GOVPH

Sex: Female
Education

• Doctor of Medicine, University of the Philippines Manila

Field of Specialization:

Tuberculosis
Nosocomial infection
Infectious Disease Epidemiology
Infectious Disease Control and Prevention
Clinical Infectious Diseases
Emerging Infectious Diseases
HIV Prevention

Researches:

Article title: Validation of Snort-spit Saliva in Detecting COVID-19 Using RT-PCR and Rapid Antigen Detection Test
Authors: Ryner Jose D. Carrillo, Abigail D. Sarmiento, Mark Anthony C. Ang, Michelle H. Diwa, Cecille C. Dungog
Publication title: Acta medica Philippina 55(2), April 2021

Abstract:
To determine the diagnostic accuracy of self-collected snorted and spit saliva in detecting COVID-19 using RT-PCR (ssRT-PCR) and lateral flow antigen test (ssLFA) versus nasopharyngeal swab RT-PCR (npRT-PCR). Methods. One hundred ninety-seven symptomatic subjects for COVID-19 testing in a tertiary hospital underwent snort-spit saliva self-collection for RT-PCR and antigen testing and nasopharyngeal swab for RT-PCR as reference. Positivity rates, agreement, sensitivity, specificity, and likelihood ratios were estimated. Results. Estimated prevalence of COVID-19 using npRT-PCR was 9% (exact 95% CI of 5.5% - 14.1%). A higher positivity rate of 13% in the ssRT-PCR assay suggested possible higher viral RNA in the snort-spit samples. There was 92.9% agreement between ssRT-PCR and npRT-PCR (exact 95% CI of 88.4% to 96.1%; Cohen’s Kappa of 0.6435). If npRT-PCR will be assumed as reference standard, the estimated Sensitivity was 83.3% (exact 95% CI of 60.8% to 94.2%), Specificity 93.9% (exact 95% CI of 89.3% to 96.5%), Positive predictive value of 57.7% (exact 95% CI of 38.9% to 74.5%), Negative predictive value of 98.2% (exact 95% CI of 95% to 99.4%), positive likelihood ratio of 3.65 (95% CI of 7.37 to 24.9), negative likelihood ratio of 0.178 (95% CI of 0.063 to 0.499). There was 84.84% agreement (95% exact CI of 79.1% to 89.5%; Cohen’s Kappa of 0.2356) between ssLFAvs npRT-PCR, sensitivity of 38.9% (exact 95% CI of 20.3% to 61.4%), specificity of 89.4% (exact 95% CI of 84.1% to 93.1%), PPV of 26.9% (95% CI of 13.7% to 46.1%), NPV of 93.6% (exact 95% CI of 88.8% to 96.4%), LR+ of 3.67 (95% CI of 1.79 - 7.51), LR – of 0.68 (95% CI of 0.47 - 0.99). Conclusion. Our data showed that snort-spit saliva RT-PCR testing had acceptable diagnostic performance characteristics and can potentially be used as an alternative to the standard nasopharyngeal/oropharyngeal swab RT-PCR test for COVID-19 in certain situations. However, our data also showed that snort-spit saliva antigen testing using lateral flow assay did not offer acceptable performance.
Full text available upon request to the author

Article title: Direct saliva versus conventional nasopharyngeal swab qRT-PCR to diagnose SARS-CoV-2: validity study
Authors: Michael Tee, Paulyn Jean R. Ubial, Diana Rose E. Ranoa, Cherica A. Tee
Publication title: Asian Journal of Research in Infectious Diseases 6(2):37-46, March 2021

Abstract:
Background: Saliva has been demonstrated as a feasible alternative specimen to nasopharyngeal swab for the detection of SARS-CoV-2 using real-time or quantitative reverse transcription polymerase chain reaction (qRT-PCR) method that bypasses the need for explicit viral ribonucleic acid (RNA) extraction.

Aim: To assess the diagnostic validity of direct saliva-to-qRT-PCR in the detection of SARS-CoV-2 compared to conventional nasopharyngeal swab qRT-PCR.

Methodology: Self-collected saliva samples were processed by heating at 95oC for 30 minutes followed by addition of buffer and detergent while viral RNA from nasopharyngeal swabs were extracted using the Sansure Biotech sample release reagent. Paired samples were used as templates for qRT-PCR using the Sansure Novel Coronavirus (COVID-19) Nucleic Acid Diagnostic Kit and Sansure Biotech MA6000 Real-Time Quantitative PCR System. Direct saliva-to-qRT-PCR was compared to nasopharyngeal swab qRT-PCR in terms of diagnostic validity and agreement parameters, and both platforms were compared separately in terms of similar parameters with a composite reference standard (CRS) wherein the criteria for a positive result is SARS-CoV-2 detection in at least either nasopharyngeal swab or saliva.

