Patient safety

International Journal of Caring Sciences September-December 2018 Volume 11 | Issue 3| Page1913

www.internationaljournalofcaringsciences.org

Original Article

Incidence Rate of Device-Associated, Hospital Acquired Infections in ICUs: A Systematic Review Developed Versus Developing Economies

Yiorgos Pettemerides, BSc

Limassol General Hospital, Cyprus

Savvoula Ghobrial PhDc University of Nicosia, Nursing program Leader, Cyprus

Raftopoulos Vasilios, PhD Cyprus University of Technology, Nursing Department, Cyprus

Iordanou Stelios, PhDc

Limassol General Hospital, Cyprus University of Technology, Nursing Department, Cyprus

Correspondence: Iordanou Stelios, Agias Elenis 9B, 4186 Ipsonas, Limassol – Cyprus e-mail: [email protected]

Abstract

Background: Device-associated hospital-acquired infections (DA-HAIs) are a major threat to patient safety; as well as a contributing factor for increased morbidity, mortality, increased cost and length of ICU stay. Rates of occurrence of DA-HAIs can be associated with the economic status of the countries where they occur. Aims: To assess all available DA-HAI incidence rates from studies published between 2007 and 2017, and compare them according to the economic status of the country of origin. Methodology: Systematic review of the published literature between 2007 and 2017. Results: 40 articles were included in this study. Central line-associated blood stream infection (CLABSI), ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infection (CAUTI) incidence rates from various countries, together with data on the countries economic status (developed vs developing), were included and correlated accordingly. The highest reported CLABSI, VAP and CAUTI rate was 72.56, 73.4 and 34.2 respectively per 1000 device days, and these all originated from developing economies. The highest incidence rates for VAP and CLABSI in developed economies are demonstrably lower than those in developing economies, demonstrating a statistical significant correlation. Lower economic statuses tend to predominate higher rates of Ventilator-Associated Pneumonia and Central Line-associated Blood-stream Infections in a statistically significant correlation, whilst for CAUTI there was no statistical difference. Conclusions: DA-HAI are affected directly in a positive or negative way according to the economic status of the originating country..

Keywords: Device Associated Infections, Central Line Associated Blood Stream Infection, Ventilator Associated Pneumonia, Catheter Associated Urinary Tract Infection, ICU.

International Journal of Caring Sciences September-December 2018 Volume 11 | Issue 3| Page1914

www.internationaljournalofcaringsciences.org

Introduction

Infections acquired in the intensive care unit (ICU) are a major healthcare related problem as they contribute to length of stay (LOS) prolongation, elevated costs of care as well as increased morbidity and mortality (Apostolopoulou et al., 2013; Tigen et al., 2014). Furthermore, health-care associated infections (HAIs), with specific reference to invasive devices utilization in healthcare settings, when considered in the far more prevalent context of ICU patients are usually referenced as device- associated HAIs (DA-HAIs) and are a complicating factor with regard to positive patient’s outcomes. Most of the infection surveillance reports comparing the outcomes of DA-HAIs with those of other countries do not consider that the economic status of the country in question can directly affect, positively or negatively. According to the WHO(World health Organization, 2015), low economic country status (developing) may be an additional factor that influences the incidence of DA-HAIs with greater prevalence than is reported in developed areas.

Aim

The aim of the study was to investigate the DA- HAI rates published in public literature between the years 2007 and 2017 and compare rates between developed and developing countries.

Materials & Methods

This systematic review was guided by the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. PRISMA is a 27-item checklist that is used to improve the reporting of systematic reviews and meta-analyses and has been endorsed by major biomedical journals for the publication of systematic reviews(Liberati et al., 2009).

A comprehensive search of the available literature was conducted by the authors, using Medline, PubMed and Cumulative Index to Nursing and Allied Health Literature [CINAHL], for articles dated from 2007 until late 2017, using

these search terms: “ventilator associated pneumonia”, “VAP”, “central line associated blood stream infection”, “CLABSI”, “catheter associated urinary tract infection”, “CAUTI”, “device associated infection” and various combinations of these terms plus “Intensive Care Unit”.

Inclusion criteria

The inclusion criteria used during the search were:

Publication dates ranging from 01/01/2007 to 31/12/2017,

Data must have been obtained from adult ICU patients,

Publications written and published in the English language,

DA-HAIs rates to be reported as incidence per 1000 device days (DD).

Publications which studied only one of the DA- HAIs rates were not excluded if they met the remainder of the inclusion criteria. The primary outcome measures for this review were:

Infection rates per device per 1000 device days,

The number of patients,

The country and place of study,

Purpose and methodology of study.

Study Selection

A Medline search yielded 377 articles, PubMed yielded 1074 articles, and CINAHL yielded 289 articles. After duplicated results and articles with access to the abstract or the title only were removed, a total of 562 articles were left for screening. Of these, 367 were related to pediatric and neonatal ICUs, 106 were not related to ICU patients (hospital wards or home ventilated patients), 22 were not research studies, 17 had very small sample sizes and/or durations and 10 studies were dismissed for other reasons not meeting the study design, leaving a total of 40 articles. The flow chart below summarizes the article selection (Figure 1).

International Journal of Caring Sciences September-December 2018 Volume 11 | Issue 3| Page1915

www.internationaljournalofcaringsciences.org

Table 1: Developing countries and DA-HAIs rates

Name, Country, Year CLABSI VAP CAUTI

Talaat, Egypt, 2016 (after intervention) 2.6 4.3 1.9

Empaire, Venezuela, 2017 5.1 7.2 3.9

Mehta, India(INICC), 2016 5.1 9.4 2.1

Kanj, Lebanon(INICC), 2012 5.2 8.1 4.1

Mehta, India(INICC), 2007 7.92 10.46 1.41

Jahani-Sherafat, Iran, 2015 5.84 7.88 8.99

El-Kholy, Egypt, 2012 2.9 17 3.4

Peng, China(INICC), 2015 2.7 19.561 1.5

Tigen, Turkey, 2014 6.4 14.3 4.3

Kübler, Poland, 2012 4.01 18.2 4.8

Kumar, India, 2017 7.4 11.8 9.7

Datta, India, 2014 13.86 6.04 9.08

Tao, China, 2011 3.1 20.8 6.4

Ranjan, India, 2014

31.7

Medeiros, Brasil, 2015 9.1 20.9 9.6

Leblebicioglou, Turkey, 2014 11.1 21.4 7.5

Patil, India, 2011 47.31

Salgado Yepez, Ecuador, 2017 6.5 44.3 5.7

Singh, India, 2013 16 32 9

Ramirez, Mexico, 2007 23.1 21.8 13.4

Madani, Morocco, 2009 15.7 43.2 11.7

Ider, Mongolia, 2016 19.7 43.7 15.7

Bamigatti, India, 2017 72.56 3.98 12.4

Rasslan, Egypt, 2012 22.5 73.4 34.2

DA-HAIs rates per 1000 device days; *missing rates = not available

International Journal of Caring Sciences September-December 2018 Volume 11 | Issue 3| Page1916

www.internationaljournalofcaringsciences.org

Table 2: Developed countries and DA-HAIs rates

Name, Country, Year CLABSI VAP CAUTI

Worth, Australia, 2015 1.34

Kaiser, Holland, 2014 1.7 3.3

Watanabe, Japan, 2011 2.38 1.14 2.4

Chen, Taiwan, 2012 3.48 3.8 3.7

Velasquez, Italy, 2016

13.2

Malacarne, Italy, 2010 1.9 8.9 4.8

Mertens, Belgium, 2013 2.3 12 5.5

Vanhems, France, 2011

20.6

Dima, Greece, 2007 12.1 12.5

Gikas, Cyprus, 2010 18.6 6.4

Iordanou, Cyprus, 2017 15.9 10.1 2.7

Boncagni, Italy, 2015 6.6 23.1 5.45

Apostolopoulou, Greece, 2013 11.8 20 4.2

DA-HAIs rates per 1000 device days; *missing rates = not available

International Journal of Caring Sciences September-December 2018 Volume 11 | Issue 3| Page1917

www.internationaljournalofcaringsciences.org

Table 3: Developing vs developed economies DA-HAI incidence rates

Ventilator Associated Pneumonia - VAP Developed economies Developing economies

Cyprus 8.25† Mongolia 43.7 France 20.6 Venezuela 7.2 Greece 16.3† Brazil 20.9 Italy 11† China 20.18† Japan 1.14 Ecuador 44.3 Holland 3.3 Egypt 31.56† Belgium 2.3 India 24.85† Iran 7.88 Lebanon 8.1 Mexico 21.8 Morocco 43.2 Turkey 17.85† P value Mean (SD) 10.09(6.82) 24.29 (13.1) 0.016 Median (IQR) 9.62(2.76-17.37) 21.35 (10.5-40.29) 0.020

