz, Mustafa; Yilmaz, Leyla; Ozgultekin, Asu; Turan, Guldem; Akgun, Nur; Ozturk, Recep; Dikmen, Yalim; Aygun, Gokhan; Akan, Ozay Arikan; Tulunay, Melek; Oral, Mehmet; Unal, Necmettin; Koksal, Iftihar; Yylmaz, Gurdal; Senel, A. C.; Sozen, Ebru Emel; Ersoz, Gulden; Kaya, Ali; Kandemir, Ozlem; Leblebicioglu, Hakan; Esen, Saban; Ulger, Fatma; Dilek, Ahmet; Aygun, Canan; Kucukoduk, Sukru; Ozgunes, Ilhan; Usluer, Gaye; Turgut, Huseyin; Sacar, Suzan; Sungurtekin, Hulya; Ugurcan, Dogac
    Ventilator-associated pneumonias (VAPs) are a worldwide problem that significantly increases patient morbidity, mortality, and length of stay (LoS), and their effects should be estimated to account for the timing of infection. The purpose of the study was to estimate extra LoS and mortality in an intensive-care unit (ICU) due to a VAP in a cohort of 69 248 admissions followed for 283 069 days in ICUs from 10 countries. Data were arranged according to the multi-state format. Extra LoS and increased risk of death were estimated independently in each country, and their results were combined using a random-effects meta-analysis. VAP prolonged LoS by an average of 2.03 days (95% CI 1.52-2.54 days), and increased the risk of death by 14% (95% CI 2-27). The increased risk of death due to VAP was explained by confounding with patient morbidity.