Results: Of the 238 nasopharyngeal swab-saliva pairs tested, 20 (8.4%) nasopharyngeal swab and 24 (10.1%) saliva specimens tested positive. We documented a sensitivity of 85.0% (95% CI: 62.1%, 96.8%), specificity of 96.8% (95% CI: 93.5%, 98.7%), accuracy of 95.8% (95% CI: 92.4%, 98.0%) and Cohen Kappa of 0.75 (95% CI: 0.60, 0.90) when direct saliva-to-qRT-PCR was compared to the conventional platform. When the two platforms were individually compared to the CRS, numerically higher but not statistically significant sensitivity and accuracy were noted for direct saliva-to-qRT-PCR than for nasopharyngeal swab qRT-PCR.

Conclusion: Direct saliva-to-qRT-PCR is non-inferior to nasopharyngeal swab qRT-PCR for detecting SARS-CoV-2 using the Sansure Novel Coronavirus Nucleic Acid Diagnostic Kit.
Full text link https://tinyurl.com/373cmxxp

Article title: The Impact of the Implementation of a Surgical Antibiotic Use Guideline in the Practice of Antibiotic Use in the Department of Surgery, Philippine General Hospital
Authors: Marie Carmela M. Lapitan, Brian S. Buckley, Esther A. Saguil, Regina P. Berba, Marissa M. Alejandria, et al.
Publication title: Acta Medica Philippina 55(1), February 2021

Abstract:
Objective. This study aimed to assess compliance with current best practice guidelines on the use of antibiotics in the Department of Surgery in the Philippine General Hospital and to determine the impact of the dissemination of an institution-based guideline on compliance and on patient outcomes.

Methods. Two antibiotic use surveys were performed 4 weeks before and 4 weeks after the implementation and dissemination of the PGH Surgical Antibiotic Use Guidelines in the Department of Surgery. The medical records of eligible patients were reviewed regarding patient and case characteristics, details on the administration of antibiotics and the collection of specimen for culture studies. Data relating to the occurrence of surgical site infection within 30 days of the operation was extracted. Compliance with antibiotic use guidelines was assessed for each case. The compliance rates in the pre- and post-intervention periods were compared.

Results. The study included a total of 477 patients, 213 in the pre-implementation and 264 in the post implementation period. Compared with the pre-intervention period, rates of compliance with guidelines improved for all parameters in the post-implementation period except for correct dosing. The greatest improvement was seen in the selection of the recommended drug, and proper duration. There was modest improvement in the timing of the preoperative drug administration. There was poor compliance with recommendations for appropriate specimen collection for culture studies, with marked improvement in collection in the pediatric group post intervention. Overall, the in-hospital SSI rate was reduced from 6.8% to 1.1%, while there was little change in the 30-day SSI rate, post-intervention.

Conclusion. A simple intervention to raise awareness of institutional guidelines on antibiotic use in the surgical setting lead to a modest improvement on overall compliance, although rates of total compliance with all relevant guidance on antibiotic use, choice, dose, timing and duration remained low. The impact on surgical site infection rates based on such compliance was modest.
Full text available upon request to the author

Article title: Clinical validation of Biotek-M dengue aqua kit in the diagnosis of dengue infections in the Philippines
Authors: Regina P. Berba, Joy Ann P. Santos, Kristine Marie G. Flores, Angelo dela Tonga
Publication title: The Southeast Asian journal of tropical medicine and public health 52(1):30-47, January 2021

Abstract:
Owing to the non-specific signs and symptoms of patients during the acute phase of dengue illness, accurate detection of dengue virus (DENV) infection by a reliable yet simple laboratory test during the early phase of illness is crucial for proper management and better clinical outcome of patients. In order to address this need, a miniature loop mediated amplification (LAMP) kit, BIOTEK-M TM Dengue Aqua kit, was developed and evaluated at four hospitals in the Philippines among 517 patients greater than six months of age who presented with prior fever of no longer than seven days. Diagnostic accuracy was determined by comparing with the gold standard of a combination of dengue heminested RT-PCR, IgM ELISA, and NS1 and paired acute-convalescent IgG ELISA, with 91.7% meeting the criteria for true DENV infection. Sensitivity, specificity, positive predictive value, and negative predictive value were 81.9% (95% confidence interval (CI): 89.3-94.1), 85.7% (95% CI: 46.7-99.3), 99.7% (95% CI: 98.3-100), and 7.5% (95% CI: 3.3-15.4), respectively. The positive likelihood ratio was 6.549 (95% CI: 1.046-40.981) and the negative likelihood ratio was 0.207 (95% CI: 0.165-0.260). These results validate the application of BIOTEK-M TM Dengue Aqua kit for detection of early DENV infection and should be a useful tool in dengue control and elimination programs in the Philippines and other dengue endemic countries.
Full text link https://tinyurl.com/h29mdnta

Article title: Six-year study on peripheral venous catheter–associated BSI rates in 262 ICUs in eight countries of South-East Asia: International Nosocomial Infection Control Consortium findings
Authors: Victor Daniel Rosenthal, Ider Bat-Erdene, Debkishore Gupta, Prasad Rajhans, Sheila Nainan Myatra, S Muralidharan, et al.
Publication title: The Journal of Vascular Access (1):112972982091725, May 2020

Abstract:
Background Short-term peripheral venous catheter–associated bloodstream infection rates have not been systematically studied in Asian countries, and data on peripheral venous catheter–associated bloodstream infections incidence by number of short-term peripheral venous catheter days are not available. Methods Prospective, surveillance study on peripheral venous catheter–associated bloodstream infections conducted from 1 September 2013 to 31 May 2019 in 262 intensive care units, members of the International Nosocomial Infection Control Consortium, from 78 hospitals in 32 cities of 8 countries in the South-East Asia Region: China, India, Malaysia, Mongolia, Nepal, Philippines, Thailand, and Vietnam. For this research, we applied definition and criteria of the CDC NHSN, methodology of the INICC, and software named INICC Surveillance Online System. Results We followed 83,295 intensive care unit patients for 369,371 bed-days and 376,492 peripheral venous catheter-days. We identified 999 peripheral venous catheter–associated bloodstream infections, amounting to a rate of 2.65/1000 peripheral venous catheter-days. Mortality in patients with peripheral venous catheter but without peripheral venous catheter–associated bloodstream infections was 4.53% and 12.21% in patients with peripheral venous catheter–associated bloodstream infections. The mean length of stay in patients with peripheral venous catheter but without peripheral venous catheter–associated bloodstream infections was 4.40 days and 7.11 days in patients with peripheral venous catheter and peripheral venous catheter–associated bloodstream infections. The microorganism profile showed 67.1% were Gram-negative bacteria: Escherichia coli (22.9%), Klebsiella spp (10.7%), Pseudomonas aeruginosa (5.3%), Enterobacter spp. (4.5%), and others (23.7%). The predominant Gram-positive bacteria were Staphylococcus aureus (11.4%). Conclusions Infection prevention programs must be implemented to reduce the incidence of peripheral venous catheter–associated bloodstream infections.
Full text link https://tinyurl.com/4kph65dd

Article title: Behavioural change: a rare presentation of leptospirosis
Authors: Isabelle Dominique Tomacruz, Joanne Carmela Sandejas, Regina Berba and Dennis Raymond Sacdalan, et al.
Publication title: BMJ Case Reports 12(8):e230619, August 2019

Abstract:
Neurological manifestations of leptospirosis without severe multiorgan involvement are a rare clinical entity. Despite the increasing prevalence of the disease in many tropical countries, its protean clinical presentations make its timely diagnosis challenging. We report the case of a 44-year-old Filipino man presenting with fever, myalgia, behavioural changes and altered sensorium. Neurological examination did not show any focal neurological deficits or clear signs of meningoencephalitis. Lumbar tap, cranial CT scan and cranial MRI were inconclusive. The diagnosis of leptospirosis with acute encephalitis relied heavily on the patient’s clinical clues, appropriate exposure history and patterns in ancillary laboratory tests. Empiric antibiotic therapy with ceftriaxone was initiated. Seroconversion and fourfold increase in serological antibody titres by leptospirosis microagglutination test later confirmed the diagnosis. The patient was successfully treated, and all neurological complications were reversed
Full text available upon request to the author

Article title: Increased predominance of HIV-1 CRF01_AE and its recombinants in the Philippines
Authors: Yue Chen, Bhavna Hora, Todd DeMarco, Regina Berba, Heidi Register, et al.
Publication title: Journal of General Virology 100(3):511-522, March 2019

Abstract:
The growth rate of new HIV infections in the Philippines was the fastest of any countries in the Asia-Pacific region between 2010 and 2016. To date, HIV-1 subtyping results in the Philippines have been determined by characterizing only partial viral genome sequences. It is not known whether recombination occurs in the majority of unsequenced genome regions. Near-full-length genome (NFLG) sequences were obtained by amplifying two overlapping half genomes from plasma samples collected between 2015 and 2017 from 23 newly diagnosed infected individuals in the Philippines. Phylogenetic analysis showed that the newly characterized sequences were CRF01_AE (14), subtype B (3), CRF01/B recombinants (5) and a CRF01/CRF07/B recombinant (1). All 14 CRF01_AE formed a tight cluster, suggesting that they were derived from a single introduction. The time to the most recent common ancestor (tMRCA) for CRF01_AE in the Philippines was 1995 (1992-1998), about 10-15 years later than that of CRF01_AE in China and Thailand. All five CRF01/B recombinants showed distinct recombination patterns, suggesting ongoing recombination between the two predominant circulating viruses. The identification of partial CRF07_BC sequences in one CRF01/CRF07/B recombinant, not reported previously in the Philippines, indicated that CRF07_BC may have been recently introduced into that country from China, where CRF07_BC is prevalent. Our results show that the major epidemic strains may have shifted to an increased predominance of CRF01_AE and its recombinants, and that other genotypes such as CRF07_BC may have been introduced into the Philippines.
Full text available upon request to the author

Article title: Evaluation of Tuberculosis Infection Control Strategies at the Philippine General Hospital
Authors: Ruth Divine Agustin, Josephine Lucero, Regina Pascua Berba
Publication title: Acta medica Philippina 52(1), February 2018

Abstract:
Background. Nosocomial TB transmission adversely affects inpatients and healthcare workers (HCWs). HCWs have a higher risk of tuberculosis and MDR-TB compared to the general population. Nosocomial TB outbreaks have occurred among patients with HIV/AIDS. Hospitals need to examine TB infection control measures in order to address this growing concern. Objective. This study aimed to evaluate the TB infection control strategies in the adult service wards of the Philippine General Hospital (PGH). Methods. This descriptive study was conducted on adult inpatients with bacteriologically-confirmed PTB admitted in April-August 2016. A data collection tool based on Center for Disease Control (CDC) guidelines was utilized for chart review. Baseline characteristics, diagnosis, treatment, and isolation intervals were obtained and compared between areas. In-hospital TB infection control practices were reviewed using the CDC TB Risk Assessment Worksheet with data from the TB-DOTS, UP Health Service, PGH Hospital Infection Control Unit, and PGH Department of Laboratories. Results. Of the 95 patients with bacteriologically-confirmed PTB, data from 72 medical records were available and included in the analysis. Majority were Medicine patients (55.6%) with a diagnosis of pneumonia (52.8%). Only 61.1% were PTB suspects on admission. The mean diagnosis interval was 5.82 days±5.473, the mean treatment interval was 0.77 days±2.941, and the mean isolation interval was 8.23 days±6.372. Only 41.7% were successfully isolated. The most common reasons for isolation failure/delay were lack of vacancy (ER, Medicine wards) and lack of isolation room (Surgical wards). Treatment initiation rate was 66.7% while TB-DOTS inpatient referral rate was 55.6%. The hospital is classified as having potential ongoing transmission of PTB. Conclusion. In this study, TB treatment was promptly started but there were delays in diagnosis and isolation. Gaps included 1) lack of recognition of a PTB case, 2) limited isolation rooms, and 3) inadequate utilization of TB-DOTS. TB infection control measures need to be strengthened in order to prevent nosocomial transmission of PTB.
Full text available upon request to the author

Article title: Effect of a Multifaceted Intervention on Hand Hygiene compliance among Healthcare Workers at the Medicine Wards and Icu in a tertiary Hospital Setting
Authors: Rich Ericson C. King, Regina Pascua Berba
Publication title: Acta medica Philippina 52(1), February 2018

Abstract:
Background. While hand hygiene is recognized as the cornerstone for reducing risk for nosocomial infections, compliance in our institution remains low. Previously identified barriers include poor access to hand hygiene products, lack of reminders, and poor knowledge on indications. Methods. At the medical wards and ICU of a tertiary hospital, a group of medical students, residents, and nurses was exposed to interventions addressing the identified barriers. Alcohol handrub was provided at each bedside, visual reminders were placed at critical locations, and commonly missed opportunities were reinforced at the start of the study. Hand hygiene compliance was covertly evaluated after two weeks and compared against that of an unexposed group. Results. 664 and 727 hand hygiene opportunities were observed in the unexposed and exposed groups, respectively. Compliance was higher in the exposed group (32.60% vs. 16.26%, p <0.05), which by subset analysis was consistent for the different healthcare worker designations and locations evaluated. Nurses had the highest compliance rate in both groups. Conclusions. These results suggest the efficacy of the employed interventions in improving hand hygiene compliance in this setting. Hand hygiene opportunities identified to be most frequently missed in this observation can guide future intervention efforts in our institution.
Full text available upon request to the author

Article title: Approach to Implementation of a Feasible Antibiotic Stewardship Program at a Tertiary University Public Hospital
Authors: Regina Pascua Berba
Publication title: Value in Health 19(7):A914-A915, November 2016

Abstract:
No abstract
Full text available upon request to the author

Article title: Predictors of outcome and severity in adult filipino patients with febrile neutropenia
Authors: Marc Gregory Y. Yu, Ralph Elvi M. Villalobos,Ma. Jasmin Marinela C. Juan-Bartolome, and Regina P. Berba
Publication title: Advances in Hematology 2015(2):920838, September 2015

Abstract:
The study aimed to describe the profile of Filipino febrile neutropenia patients and to determine parameters associated with severe outcomes. Methods . This is a retrospective study of Filipino febrile neutropenia patients admitted to the Philippine General Hospital. Patients were described in terms of clinical presentation and stratified according to the presence or absence of severe outcomes. Prognostic factors were then identified using regression analysis. Results . 115 febrile episodes in 102 patients were identified. Regression analysis yielded prolonged fever >7 days prior to admission (OR 2.43; 95% CI, 0.77–7.74), isolation of a pathogen on cultures (OR 2.69; 95% CI, 1.04–6.98), and nadir absolute neutrophil count (ANC) < 100 during admission (OR 1.96; 95% CI, 0.75–5.12) as significant predictors of poor outcome. Factors that significantly correlated with better outcome were granulocyte colony-stimulating factor (G-CSF) use (OR 0.31; 95% CI, 0.11–0.85) and completeness of antibiotic therapy (OR 0.26; 95% CI, 0.10–0.67). Conclusion . Prolonged fever >7 days prior to admission, positive pathogen on cultures, and nadir ANC < 100 during admission predicted severe outcomes, whereas G-CSF use and complete antibiotic therapy were associated with better outcomes. These prognostic variables might be useful in identifying patients that need more intensive treatment and monitoring.
Full text link https://tinyurl.com/3cprwv6u

Article title: Prevalence and risk factors for HIV infection among men having sex with men in Metro Manila, Philippines
Authors: Louie Mar A. Gangcuangco, Maria Lourdes Tan and Regina P. Berba
Publication title: The Southeast Asian journal of tropical medicine and public health 44(5):810-7, September 2013

Abstract:
HIV incidence in the Philippines is increasing at an alarming rate. We conducted this study to understand the factors catalyzing the HIV epidemic among men having sex with men (MSM) in Metro Manila. From November 2009 to January 2010, an HIV testing booth was set up adjacent to bars and restaurants in Metro Manila frequented by MSM at night. Participants aged > or =18 years were interviewed using a structured questionnaire. Rapid HIV antibody screening was performed using SD Bioline HIV 1/2 3.0 (Standard Diagnostics). Of 406 MSM included in the study, the mean age was 26.2 years [standard deviation (SD) 5.4]; 96% believed condoms reduced HIV risk but only 3% reported consistent use. The leading reasons for not using condoms were belief that the partner was HIV negative (34.4%), diminished pleasure (32%), and unavailability (23.4%). The HIV prevalence using the rapid test was 11.8% [95% confidence interval (CI): 8.7- 15.0]. All 40 cases who had a confirmatory Western blot test were positive, of whom 24 were business process outsourcing employees (BPOEs). On multivariate analysis, work as a BPOE [adjusted OR (aOR): 3.37; p=0.001], preference for receptive anal sex (aOR: 5.26; p=0.04), and sex while under the influence of excessive alcohol (aOR: 2.71; p=0.04) were independently associated with HIV. The proportion of BPOEs who consistently use condoms when having insertive anal sex with a stranger was significantly lower compared to non-BPOEs (24.5% versus 38.2%; p=0.02). Urgent interventions are needed to address the HIV epidemic in the Philippines.
Full text link available https://tinyurl.com/59smcb7f

Article title: Impact of an International Nosocomial Infection Control Consortium multidimensional approach on catheter-associated urinary tract infections in adult intensive care units in the Philippines: International Nosocomial Infection Control Consortium (INICC) findings
Authors: Josephine Anne Navoa-Nga, Regina Berbab, Victor D. Rosenthalc,Victoria D. Villanueva, et al.
Publication title: Journal of Infection and Public Health 6:389-399, June 2013

Abstract:
To assess the impact of a multidimensional infection control approach on the reduction of catheter-associated urinary tract infection (CAUTI) rates in adult intensive care units (AICUs) in two hospitals in the Philippines that are members of the International Nosocomial Infection Control Consortium. This was a before-after prospective active surveillance study to determine the rates of CAUTI in 3183 patients hospitalized in 4 ICUS over 14,426 bed-days. The study was divided into baseline and intervention periods. During baseline, surveillance was performed using the definitions of the US Centers for Disease Control and Prevention and the National Healthcare Safety Network (CDC/NHSN). During intervention, we implemented a multidimensional approach that included: (1) a bundle of infection control interventions, (2) education, (3) surveillance of CAUTI rates, (4) feedback on CAUTI rates, (5) process surveillance and (6) performance feedback. We used random effects Poisson regression to account for the clustering of CAUTI rates across time. We recorded 8720 urinary catheter (UC)-days: 819 at baseline and 7901 during intervention. The rate of CAUTI was 11.0 per 1000 UC-days at baseline and was decreased by 76% to 2.66 per 1000 UC-days during intervention [rate ratio [RR], 0.24; 95% confidence interval [CI], 0.11-0.53; P-value, 0.0001]. Our multidimensional approach was associated with a significant reduction in the CAUTI rates in the ICU setting of a limited-resource country.
Full text link https://tinyurl.com/2ru3xa7b

Article title: Findings of the International Nosocomial Infection Control Consortium (INICC), Part II: Impact of a Multidimensional Strategy to Reduce Ventilator-Associated Pneumonia in Neonatal Intensive Care Units in 10 Developing Countries
Authors: Victor D. Rosenthal, Maria E Rodríguez-Calderón, Marena Rodriguez Ferrer, anu Singhal, et al.
Publication title: Infection Control and Hospital Epidemiology 33(7):704-10, July 2012

Abstract:
Design Before-after prospective surveillance study to assess the efficacy of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control program to reduce the rate of occurrence of ventilator-associated pneumonia (VAP). Setting Neonatal intensive care units (NICUs) of INICC member hospitals from 15 cities in the following 10 developing countries: Argentina, Colombia, El Salvador, India, Mexico, Morocco, Peru, Philippines, Tunisia, and Turkey. Patients NICU inpatients. Methods VAP rates were determined during a first period of active surveillance without the implementation of the multidimensional approach (phase 1) to be then compared with VAP rates after implementation of the INICC multidimensional infection control program (phase 2), which included the following practices: a bundle of infection control interventions, education, outcome surveillance, process surveillance, feedback on VAP rates, and performance feedback on infection control practices. This study was conducted by infection control professionals who applied National Health Safety Network (NHSN) definitions for healthcare-associated infections and INICC surveillance methodology. Results During phase 1, we recorded 3,153 mechanical ventilation (MV)–days, and during phase 2, after the implementation of the bundle of interventions, we recorded 15,981 MV-days. The VAP rate was 17.8 cases per 1,000 MV-days during phase 1 and 12.0 cases per 1,000 MV-days during phase 2 (relative risk, 0.67 [95% confidence interval, 0.50–0.91]; P = .001 ), indicating a 33% reduction in VAP rate. Conclusions Our results demonstrate that an implementation of the INICC multidimensional infection control program was associated with a significant reduction in VAP rate in NICUs in developing countries.
Full text link https://tinyurl.com/hhawkm7d

Article title: Impact of a multidimensional infection control strategy on catheter-associated urinary tract infection rates in the adult intensive care units of 15 developing countries: Findings of the International Nosocomial Infection Control Consortium (INICC)
Authors: V. D. Rosenthal, S. K. Todi, C. Alvarez-Moreno, M. Pawar, A. Karlekar
Publication title: Infection 40(5):517-26, June 2012

Abstract:
We aimed to evaluate the impact of a multidimensional infection control strategy for the reduction of the incidence of catheter-associated urinary tract infection (CAUTI) in patients hospitalized in adult intensive care units (AICUs) of hospitals which are members of the International Nosocomial Infection Control Consortium (INICC), from 40 cities of 15 developing countries: Argentina, Brazil, China, Colombia, Costa Rica, Cuba, India, Lebanon, Macedonia, Mexico, Morocco, Panama, Peru, Philippines, and Turkey. We conducted a prospective before-after surveillance study of CAUTI rates on 56,429 patients hospitalized in 57 AICUs, during 360,667 bed-days. The study was divided into the baseline period (Phase 1) and the intervention period (Phase 2). In Phase 1, active surveillance was performed. In Phase 2, we implemented a multidimensional infection control approach that included: (1) a bundle of preventive measures, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of CAUTI rates, and (6) feedback of performance. The rates of CAUTI obtained in Phase 1 were compared with the rates obtained in Phase 2, after interventions were implemented. We recorded 253,122 urinary catheter (UC)-days: 30,390 in Phase 1 and 222,732 in Phase 2. In Phase 1, before the intervention, the CAUTI rate was 7.86 per 1,000 UC-days, and in Phase 2, after intervention, the rate of CAUTI decreased to 4.95 per 1,000 UC-days [relative risk (RR) 0.63 (95 % confidence interval [CI] 0.55-0.72)], showing a 37 % rate reduction. Our study showed that the implementation of a multidimensional infection control strategy is associated with a significant reduction in the CAUTI rate in AICUs from developing countries.
Full text link https://tinyurl.com/eyr8tdjs

Article title: Device-associated infections rates in adult, pediatric, and neonatal intensive care units of hospitals in the Philippines: International Nosocomial Infection Control Consortium (INICC) findings
Authors: Josephine Anne Navoa-Ng, MD, Regina Berba, MD, Yolanda Arreza Galapia, RN, Victor Daniel Rosenthal, MD, CIC, MSc., et al.
Publication title: American Journal of Infection Control 39(7):548-54, May 2011

Abstract:
This study investigated the rate of device-associated health care-associated infection (DA-HAI), microbiological profiles, bacterial resistance, length of stay (LOS), and mortality rate in 9 intensive care units (ICUs) of 3 hospital members of the International Nosocomial Infection Control Consortium (INICC) in the Philippines. This was an open-label, prospective cohort, active DA-HAI surveillance study of adult, pediatric, and newborn patients admitted to 9 tertiary care ICUs in the Philippines between January 2005 and December 2009, implementing methodology developed by the INICC. Data collection was performed in the participating ICUs, and data were uploaded and analyzed at the INICC headquarters using proprietary software. DA-HAI rates were registered based on definitions promulgated by the Centers for Disease Control and Prevention's National Healthcare Safety Network. Over a 5-year period, 4952 patients hospitalized in ICUs for a total of 40,733 days acquired 199 DA-HAIs, for an overall rate of 4.9 infections per 1,000 ICU-days. Ventilator-associated pneumonia posed the greatest risk (16.7 per 1,000 ventilator-days in the adult ICUs, 12.8 per 1,000 ventilator-days in the pediatric ICU, and 0.44 per 1,000 ventilator-days in the neonatal ICUs), followed by central line-associated bloodstream infections (4.6 per 1,000 catheter-days in the adult ICUs, 8.23 per 1,000 ventilator-days in the pediatric ICU, and 9.6 per 1,000 ventilator-days in the neonatal ICUs) and catheter-associated urinary tract infections (4.2 per 1,000 catheter-days in the adult ICUs and 0.0 in the pediatric ICU). DA-HAIs pose far greater threats to patient safety in Philippine ICUs than in US ICUs. The establishment of active infection control programs that involve infection surveillance and implement guidelines for prevention can improve patient safety and should become a priority.
Full text link https://tinyurl.com/p6rxj2r2

Article title: Impact of International Nosocomial Infection Control Consortium (INICC) Strategy on Central Line-Associated Bloodstream Infection Rates in the Intensive Care Units of 15 Developing Countries
Authors: Victor D. Rosenthal, Dennis G. Maki, Camila Rodrigues, Carlos Alvarez-Moreno, et al.
Publication title: Infection Control and Hospital Epidemiology 31(12):1264-72, October 2010

Abstract:
Background: The International Nosocomial Infection Control Consortium (INICC) was established in 15 developing countries to reduce infection rates in resource-limited hospitals by focusing on education and feedback of outcome surveillance (infection rates) and process surveillance (adherence to infection control measures). We report a time-sequence analysis of the effectiveness of this approach in reducing rates of central line-associated bloodstream infection (CLABSI) and associated deaths in 86 intensive care units with a minimum of 6-month INICC membership.

Methods: Pooled CLABSI rates during the first 3 months (baseline) were compared with rates at 6-month intervals during the first 24 months in 53,719 patients (190,905 central line-days). Process surveillance results at baseline were compared with intervention period data.

Results: During the first 6 months, CLABSI incidence decreased by 33% (from 14.5 to 9.7 CLABSIs per 1,000 central line-days). Over the first 24 months there was a cumulative reduction from baseline of 54% (from 16.0 to 7.4 CLABSIs per 1,000 central line-days; relative risk, 0.46 [95% confidence interval, 0.33-0.63]; P < .001). The number of deaths in patients with CLABSI decreased by 58%. During the intervention period, hand hygiene adherence improved from 50% to 60% (P < .001); the percentage of intensive care units that used maximal sterile barriers at insertion increased from 45% to 85% (P < .001), that adopted chlorhexidine for antisepsis increased from 7% to 27% (P < .001), and that sought to remove unneeded catheters increased from 37% to 83% (P < .001); and the duration of central line placement decreased from 4.1 to 3.5 days (P < .001).

Conclusions: Education, performance feedback, and outcome and process surveillance of CLABSI rates significantly improved infection control adherence, reducing the CLABSI incidence by 54% and the number of CLABSI-associated deaths by 58% in INICC hospitals during the first 2 years.
Full text available upon request to the author

Article title: Cochrane review: Reminder systems and late patient tracers in the diagnosis and management of tuberculosis
Authors: Qin Liu, Katharine Abba, Marissa Alejandria, Vincent M. Balanag
Publication title: Evidence-Based Child Health A Cochrane Review Journal 5(3):1206 - 1245, September 2010

Abstract:
Reminder systems and late patient tracers as strategies to improve patients' adherence to tuberculosis screening, diagnosis, and treatment are used in some countries, but their effectiveness has not previously been systematically reviewed. To assess the effects of reminder systems and late patient tracers on completion of diagnostics, commencement of treatment in people referred for curative or prophylactic treatment of tuberculosis, completion of treatment in people starting curative or prophylactic treatment for tuberculosis, and cure in people being treated for active tuberculosis. We searched the Cochrane Infectious Diseases Group Specialized Register (June 2008), Cochrane Effective Practice and Organization of Care Group Specialized Register (April 2007), CENTRAL (The Cochrane Library 2008, Issue 2), MEDLINE (1966 to June 2008), EMBASE (1974 to June 2008), LILACS (1982 to June 2008), CINAHL (1982 to June 2008), SCI-EXPANDED (1945 to June 2008), SSCI (1956 to June 2008), mRCT (June 2008), Indian Journal of Tuberculosis (1983 to June 2008), and reference lists. We also contacted researchers working in the field. Randomized controlled trials (RCTs), including cluster RCTs and quasi-RCTs, and controlled before-and-after studies comparing any reminders or late patient tracers with no or other kinds of reminders or late patient tracers. We included people in any setting who require treatment for tuberculosis or require prophylaxis against tuberculosis and are referred to tuberculosis diagnostic or screening services. Two authors independently assessed trial risk of bias and extracted data. No meta-analysis could be undertaken due to the heterogeneity of interventions across trials. Nine trials involving 5257 participants met the inclusion criteria. Three assessed the use of late patient tracers, and six assessed reminder systems. Late patient tracers (home visit and letter) were shown to be beneficial in increasing adherence to tuberculosis treatment compared with no late patient tracer. The results from almost all the reminder trials, except one, show benefits of different types of reminders compared to no reminder on adherence to tuberculosis clinic appointments. The included trials show significantly better outcomes among those tuberculosis patients for which late patient tracers and reminders are used. Studies of good quality (large and with rigorous study design) are needed to decide the most effective late patient tracer actions and reminders in different settings. Future studies of reminders in chemoprophylaxis and treatment settings would be useful. Reminder systems and late patient tracers in the diagnosis and management of tuberculosis This review aimed to assess the effects of reminder systems and late patient tracers on patients' adherence to medical advice (such as attending clinic appointments for taking anti-tuberculosis drugs) and on clinical outcomes (such as cure of tuberculosis) in the following situations: treatment for active tuberculosis; tests for diagnosis of tuberculosis; and treatment to prevent tuberculosis in high-risk individuals. Reminder systems are used before a clinic or drug-collection appointment to remind patients to attend the appointment, or sometimes during treatment at home to remind patients to take their drugs. Late patient tracers are similar interventions undertaken when patients fail to keep an appointment to encourage them to return to treatment. The review found nine trials involving 5257 participants. Six trials assessed reminder systems and three trials assessed the use of late patient tracers. The results from five of the six reminder trials showed benefits. Trials of late patient tracers (home visits and letters) also showed benefits of the intervention in increasing adherence to tuberculosis treatment. Hence, overall, the results showed better outcomes among those patients for whom reminders or late patient tracers were used.
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Article title: International Nosocomial Infection Control Consortium (INICC) report, data summary for 2003-2008, issued June 2009
Authors: Victor D. Rosenthal, MD, Dennis G. Maki, MD, Silom Jamulitrat, MD, Eduardo A. Medeiros, MD, et al.
Publication title: American Journal of Infection Control 38(2):95-104.e2, March 2010

Abstract:
We report the results of the International Infection Control Consortium (INICC) surveillance study from January 2003 through December 2008 in 173 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study, using Centers for Disease Control and Prevention (CDC) US National Healthcare Safety Network (NHSN; formerly the National Nosocomial Infection Surveillance system [NNIS]) definitions for device-associated health care-associated infection, we collected prospective data from 155,358 patients hospitalized in the consortium's hospital ICUs for an aggregate of 923,624 days. Although device utilization in the developing countries' ICUs was remarkably similar to that reported from US ICUs in the CDC's NHSN, rates of device-associated nosocomial infection were markedly higher in the ICUs of the INICC hospitals: the pooled rate of central venous catheter (CVC)-associated bloodstream infections (BSI) in the INICC ICUs, 7.6 per 1000 CVC-days, is nearly 3-fold higher than the 2.0 per 1000 CVC-days reported from comparable US ICUs, and the overall rate of ventilator-associated pneumonia (VAP) was also far higher, 13.6 versus 3.3 per 1000 ventilator-days, respectively, as was the rate of catheter-associated urinary tract infection (CAUTI), 6.3 versus 3.3 per 1000 catheter-days, respectively. Most strikingly, the frequencies of resistance of Staphylococcus aureus isolates to methicillin (MRSA) (84.1% vs 56.8%, respectively), Klebsiella pneumoniae to ceftazidime or ceftriaxone (76.1% vs 27.1%, respectively), Acinetobacter baumannii to imipenem (46.3% vs 29.2%, respectively), and Pseudomonas aeruginosa to piperacillin (78.0% vs 20.2%, respectively) were also far higher in the consortium's ICUs, and the crude unadjusted excess mortalities of device-related infections ranged from 23.6% (CVC-associated bloodstream infections) to 29.3% (VAP).
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