Central Line-Associated Bloodstream Infection - CLABSI Developed economies Developing economies

Belgium 2.3 Mongolia 19.7 Cyprus 17.25† Venezuela 5.1 Greece 11.95† Brazil 9.1 Italy 4.25† China 2.9† Japan 2.38 Ecuador 6.5 Holland 1.7 Egypt 9.33† Australia 1.34 India 14.15† Iran 5.84 Lebanon 5.2 Mexico 23.1 Morocco 15.7 Turkey 8.75† P value Mean (SD) 5.88(5.75) 10.44 (6.07) 0.011 Median (IQR) 2.38(1.7-11.95) 8.92 (5.36-15.31) 0,025

Catheter-Associated Urinary Tract Infection - CAUTI Developed economies Developing economies

Belgium 5.5 Mongolia 15.7 Cyprus 2.75† Venezuela 3.9 Greece 4.5 Brazil 9.6 Italy 5.45 China 6† Japan 2.4 Ecuador 5.7 Poland 4.8 Egypt 34.1† India 7.31† Iran 8.99 Lebanon 4.1 Mexico 13.4 Morocco 11.7 Turkey 5.9† P value Mean (SD) 5.31 (3.18) 9.02 (3.66) 0,13 Median (IQR) 4.65 (2.6-7) 8.94 (5.75-12.75) 0,066 Abbreviation: † mean (more than one study)

Table 4: Summary of reviewed articles

1 Leblebicioglu et al., -Turkey -Frequency Documentation -Prospective -94498 -CLABSI: 11.1

International Journal of Caring Sciences September-December 2018 Volume 11 | Issue 3| Page1918

www.internationaljournalofcaringsciences.org

2014 (Turkey) - 63 ICUs. from 29 hospitals in 19 cities

of Device Associated Hospital Acquired Infections

observational cohort study

ICU Patients

-VAP: 21.4 -CAUTI: 7.5

2 Kaiser et al., 2014 (The Netherlands)

-ICU Department of VU University Medical Centre -Amsterdam –Holland

-Evaluation of a Semi- Automated VAP and CLABSI detection protocol in the ICU

-Prospective surveillance study

-533 ICU Patients

-CLABSI: 1.7/1000 -VAP: 3.3/1000 -CAUTI: Not Measured

3 Datta et al., 2014 (India)

-Two ICUs at a 750-bed hospital in India

-Evaluation of infection frequency and risk factors from invasive devices in the ICU

-Prospective clinical observation study

-679 ICU Patients

-CLABSI: 13.86/1000 -VAP: 6.04/1000 -CAUTI: 9.08/1000

4 Kanj et al., 2012 (INICC Lebanon)

-University hospital ICU in Lebanon

-Evaluation of device related infection frequency in the ICU

-Prospective observational study

-666 ICU Patients

-CLABSI: 5.2/1000 -VAP: 8.1/1000 -CAUTI: 4.1/1000

5 Madani et al., 2009 (Morocco)

-12-bed icu of the university hospital of Morocco

-Evaluation of device related infection frequency in the ICU. microbiological profile. resistance. length of stay and increase in mortality

-Prospective surveillance study

-1731 ICU Patients

-CLABSI: 15.7/1000 -VAP: 43.2/1000 -CAUTI: 11.7/1000

6 Chen et al., 2012 (Taiwan)

-42-bed ICU of a university hospital in Taiwan

-Evaluation of device related infection frequency in the ICU

-Retrospective and prospective observational study

-14734 ICU Patients

-CLABSI: 3.48/1000 -VAP: 3.8/1000 -CAUTI: 3.7/1000

7 Singh et al., 2013 (India)

-10-bed ICU in a tertiary care hospital in India

-Evaluation of the total frequency of DA-HAI incidence

-Prospective observational study

- 293 ICU Patients

-CLABSI: 16/1000 -VAP: 32/1000 -CAUTI: 9/1000

8 Watanabe et al., 2011 (Japan)

-20 ICUs from university hospitals in Japan

-Evaluation of the frequency of invasive device related infections using a data collection system to aggregate information in a national database and enhance quality improvement activities

-Prospective observational study

-1989 ICU Patients

-CLABSI: 2.38/1000 -VAP: 1.14/1000 -CAUTI: 2.4/1000

9 Ranjan et al., 2014 (India)

-12-bed ICU in a tertiary care hospital in India

-Evaluation of VAP incidence rate. risk factors and mortality

-Prospective observational study

-105 ICU Patients

-CLABSI: Not measured -VAP: 31.7/1000 -CAUTI: Not measured

10 Velasquez et al., 2016 (Italy)

-21 ICUs in Italy

- Evaluation of VAP incidence rate and risk factors

-Prospective observational study

-772 ICU Patients

-CLABSI: Not measured -VAP: 13.2/1000 -CAUTI: Not measured

11 Vanhems et al., 2011 (France)

-11 ICUs in France

-Evaluation of incidence rate of early onset VAP

-Prospective observational study

-3387 ICU Patients

-CLABSI: Not measured -VAP: 20.6/1000 -CAUTI: Not measured

12 Mehta et al., 2007 (INICC India)

-12 ICUs from 7 tertiary care hospitals in India

-Evaluation of DA-HAI s incidence rate. their microbiological profile. drug resistance. mortality and length of stay

-Prospective observational study

-10835 ICU Patients

-CLABSI: 7.92/1000 -VAP: 10.46/1000 -CAUTI: 1.41/1000

13 Patil et al., 2011 (India)

-1 ICU of a public University hospital in India

-Define incidence rate of BSIs related with CVCs

-Prospective observational study

-54 ICU Patients

-CLABSI: 47.31/1000 -VAP: Not measured -CAUTI: Not measured

14 Apostolopoulou et al., 2013 (Greece)

-3 ICUs from 3 hospitals in Greece

-Evaluation of DA-HAI incidence rate. microbiological profile. drug resistance and morbidity

-Prospective observational study

-294 ICU Patients

-CLABSI: 11.8/1000 -VAP: 20/1000 -CAUTI: 4.2/1000

International Journal of Caring Sciences September-December 2018 Volume 11 | Issue 3| Page1919

www.internationaljournalofcaringsciences.org

15 Bammigatti et al., 2017 (India)

-1 ICU in a university hospital in India

-Evaluation of risk factors and microbial resistance in DA-HAIs

-Prospective observational study

-341 ICU Patients

-CLABSI: 72.56/1000 -VAP: 3.98/1000 -CAUTI: 12.4/1000

16 Boncagni et al., 2015 (Italy)

-12 bed ICU of a tertiary care hospital in Italy

-Evaluation of DA-HAI incidence rate

-Prospective observational study

-1382 ICU Patients

-CLABSI: 6.6/1000 -VAP: 23.1/1000 -CAUTI: 5.45/1000

17 Gikas et al., 2010 (Cyprus)

-4 ICUs in 4 major hospitals of Cyprus

-Evaluation of DA-HAI incidence rate and identification of areas of improvement

-Prospective observational study

-2692 ICU Patients

-CLABSI: 18.6/1000 -VAP: 6.4/1000 -CAUTI: Not measured

18 Dima et al., 2007 (Greece)

-8 ICUs in Greece

-Evaluation of DA-HAI incidence rate

-Prospective observational study

-1739 ICU Patients

-CLABSI: 12.1/1000 -VAP: 12.5/1000 -CAUTI: Not measured

19 Iordanou et al., 2017 (Cyprus)

-8 bed ICU in a major general hospital in Cyprus

-Evaluation of DA-HAI incidence rate for one year

-Prospective cohort and active surveillance study

-198 ICU Patients

-CLABSI: 15.9/1000 -VAP: 10.1/1000 -CAUTI: 2.7/1000

20 Jahani-Sherafat et al., 2015 (Iran)

-6 ICUs of university hospitals in Tehran-Iran

-Evaluation of DA-HAI incidence rate

-Prospective cohort and active surveillance study

-2584 ICU Patients

-CLABSI: 5.84/1000 -VAP: 7.88/1000 -CAUTI: 8.99/1000

21 Rasslan et al., 2012 (Egypt)

-3 ICUs of 3 hospitals in 2 towns in Egypt

-Evaluation of DA-HAI incidence rate

-Prospective cohort and active surveillance study

-473 ICU Patients

-CLABSI: 22.5/1000 -VAP: 73.4/1000 -CAUTI: 34.2/1000

22 Salgado Yepez et al., 2017 (Ecuador)

-2 ICUs of 3 hospitals in Ecuador

-Evaluation of DA-HAI incidence rate

-Prospective cohort and active surveillance study

-776 ICU Patients

-CLABSI: 6.5/1000 -VAP: 44.3/1000 -CAUTI: 5.7/1000

23 Tigen. et al., 2014 (Turkey)

-16 bed ICU of a university hospital in Turkey

-Evaluation of DA-HAI incidence rate

-Prospective cohort and active surveillance study

-1798 ICU Patients

-CLABSI: 6.4/1000 -VAP: 14.3/1000 -CAUTI: 4.3/1000

24 Medeiros et al., 2015 (Brazil)

- 4 ICUs of 3 hospitals in 3 towns in Brazil

-Evaluation of DA-HAI incidence rate

-Prospective cohort and active surveillance study

-1031 ICU Patients

-CLABSI: 9.1/1000 -VAP: 20.9/1000 -CAUTI: 9.6/1000

25 Ramirez et al., 2007 (Mexico)

-5 ICUs of 4 hospitals in Mexico

-Evaluation of DA-HAI incidence rate

-Prospective cohort study

-1055 ICU Patients

-CLABSI: 23.1/1000 -VAP: 21.8/1000 -CAUTI: 13.4/1000

26 El-Kholy et al., 2012 (Egypt)

-3 ICUs of 3 hospitals in Egypt

-Evaluation of DA-HAI incidence rate

-Prospective observational study

-1101 ICU Patients

-CLABSI 2.9/1.000 -VAP 17/1.000 -CAUTI 3.4/1.000

27 Tao et al., 2011 (China)

-398 ICUs of 70 hospitals in China

-Evaluation of DA-HAI incidence rate

-Multicentered prospective cohort study

-391527 ICU Patients

-CLABSI 3.1/1.000 -VAP 20.8/1.000 -CAUTI 6.4/1000

28 Empaire et al., 2017 (Venezuela)

-2 ICUs of 2 hospitals in Venezuela

-Evaluation of DA-HAI incidence rate microbiological resistance of identified microorganisms

-Multicentered prospective observational study

-1014 ICU Patients

-CLABSI 5.1/1.000 -VAP 7.2/1.000 -CAUTI 3.9/1000

29 Kumar et al., 2017 (India)

-ICU of a tertiary care hospital in India

-Evaluation of DA-HAI incidence rate

-Prospective observational study

-343 ICU Patients

-CLABSI 7.4/1.000 -VAP 11.8/1.000 -CAUTI 9.7/1000

30 Rosenthal et al., 2016

-703 ICUs of 50 countries from Latin America. Eastern Mediterranean. Southeast Asia and the West Pacific

-Evaluation of DA-HAI incidence rate

-Prospective observational study

-861284 ICU Patients

-CLABSI 4.1/1.000 -VAP 13.1/1.000 -CAUTI 5.7/1000

International Journal of Caring Sciences September-December 2018 Volume 11 | Issue 3| Page1920

www.internationaljournalofcaringsciences.org

31 Talaat et al., 2016 (Egypt)

-91 ICUs of 28 hospitals in Egypt

-Evaluation of DA-HAI incidence rate and the effectiveness of a reduction program

-Prospective observational study before and after intervention

-59318 ICU Patients

Results following intervention -CLABSI 2.6/1.000 -VAP 4.3/1.000 -CAUTI 1.9/1000

32 Ider et al., 2016 (Mongolia)

-3 ICUs of 3 hospitals in Mongolia

-Evaluation of DA-HAI incidence rate

-Prospective observational/surv eillance study

-467 ICU Patients

-CLABSI 19.7/1.000 -VAP 43.7/1.000 -CAUTI 15.7/1000

33 Mehta et al., 2016 (INICC India)

-Hospitals from 20 cities in India

-Evaluation of DA-HAI incidence rate

-Prospective observational study

-236.700 ICU Patients

-CLABSI 5.1/1.000 -VAP 9.4/1.000 -CAUTI 2.1/1000

34 Hui-Peng et al., 2015 (INICC China)

-26 bed ICU of a tertiary care hospital in China

-Evaluation of DA-HAI incidence rate

-Prospective observational study

-4013 ICU Patients

-CLABSI 2.7/1.000 -VAP 19.561/1.000 -CAUTI 1.5/1000

35 Worth et al., 2015 (Australia)

-ICUs of 29 hospitals in Australia

-Describe time-trends in CLABSI rates. Infections by ICU peer-groups. Etiology. and antimicrobial susceptibility of pathogens

-Prospective observational study

-No Data -CLABSI 1.34/1.000 -VAP Not measured -CAUTI Not measured

36 Rosenthal et al., 2014 (International Nosocomial Infectio n Control Consortium (INICC) report. data summary of 43 countries for 2007-2012. Device- associated module.)

-503 ICUs from 43 countries in Latin America. Asia. Europe and Africa

-Evaluation of DA-HAI incidence rate

-Prospective observational study

-605310 ICU Patients

-CLABSI 4.9/1.000 -VAP 16.8/1.000 -CAUTI 5.5/1000

37 Mertens et al., 2013 (Belgium)

-ICUs of 18 hospitals in Belgium

-Evaluation of DA-HAI incidence rate (VAP & CLABSI) and the surveillance procedure

-Prospective observational study

-6478 ICU Patients

-CLABSI 2.3/1.000 -VAP 12/1.000 -CAUTI 5.5/1000

38 Rosenthal et al., 2012 (International Nosocomial Infectio n Control Consortium (INICC) report. data summary of 36 countries. for 2004-2009)

-422 ICUs from 36 countries in Latin America. Asia and Europe

-Evaluation of DA-HAI incidence rate

-Prospective cohort study

-313008 ICU Patients

-CLABSI 6.8/1.000 -VAP 15.8/1.000 -CAUTI 6.3/1000

39 Kübler et al., 2012 (Poland)

-15 bed ICU of a university hospital in Poland

- Evaluation of DA-HAI incidence rate

-Prospective surveillance study

-847 ICU Patients

-CLABSI 4.01/1.000 -VAP 18.2/1.000 -CAUTI 4.8/1000

40 Malacarne et al., 2010 (Italy)

-125 ICUs in Italy

- Evaluation of DA-HAI incidence rate

-Prospective epidimiological study

-34472 ICU Patients

-CLABSI 1.9/1.000 -VAP 8.9/1.000 -CAUTI 4.8/1000

International Journal of Caring Sciences September-December 2018 Volume 11 | Issue 3| Page1921

www.internationaljournalofcaringsciences.org

PubMed articles

n=1074

CINAHL articles

n=289

Screened articles

n=562

Removal of duplicates, title only and abstract only articles

n=562

Excluded articles n=522

Full Text

n=40

Medline articles

n=377

Figure 1: Flow diagram for article selection, as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and CINAHL recommendations

International Journal of Caring Sciences September-December 2018 Volume 11 | Issue 3| Page1922

www.internationaljournalofcaringsciences.org

Figure 2: Number of studies per country

Characteristics of Studies

Table 4 summarizes the characteristics of the 40 studies used in this review. Although highly developed countries are pioneers in infection surveillance, in this review no studies were included from the USA, UK, Canada or Scandinavia. A search for older articles yielded numerous texts from these countries but they were not relevant to this study nor did they meet the study inclusion criteria (spicifically age<10 years), so their results were not included but their content supported the conclusion that DAI rates were a popular research topic for advanced health provision countries in the past decades, but are no longer as relevant. Despite the absence of appropriate articles from the aforementioned countries, many other countries have studies that were conducted during the last decade and were relevant to the subject. Most of the articles (92.68%) came from 22 countries (Figure 2), whilst the remaining 7.32% articles came from multinational studies conducted on behalf of the International Nosocomial Infection Control Consortium (INICC) and were included in this

review as their multinational nature was not a restriction in article selection.

Developed & developing countries

The International Monetary Fund (IMF) (IMF, 2017) classifies national economies by their degree of development and publishes this list yearly. Of the participating countries in this review, the economies of Brazil, China, Ecuador, Egypt, India, Iran, Lebanon, Mexico, Mongolia, Morocco, Poland, Turkey and Venezuela are listed as developing (table 1) while the economies of Australia, Belgium, Cyprus, France, Greece, Holland, Italy, Japan and Taiwan are listed as advanced (table 2). Poland however, is listed by the United Nations (UN)(United Nations Development Programme, 2016) among the list of countries with a high human development index (HDI), along with all of the countries on the advanced economies list and is the only country in this review that does not appear in the developed economy list.

Overall, the most represented country in terms of reviewed articles was India with eight

2 1

8 1 1 1 1

3 1

2 1

2 2

3 1 1 1

2 1 1 1 1

0 1 2 3 4 5 6 7 8 9

Turkey

India

Morocco

Japan

France

Poland

Iran

Equador

Mexio

Venezuela

Australia

Study No

Number of studies found per country (n=37) *multinational studies excluded

International Journal of Caring Sciences September-December 2018 Volume 11 | Issue 3| Page1923

www.internationaljournalofcaringsciences.org

articles(Mehta et al., 2007, 2016; H. Patil et al., 2011; Singh et al., 2013; Datta et al., 2014; Ranjan et al., 2014; Bammigatti et al., 2017; Kumar et al., 2017) (20%), followed by Egypt(El-Kholy et al., 2012; Rasslan et al., 2012; Talaat et al., 2016) and Italy (Malacarne et al., 2010a; Boncagni et al., 2015; Velasquez et al., 2016) with 3 studies each (7.5% each or 15% of the total), whilst China(Tao et al., 2011; Peng et al., 2015), Greece(Dima et al., 2007; Apostolopoulou et al., 2013), Cyprus(Gikas, M. Roumbelaki, et al., 2010; Iordanou et al., 2017) and Turkey(Leblebicioglu et al., 2014; Tigen et al., 2014) are represented with 2 studies each (5% each or 20% of the total). Australia (Worth et al., 2015), Belgium(Mertens, Morales and Catry, 2013), Brazil(Medeiros et al., 2015), Ecuador(Salgado Yepez et al., 2017), France(Vanhems et al., 2011), Holland(Kaiser et al., 2014), Iran(Jahani-Sherafat et al., 2015), Japan(Watanabe et al., 2011), Lebanon(Ss Kanj et al., 2012), Mexico(Ramirez Barba et al., 2007), Mongolia(Ider et al., 2016), Morocco(Madani et al., 2009), Poland(Kübler et al., 2012), Taiwan(Chen et al., 2012) and Venezuela(Empaire et al., 2017) were represented by one study each (2.5% each or 37.5% combined). 80% of studies (32/40) studied all three DAIs (CLABSI, VAP and CAUTI) while a smaller number (3/40 or 7.5%) studied two out of the three DA-HAIs, specifically CLABSI and VAP. The remaining five articles looked at only one of the three DA-HAIs (5/40, 12.5%). Interestingly, no researchers chose to study CAUTI with either CLABSI or VAP and none of the researchers that chose to study a single type of DA-HAI in the ICU chose to focus on CAUTI, unlike VAP with 3/40 (7.5%) articles or CLABSI with 2/40 (5%) articles. On the other hand, CAUTI is highly researched with regard to non-ICU patients and many of the rejected articles focussed on CAUTI outside the ICU. Urinary catheter care in the ICU differs very little from urinary catheter care elsewhere in healthcare setting and since subject is heavily studied outside the ICU, this may explain the apparent lack of interest among ICU researchers.

Less than a third of the articles (12/40, 30%) were conducted in a single ICU, while the remaining 70% (28/40) of articles study data gathered from more than one ICU. Furthermore, three articles, published by the INICC combine data from ICUs in different countries and even different continents;

more specifically 422 ICUs from 36 countries in Latin America, Asia and Europe(Rosenthal et al., 2012), 503 ICUs from 43 countries in Latin America, Asia, Europe and Africa(Rosenthal et al., 2014) and 703 ICUs from 50 countries from Latin America, Eastern Mediterranean, Southeast Asia and the West Pacific(Rosenthal et al., 2016).

The sample sizes among studies vary greatly. The largest sample of ICU patients is seen in the INICC studies, and more specifically in Rosenthal’s et al report from 703 ICUs in 50 countries(Rosenthal et al., 2016), with 861,284 ICU patents, followed by another INICC report, in 503 ICUs from 43 countries with a sample of 605,310 ICU patients (Rosenthal et al., 2014) and the third largest study is the Chinese(Tao et al., 2011) one with a sample size of 391,527 patients, from 398 ICUs of 70 hospitals. On the other hand, the smallest sample is found in one of the studies from India (H. Patil et al., 2011) with 54 ICU patients, followed by another study from the same country (Ranjan et al., 2014) with 105 patients, whilst the third smallest sample is found in one of the studies from the republic of Cyprus(Iordanou et al., 2017) with 198 ICU patients.

Statistical analysis

For statistical analysis, median and interquartile range (IQR) values, the mean and standard deviation (SD) values of the DA-HAIs were used to describe the constant variables. T-test was used to examine the means between developed and developing countries and the Wilcoxon rank-sum test was used for comparing the medians.

Methodological Quality

Of the 40 reviewed articles, 32.5% (13/40) were conducted in single ICUs. The remaining 27 articles are multicentered, while the three of the 27 INICC articles were not only multicentered but conducted in multiple countries on multiple continents. Also, a great variation in sample size is noted. The results cannot be used to extract conclusions about all the ICUs of a country and, even though there may be many studies in a country, the results are not necessarily indicative of all the ICUs in that country as these individual units may vary greatly from the infection standpoint norm. India is the most represented among the 40 studies. While results may not

International Journal of Caring Sciences September-December 2018 Volume 11 | Issue 3| Page1924

www.internationaljournalofcaringsciences.org

considered necessarily representative for an entire country, this does not mean they are not useful. Potentially, comparison among ICUs can help researchers and infection control staff to develop better infection prevention practices.

DA-HAI Incidence rates

Both the first and second highest identified CLABSIs rates were found in India(H. Patil et al., 2011; Bammigatti et al., 2017) with a frequency of 72.56 and 47.31 incidents per 1000 device days respectively. The third highest infection rate was found in the Mexican study (23.1)(Ramirez Barba et al., 2007). The lowest rates were found in the Australian study(Worth et al., 2015) with a reported incidence rate of 1.34 infections per 1000 device days. The Australian study reports only CLABSI rates, so there is no data available for VAP and CAUTI. The study with the second lowest CLABSI rate was from the Netherlands (Kaiser et al., 2014) with 1.7 cases per 1000 device days and the third best result was from Italy(Malacarne et al., 2010).

The highest VAP rates are reported in an Egyptian study (73.4/1000DD)(Rasslan et al., 2012), second highest in an Ecuadorian study (44.3/1000DD)(Salgado Yepez et al., 2017) and the third in a Mongolian study (43.7/1000DD)(Ider et al., 2016). The lowest reported VAP rates come from a Japanese study (1.14/1000DD)(Watanabe et al., 2011), with the second lowest being reported in the Netherlands (3.3/1000DD)(Kaiser et al., 2014) and the third in Taiwan (3.8/1000DD)(Chen et al., 2012). Ventilator associated pneumonia was researched in 38 of the 40 reviewed studies and the total sum of the 38 studies is 672161 instances of VAP.

CAUTIs appear to be the third and least encountered type of all DA-HAI, where rates of infection are much lower than VAP and CLABSIs in most studies. Higher CAUTI rates were found in an Egyptian study (34.2/1000DD)(Rasslan et al., 2012), second highest in a Mongolian study (15.7/1000DD)(Ider et al., 2016) and third in a Mexican and Mongolian study (13.4/1000DD)(Ramirez Barba et al., 2007; Ider et al., 2016) with exactly the same incidence rate per 1000 DD. The lowest CAUTI incidence rates comes from India (1.41/1000DD)(Mehta et al., 2007), the second lowest from China

(1.5/1000DD)(Peng et al., 2015) and third from Egypt (1.9/1000DD)(Talaat et al., 2016).

The results of this particular Egyptian study(Talaat et al., 2016) are reportedly after intervention, noting that the results prior the intervention are not disclosed.

Overall, the highest reported DA-HAI rate was reported by Rasslan(Rasslan et al., 2012) whose VAP infection rate was at 73.4 per 1000 ventilator days, followed closely behind by Bammigatti et al.’s(Bammigatti et al., 2017) who reported 72.56 CLABSI incidents per 1000 central line days(Bammigatti et al., 2017). The lowest reported DAI rate was 1.14(Watanabe et al., 2011) pneumonias associated with mechanical ventilation per 1000 device days.

Developing economies DA-HAI Incidence rates

In developing economies, VAP incidence rates per 1000 device days are reported by several studies included in the present review. These reports originate from twelve geographical locations, specifically Mongolia (43.7/1000), Venezuela (7.2/1000), Brazil (20.9/1000), China (20.18 [mean]), Ecuador (44.3/1000), Egypt (31.56/1000 [mean]), India (24.85/1000[mean]), Iran (7.88/1000), Lebanon (8.1/1000), Mexico (21.8/1000), Morocco (43.2/1000) and Turkey (17.85/1000 [mean]). Mean and median values computed using data from all developing economies gives VAP rates of 24.29 (SD, 13.1) and 21.35 (IQR, 10.5-40.29) respectively. Also, CLABSI rates were found for 12 developing economies, specifically Mongolia (19.7/1000), Venezuela (5.1/1000), Brazil (9.1/1000), China (2.9/1000[mean]), Ecuador (6.5/1000), Egypt (9.33/1000[mean]), India (14.15/1000[mean]), Iran (5.84), Lebanon (5.2/1000), Mexico (23.1/1000), Morocco (15.7/1000) and Turkey (8.75/1000). Mean developing economies CLABSI rate is 10.44/1000 (SD, 6.07) and median 8.92 (IQR, 5.36-15.31).

CAUTI rates are reported in public literature for 12 developing economies, Mongolia (15.7/1000), Venezuela (3.9/1000), Brazil (9.6/1000), China (6/1000[mean]), Ecuador (5.7/1000), Egypt (34.1/1000[mean]), India (7.31/1000[mean]), Iran (8.99/1000), Lebanon (4.1/1000), Mexico (13.4/1000), Morocco (11.7/1000) and Turkey

International Journal of Caring Sciences September-December 2018 Volume 11 | Issue 3| Page1925

www.internationaljournalofcaringsciences.org

(5.9/1000). Developing economies mean and median value is 9.2 (SD: 3.66) and 8.94 (IQR; 5.75-12.75) (Table 3).

Developed Economies DA-HAI Incidence

Examining DA-HAIs found in publicly available literature over the last ten years (2007-2017). VAP incidence rates for developed economies include data from for Cyprus (8.25/1000[mean]), France (20.6/1000), Greece (16.3/1000[mean]), Italy (11/1000[mean]), Japan (1.14/1000), Holland (13.3/1000) and Belgium (2.3/1000). Mean and median values for VAP rates in developed economies were found to be 10.09 (SD, 6.82) and 9.62 (IQR, 2.76-17.37) respectively.

CLABSI rates are mentioned in several reports from eight countries, Belgium (2.3/1000), Cyprus (17.25/1000[mean]), Greece (11.95/1000[mean]), Italy (4.25/1000[mean]), Japan (2.38/1000), Holland (1.7/1000) and Australia (1.34/1000). Mean and median values for CLABSI rates in developed economies were found to be 5.88 (SD, 5.75) and 2.38 (IQR, 1.7 – 11.95) respectively.

CAUTI is mentioned in seven studies reporting incidence rates from six countries. Belgium reports 12 instances of CAUTI per 1000 device days (5.5/1000), Cyprus 2.75/1000 (mean), Greece 4.5/1000, Italy 5.45/1000, Japan 2.4/1000 and Poland 4.8/1000. Developed countries’ mean and median values per 1000 device days is 5.31 (SD, 3.18) and 4.65 (IQR, 2.6-7.08) (Table 3).

Overall, the highest reported infection rate was described by Rasslan(Rasslan et al., 2012) whose VAP infection rate was 73.4 per 1000 ventilator days, followed closely behind by Bammigatti’s 72.56 CLABSI incidents per 1000 central line days(Bammigatti et al., 2017).

Aggregated Results

In total, 40 articles were found and reviewed in this project, coming from 22 countries over the last 10 years and published in international literature. The majority of these articles came from developing economies (24/41) while the sample from economies classified as developed, according to the IMF(IMF, 2017) classification, was limited to 14 articles (14/41). The remaining three articles (3/41) came from the INICC and were based on research conducted in multiple ICUs from

36(Rosenthal et al., 2012), 43(Rosenthal et al., 2014) and 50(Rosenthal et al., 2016) countries respectively, so these studies cannot be classified based on the economic status of a specific originating country.

The highest DAI rates come from Egypt (Rasslan et al., 2012), India (Bammigatti et al., 2017) and Mongolia (Ider et al., 2016) while the lowest come from Japan (Watanabe et al., 2011) and the Netherlands (Kaiser et al., 2014). The most frequently reported DAI among the reviewed articles was VAP with 73.4 lung infections per 1000 ventilator days (Rasslan et al., 2012), the second highest reported DAI was CLABSI with 72.56 BSIs per 1000 central line days (Bammigatti et al., 2017) and the least frequently encountered DAI was CAUTI with a highest reported rate of 34.2 UTIs per 1000 urinary catheter days (Rasslan et al., 2012). The overall mean and median values for all articles were 10.83 and 6.45 respectively for BSIs, 17.28 and 13.2 for pneumonia and for UTIs 6.89 and 5.5.

In general, the incidence rate of infections related to invasive device use is higher in developing economies than in those considered developed. The mean and median values of all DAI rates in developing economies are from 40% to 60% higher than those of developed economies, confirming the World Health Organization’s findings(World health Organization, 2015).

DA-HAI rate comparison between developed and developing countries

Mean and median VAP value for developed economies are 10.09 (SD. 6.82) and 9.62 (IQR. 2.76-17.37) respectively, while in developing countries, mean was 24.29 (SD.13.1) and median 21.35 (IQR.10.5-40.29). P Values between means and medians for developed vs developing economies were found in both correlations to have statistical significance (mean correlation [p=0.016], median correlation [p=0.02])(table 3).

Furthermore, CLABSI mean and median comparisons between developed and developing economies resulted in a significant statistical correlation (mean correlation [p=0.011], median correlation [p=0.025]). Mean and median for developed and developing economies was 5.88(SD. 5.75) vs 10.44 (SD. 6.07) and 2.38(IQR.

International Journal of Caring Sciences September-December 2018 Volume 11 | Issue 3| Page1926

www.internationaljournalofcaringsciences.org

1.7-11.95) vs 21.35 (IQR. 10.5-40.29) respectively (table 3).

Comparing CAUTI mean and median figures, no statistical correlation was found since the p value was, in both cases, more than 0.05 (p>0.05). Mean and median for developed and developing economies was found to be 5.31 (SD. 3.18) vs 9.02 (SD. 3.66) and 4.65 (IQR. 2.6-7) vs 8.94 (IQR.5.75-12.75) (table 3).

Discussion

Systematic surveillance, recording and analysis of local DA-HAI events in comparison to published DA-HAI literature is highly significant in the ICU setting. A single ICU’s results may be lost in a countrywide multicentered study, but comparison of local results with better results from a wider source(es) and identification of possible areas for improvement can directly affect ICU patient’s hospitalization and outcomes by reducing the risk of DA-HAIs and so impacting the negative consequences of ICU hospitalization.

The aim of the current review was to gather articles published since the 01/01/2007 to determine DAI infection rates per 1000 device days per article and per country and then use this data to extract conclusions. Following an extensive search in the scientific databases PubMed, Medline and CINAHL and subsequent evaluation; 40 articles were found (table 4) from 22 countries and reviewed.

In an attempt to improve analysis of the articles and extract more conclusive results, the articles were grouped for analysis in various ways. By examining the articles based on their total number of infections, the worst results come from Egypt(Rasslan et al., 2012), India(Bammigatti et al., 2017) and Mongolia(Ider et al., 2016). The best results come from Japan(Watanabe et al., 2011) and Egypt(Talaat et al., 2016). It was noted that Australia(Worth et al., 2015) and the Netherlands(Kaiser et al., 2014) have very low results for CLABSI and CLABSI and VAP respectively but do not have collective results for all DAIs. First and third results were obtained following intervention, making them of greater interest as they demonstrate the effectiveness of studying research backed literature and applying

the conclusions reached to daily practice in order to identify and eliminate unsafe practices.

According to the WHO(World health Organization, 2015), developing economies have more DA-HAIs per 1000 device days than developed ones. In order to avoid bias, the reviewed articles were grouped based on their geographical location and their economic status (developed or developing). According to the IMF(IMF, 2017), of the countries participating in this review, the economies of Australia, Belgium, Cyprus, France, Greece, Holland, Italy, Japan and Taiwan are listed as developed, while the economies of Brazil, China, Ecuador, Egypt, India, Iran, Lebanon, Mexico, Mongolia, Morocco, Poland, Turkey and Venezuela are listed as developing. Three of the reviewed articles, published on behalf of the INICC were conducted in multiple countries and cannot be used in a comparison by means of economic status of their source country(Rosenthal et al., 2012, 2014, 2016). Of the remaining 37 articles, 13 referred to ICUs in developed economies (Dima et al., 2007; Gikas, Á. M. Roumbelaki, et al., 2010; Malacarne et al., 2010b; Watanabe et al., 2011; Vanhems et al., 2011; Chen et al., 2012; Apostolopoulou et al., 2013; Mertens, Morales and Catry, 2013; Kaiser et al., 2014; Boncagni et al., 2015; Worth et al., 2015; Velasquez et al., 2016; Iordanou et al., 2017), while 24 of the reviewed articles were in developing economies (Boyce et al., 2002; Mehta et al., 2007; Ramirez Barba et al., 2007; Madani et al., 2009; Tao et al., 2011; H. V Patil et al., 2011; Rasslan et al., 2012; SS Kanj et al., 2012; El- Kholy et al., 2012; Kübler et al., 2012; Singh et al., 2013; Leblebicioglu et al., 2014; Ranjan et al., 2014; Datta et al., 2014; Tigen et al., 2014; Medeiros et al., 2015; Peng et al., 2015; Jahani- Sherafat et al., 2015; Rosenthal et al., 2016; Talaat et al., 2016; Ider et al., 2016; Bammigatti et al., 2017; Salgado Yepez et al., 2017; Empaire et al., 2017; Kumar et al., 2017).

Among developed economies, the highest reported DAI rate was 23.1/1000 DD, specifically VAP in Italy(Boncagni et al., 2015), and the second highest was again VAP with an incidence rate of 20.6/1000 DD in France(Vanhems et al., 2011). Of the 13 articles, 12 reviewed the incidence of VAP with the highest reported incidence being 23.1 infections to the lowest 1.14(Watanabe et al.,

International Journal of Caring Sciences September-December 2018 Volume 11 | Issue 3| Page1927

www.internationaljournalofcaringsciences.org

2011) per 1000 DD. In comparison, the highest VAP incidence rate for developing economies was in Egypt with 73.4(Rasslan et al., 2012) per 1000 ventilator days and the best result came from India(Bammigatti et al., 2017) with 3.98 VAP incidents per 1000 ventilator days. For developing economies, 23 researchers studied VAP rates as opposed to 12 researchers for developed economies. The mean value of the samples was 24.29 vs 10.09 (p=0.016) for developed economies. The median value is 21.35 against 9.62 (p=0.02) for developed economies.

The same statistically significant correlation was found in the comparison of mean and median values for CLABSI. The mean value for CLABSI rates among developing economies is 10.44 versus 5.88 (p=0.011) for advanced economies and median value is 8.92 against 2.38 (p=0.025), where the highest advanced economies rate was found in Cyprus(Gikas, M. Roumbelaki, et al., 2010) (18.6/1000DD) and the lowest in Australia(Worth et al., 2015) (1.34/1000DD). The highest rate for developing economies comes from India(Bammigatti et al., 2017) (72.56/1000DD) and the lowest from Egypt(Talaat et al., 2016) (2.6/1000DD).

Despite the fact that mean and median values for developed economies are higher than is described in the NHSN ICUs report(Dudeck et al., 2011) (for VAP, 4/1000DD and for CLABSI, 3/1000DD), these values still appear to be much lower than the figures for developing economies in a statistically significant correlation. Accordingly, VAP and CLABSI is directly associated and affected by the economic status of the country under study.

Indwelling urinary catheters are common in healthcare settings outside the ICU and are far more researched, so CAUTI prevention steps are better known and better followed by healthcare professionals. Also, there is limited interest among ICU researchers to investigate this subject and then to employ scientific literature recommendations as the current relatively low infection rates are judged acceptable. This is reflected in the fact that only seven out of the 14 articles reviewed studied CAUTI rates, and the low infection rates reported in both developed and developing economies. The highest reported CAUTI rate comes from Belgium(Mertens, Morales and Catry, 2013) at

5.5/1000DD and the best result is reported from Japan(Watanabe et al., 2011) (2.4/1000DD). The mean CAUTI rate among developed economies is 5.31(SD. 3.18) while the median is 2.38(IQR. 1.7- 11.95).

In developing economies, there is significantly greater interest among researchers with regard to CAUTI rates. Of the 24 reviewed articles from developing economies, 22 measured CAUTI incidence rates in their hospitals. The highest reported CAUTI rate came from Egypt(Rasslan et al., 2012) (34.2/1000DD) and the lowest result was reported from India(Mehta et al., 2016) (2.1/1000DD). Mean and median were found to be 9.02(SD. 3.66) and 8.94(IQR. 5.75-12.75) respectively. There was no statistically significant correlation in the comparison of the mean and median values although much higher rates of incidence were found in developing economies. Accordingly, country of origin may associated with high or low CAUTIs rates, but it cannot be considered as the only cause of positive or negative results.

In general, the incidence rate of infections related with invasive devices usage is higher in developing than in developed economies. In comparison, the mean and median values of all DA-HAI rates in developing economies are 50% - 60% higher than those of developed economies, verifying the World Health Organization’s findings(World health Organization, 2015).

Conclusions

There are many gaps in bibliography when it comes to aggregating results per ICU and per country as most studies are multicentered, and sometimes even from multiple countries so conclusive results cannot be extracted on a per country or per ICU basis.

When it comes to correlations between developed and developing economies DA-HAI rates, we concluded that the economic status of countries tend to be associated with marked variations in DA-HAI rates.

The most practical way to separate DA-HAIs rates for comparison is by considering the economic status of the article’s originating country (as per the International Monetary Fund classification), as it is more likely for limited resource ICUs from

International Journal of Caring Sciences September-December 2018 Volume 11 | Issue 3| Page1928

www.internationaljournalofcaringsciences.org

developing economies to have higher DA-HAIs rates as compared with ICUs from countries with developed economies and therefore resources.

Limitations

Grey literature was not included in the study.

References

Apostolopoulou, E., Raftopoulos, V., Filntisis, G., Kithreotis, P., Stefanidis, E., Galanis, P., Veldekis, D., (2013). Surveillance of device-associated infection rates and mortality in 3 greek intensive care units. Am. J. Crit. Care 22, e12-20.

Bammigatti, C., Doradla, S., Belgode, H.N., Kumar, H., Swaminathan, R.P., (2017). Healthcare associated infections in a resource limited setting. J. Clin. Diagnostic Res. 11, OC01-OC04.

Boncagni, F., Francolini, R., Nataloni, S., Skrami, E., Gesuita, R., Donati, A., Pelaia, P., (2015). Epidemiology and clinical outcome of healthcare- associated Infections: A 4-year experience of an Italian ICU. Minerva Anestesiol. 81, 765–775.

Boyce, J.M., Pittet, D., Committee, H.I.C.P.A., Force, H.H.H.T., Healthcare Infection Control Practices Advisory Committee, HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force, (2002). Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Prof. MMWR.Recommendations reports Morb. Mortal. Wkly. report.Recommendations reports / Centers Dis. Control 51, 1–45, quiz CE1-4.

Chen, Y.-Y., Chen, L.-Y., Lin, S.-Y., Chou, P., Liao, S.- Y., Wang, F.-D., (2012). Surveillance on secular trends of incidence and mortality for device- associated infection in the intensive care unit setting at a tertiary medical center in Taiwan, 2000-2008: a retrospective observational study. BMC Infect. Dis. 12, 209.

Datta, P., Rani, H., Chauhan, R., Gombar, S., Chander, J., (2014). Health-care-associated infections: Risk factors and epidemiology from an intensive care unit in Northern India. Indian J. Anaesth. 58, 30–35.

Dima, S., Kritsotakis, E.I., Roumbelaki, M., Metalidis, S., Karabinis, A., Maguina, N., Klouva, F., Levidiotou, S., Zakynthinos, E., Kioumis, J., Gikas, A., (2007). Device-associated nosocomial infection rates in intensive care units in Greece. Infect. Control Hosp. Epidemiol. 28, 602–605.

Dudeck, M.A., Horan, T.C., Peterson, K.D., Allen- Bridson, K., Morrell, G., Pollock, D.A., Edwards, J.R., (2011). National Healthcare Safety Network

(NHSN) Report, data summary for 2010, device- associated module. Am. J. Infect. Control 39, 798– 816.

El-Kholy, A., Saied, T., Gaber, M., Younan, M.A., Haleim, M.M.A., El-Sayed, H., El-Karaksy, H., Bazara’a, H., Talaat, M., (2012). Device-associated nosocomial infection rates in intensive care units at Cairo University hospitals: first step toward initiating surveillance programs in a resource-limited country. Am. J. Infect. Control 40, e216-20.

Empaire, G.D., Guzman Siritt, M.E., Rosenthal, V.D., Pérez, F., Ruiz, Y., Díaz, C., Di Silvestre, G., Salinas, E., Orozco, N., (2017). Multicenter prospective study on device-associated infection rates and bacterial resistance in intensive care units of Venezuela: International Nosocomial Infection Control Consortium (INICC) findings. Int. Health 9, 44–49.

Gikas, A., Roumbelaki, Á.M., Bagatzouni-Pieridou, D., Alexandrou, M., Zinieri, V., Kritsotakis, E.I., Roumbelaki, M., Bagatzouni-Pieridou, D., Alexandrou, M., Zinieri, V., Dimitriadis, I., Kritsotakis, E.I., (2010a). Device-associated infections in the intensive care units of Cyprus: results of the first national incidence study. Infection 38, 165–171.

Gikas, A., Roumbelaki, M., Bagatzouni-Pieridou, D., Alexandrou, M., Zinieri, V., Dimitriadis, I., Kritsotakis, E.I., (2010b). Device-associated infections in the intensive care units of Cyprus: results of the first national incidence study. Infection 38, 165–171.

Ider, B.-E., Baatar, O., Rosenthal, V.D., Khuderchuluun, C., Baasanjav, B., Donkhim, C., Batsuur, B., Jambiimolom, M., Purevdorj, S.-E., Tsogtbaatar, U., Sodnomdarjaa, B., Gendaram, B., Mendsaikhan, N., Begzjav, T., Narankhuu, B., Ariungerel, B.-E., Tumendemberel, B., Orellano, P.W., (2016). Multicenter study of device-associated infection rates in hospitals of Mongolia: Findings of the International Nosocomial Infection Control Consortium (INICC). Am. J. Infect. Control 44, 327–331.

IMF, (2017). World Advanced Economies [WWW Document]. URL https://en.wikipedia.org/wiki/Developed_country#I MF_advanced_economies

Iordanou, S., Middleton, N., Papathanassoglou, E., Raftopoulos, V., (2017). Surveillance of device associated infections and mortality in a major intensive care unit in the Republic of Cyprus. BMC Infect. Dis. 17, 607.

Jahani-Sherafat, S., Razaghi, M., Rosenthal, V.D., Tajeddin, E., Seyedjavadi, S., Rashidan, M., Alebouyeh, M., Rostampour, M., Haghi, A., Sayarbayat, M., Farazmandian, S., Yarmohammadi,

International Journal of Caring Sciences September-December 2018 Volume 11 | Issue 3| Page1929

www.internationaljournalofcaringsciences.org

T., Arshadi, F.K., Mansouri, N., Sarbazi, M.R., Vilar, M., Zali, M.R., (2015). Device-associated infection rates and bacterial resistance in six academic teaching hospitals of Iran: Findings from the International Nocosomial Infection Control Consortium (INICC). J. Infect. Public Health 8, 553–561.

Kaiser, A.M., de Jong, E., Evelein-Brugman, S.F., Peppink, J.M., Vandenbroucke-Grauls, C.M., Girbes, A.R., (2014). Development of trigger-based semi-automated surveillance of ventilator-associated pneumonia and central line-associated bloodstream infections in a Dutch intensive care. Ann. Intensive Care 4, 40.

Kanj, S., Kanafani, Z., Sidani, N., Alamuddin, L., Zahreddine, N., Rosenthal, V., (2012). International nosocomial infection control consortium findings of device-associated infections rate in an intensive care unit of a lebanese university hospital. J. Glob. Infect. Dis. 4, 15–21.

Kanj, S., Kanafani, Z., Sidani, N., Alamuddin, L., Zahreddine, N., Rosenthal, V., (2012). International nosocomial infection control consortium findings of device-associated infections rate in an intensive care unit of a Lebanese university hospital. J. Glob. Infect. Dis. 4, 15.

Kübler, A., Duszynska, W., Rosenthal, V.D., Fleischer, M., Kaiser, T., Szewczyk, E., Barteczko-Grajek, B., (2012). Device-associated infection rates and extra length of stay in an intensive care unit of a university hospital in Wroclaw, Poland: International Nosocomial Infection Control Consortium’s (INICC) findings. J. Crit. Care 27, 105.e5-105.e10.

Kumar, S., Sen, P., Gaind, R., Verma, P.K., Gupta, P., Suri, P.R., Nagpal, S., Rai, A.K., (2012). Prospective surveillance of device-associated health care– associated infection in an intensive care unit of a tertiary care hospital in New Delhi, India. Am. J. Infect. Control. https://doi.org/10.1016/j.ajic.2017.08.037

Leblebicioglu, H., Erben, N., Rosenthal, V.D., Atasay, B., Erbay, A., Unal, S., Senol, G., Willke, A., Özgültekin, A., Altin, N., Bakir, M., Oncul, O., Ersöz, G., Ozdemir, D., Yalcin, A.N., Özdemir, H., Yıldızdaş, D., Koksal, I., Aygun, C., Sirmatel, F., Sener, A., Tuna, N., Akan, Ö.A., Turgut, H., Demiroz, A.P., Kendirli, T., Alp, E., Uzun, C., Ulusoy, S., Arman, D., 2014. International Nosocomial Infection Control Consortium (INICC) national report on device-associated infection rates in 19 cities of Turkey, data summary for 2003-2012. Ann. Clin. Microbiol. Antimicrob. 13, 51.

Liberati, A., Altman, D.G., Tetzlaff, J., Mulrow, C., Gøtzsche, P.C., Ioannidis, J.P.A., Clarke, M., Devereaux, P.J., Kleijnen, J., Moher, D., (20097).

The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoS Med. https://doi.org/10.1371/journal.pmed.1000100

Madani, N., Rosenthal, V.D., Dendane, T., Abidi, K., Zeggwagh, A.A., Abouqal, R., (2009). Health-care associated infections rates, length of stay, and bacterial resistance in an intensive care unit of Morocco: findings of the International Nosocomial Infection Control Consortium (INICC). Int. Arch. Med. 2, 29. https://doi.org/10.1186/1755-7682-2-29

Malacarne, P., Boccalatte, D., Acquarolo, A., Agostini, F., Anghileri, A., Giardino, M., Giudici, D., Langer, M., Livigni, S., Nascimben, E., Rossi, C., Bertolini, G., (2010a). Epidemiology of nosocomial infection in 125 Italian intensive care units. Minerva Anestesiol. 76, 13–23.

Malacarne, P., Boccalatte, D., Acquarolo, A., Agostini, F., Anghileri, A., Giardino, M., Giudici, D., Langer, M., Livigni, S., Nascimben, E., Rossi, C., Bertolini, G., (2010b). Epidemiology of Nosocomial infection in 125 Italian Intensive Care units. Minerva Anestesiol. 76, 13–23.

Medeiros, E.A., Grinberg, G., Rosenthal, V.D., Bicudo Angelieri, D., Buchner Ferreira, I., Bauer Cechinel, R., Zanandrea, B.B., Rohnkohl, C., Regalin, M., Spessatto, J.L., Scopel Pasini, R., Ferla, S., (2015). Impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional hand hygiene approach in 3 cities in Brazil. Am. J. Infect. Control 43, 10–15.

Mehta, A., Rosenthal, V.D., Mehta, Y., Chakravarthy, M., Todi, S.K., Sen, N., Sahu, S., Gopinath, R., Rodrigues, C., Kapoor, P., Jawali, V., Chakraborty, P., Raj, J.P., Bindhani, D., Ravindra, N., Hegde, A., Pawar, M., Venkatachalam, N., Chatterjee, S., Trehan, N., Singhal, T., Damani, N., (2007). Device- associated nosocomial infection rates in intensive care units of seven Indian cities. Findings of the International Nosocomial Infection Control Consortium (INICC). J. Hosp. Infect. 67, 168–174.

Mehta, Y., Jaggi, N., Rosenthal, V.D., Kavathekar, M., Sakle, A., Munshi, N., Chakravarthy, M., Todi, S.K., Saini, N., Rodrigues, C., Varma, K., Dubey, R., Kazi, M.M., Udwadia, F.E., Myatra, S.N., Shah, S., Dwivedy, A., Karlekar, A., Singh, S.P.S., Sen, N., Limaye-Joshi, K., Ramachandran, B., Sahu, S.S., Pandya, N., Mathur, P., Sahu, S.S., Singh, S.P.S., Bilolikar, A.K., Kumar, S., Mehta, P., Padbidri, V., Gita, N., Patnaik, S.K., Francis, T., Warrier, A.R., Muralidharan, S., Nair, P.K., Subhedar, V.R., Gopinath, R., Azim, A., Sood, S., (2016). Device- Associated Infection Rates in 20 Cities of India, Data Summary for 2004–2013: Findings of the International Nosocomial Infection Control

International Journal of Caring Sciences September-December 2018 Volume 11 | Issue 3| Page1930

www.internationaljournalofcaringsciences.org

Consortium. Infect. Control Hosp. Epidemiol. 37, 172–181.

Mertens, K., Morales, I., Catry, B., 2013. Infections acquired in intensive care units: results of national surveillance in Belgium, 1997–2010. J. Hosp. Infect. 84, 120–125.

Patil, H., Ramteerthkar, M., Patil, V., Kulkarni, R., (2011). Central venous catheter-related bloodstream infections in the intensive care unit. Indian J. Crit. Care Med. 15, 213.

Patil, H. V, Patil, V.C., Ramteerthkar, M.N., Kulkarni, R.D., (2011). Central venous catheter-related bloodstream infections in the intensive care unit. Indian J. Crit. Care Med. 15, 213–23.

Peng, H., Tao, X.-B., Li, Y., Hu, Q., Qian, L.-H., Wu, Q., Ruan, J.-J., Cai, D.-Z., (2015). Health care- associated infections surveillance in an intensive care unit of a university hospital in China, 2010- 2014: Findings of International Nosocomial Infection Control Consortium. 43. https://doi.org/10.1016/j.ajic.2015.07.023

Ramirez Barba, E.J., Rosenthal, V.D., Higuera, F., Oropeza, M.S., Hernández, H.T., López, M.S., Lona, E.L., Duarte, P., Ruiz, J., Hernandez, R.R., Chavez, A., Cerrato, I.P., Ramirez, G.E., Safdar, N., (2007). Device-associated nosocomial infection rates in intensive care units in four Mexican public hospitals. Am. J. Infect. Control 34, 244–247.

Ranjan, N., Chaudhary, U., Chaudhry, D., Ranjan, K.P., (2014). Ventilator-associated pneumonia in a tertiary care intensive care unit: Analysis of incidence, risk factors and mortality. Indian J. Crit. Care Med. 18, 200–4.

Rasslan, O., Seliem, Z.S., Ghazi, I.A., El Sabour, M.A., El Kholy, A.A., Sadeq, F.M., Kalil, M., Abdel-Aziz, D., Sharaf, H.Y., Saeed, A., Agha, H., El-Abdeen, S.A.E.-W.Z., El Gafarey, M., El Tantawy, A., Fouad, L., Abel-Haleim, M.M., Muhamed, T., Saeed, H., Rosenthal, V.D., (2012). Device- associated infection rates in adult and pediatric intensive care units of hospitals in Egypt. International Nosocomial Infection Control Consortium (INICC) findings. J. Infect. Public Health 5, 394–402.

Rosenthal, V.D., Al-Abdely, H.M., El-Kholy, A.A., AlKhawaja, S.A.A., Leblebicioglu, H., Mehta, Y., Rai, V., Hung, N.V., Kanj, S.S., Salama, M.F., Salgado-Yepez, E., Elahi, N., Morfin Otero, R., Apisarnthanarak, A., De Carvalho, B.M., Ider, B.E., Fisher, D., Buenaflor, M.C.S.G., Petrov, M.M., Quesada-Mora, A.M., Zand, F., Gurskis, V., Anguseva, T., Ikram, A., Aguilar de Moros, D., Duszynska, W., Mejia, N., Horhat, F.G., Belskiy, V., Mioljevic, V., Di Silvestre, G., Furova, K., Ramos- Ortiz, G.Y., Gamar Elanbya, M.O., Satari, H.I., Gupta, U., Dendane, T., Raka, L., Guanche-Garcell,

H., Hu, B., Padgett, D., Jayatilleke, K., Ben Jaballah, N., Apostolopoulou, E., Prudencio Leon, W.E., Sepulveda-Chavez, A., Telechea, H.M., Trotter, A., Alvarez-Moreno, C., Kushner-Davalos, L., Desse, J.E., Maurizi, D.M., Montanini, A.M., Chaparro, G.J., Stagnaro, J.P., Romani, A., Bianchi, A.C., Álvarez, G., Palaoro, A., Bernan, M., Cabrera- Montesino, R., Domínguez, C., Rodríguez, C.G., Silva, C.G., Bogdanowicz, E., Riera, F.O., Benchetrit, G., Perez, I., Vimercati, J., Marcos, L.S., Ramasco, L., Caridi, M., Oyola, M.C., Rodríguez, M.C., Spadaro, M.L., Olivieri, M.S., Saul, P., Juarez, P.D., Pérez, R.H., Botta, P., Quintana, D.Q., Ríos, A.M., Stagnaro, J.P., Chediack, V., Chilon, W., Alsayegh, A.I., Yaseen, F.H., Hani, L.F., Sowar, S.F., Magray, T.A., Medeiros, E.A., Alves De Oliveira, A., Romario-Mendes, A., Fernandes- Valente, C., Santos, C., Escudeiro, D., Azevedo- Ferreira Lima, D., Azevedo-Pereira, D., Onzi- Siliprandi, E.M., Serpa-Maia, F., