The findings of this study on Egypt DA-HAI rates form an integral part of the INICC and reflect the outcome and process surveillance data that were systematically collected. The study was carried out in 3 ICUs in three hospitals in two cities in Egypt from December 2008

to July 2010. Each hospital had an infection control team (ICT) with a physician, an infection control practitioner (ICP) with at least one year of experience in infection control (Table 1) and a microbiology laboratory to perform in vitro susceptibility testing of clinical isolates using standardized methods. Every hospital’s institutional review board agreed to the study protocol. Patient Sirolimus purchase confidentiality was protected by codifying the recorded information, making it identifiable only to the ICT. The INICC surveillance program includes two components: outcome surveillance (DA-HAI rates and their adverse effects) and process surveillance (adherence to hand hygiene and other basic preventive infection control practices) [16]. Investigators were required to complete outcome and process surveillance forms at their hospitals, which were then sent to the INICC headquarters office in Buenos selleck inhibitor Aires for their monthly analysis. The INICC surveillance program applies methods

and definitions for healthcare-associated infections (HAIs) developed by the U.S. Centers for Disease Control and Prevention (CDC) for the NNIS/NHSN program [6] and [17]; however, the INICC methods have been adapted to the setting of developing countries due to their different socioeconomic status and specific resource limitations [16]. Outcome surveillance includes the rates of CLAB, ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infection (CAUTI) per 1000 device-days, the microorganism profile, and the length of stay and

mortality in ICUs. The infection control and prevention strategies implemented in INICC member hospitals are based on inexpensive and basic evidence-based measures, including outcome surveillance, process surveillance, education and pheromone performance feedback on outcome surveillance and process surveillance [18], [19], [20] and [21]. Process surveillance was designed to assess compliance with easily measurable key infection control practices, such as surveillance of compliance rates for hand hygiene practices and specific measures for the prevention of CLAB, CAUTI and VAP [16]. Hand hygiene compliance by healthcare workers (HCWs), based on the frequency with which hand hygiene is performed when clearly indicated, is monitored by the ICP during randomly selected 1-h observation periods three times per week. Although HCWs are aware that hand hygiene practices are regularly monitored, they are not informed of the schedule for hand hygiene observations.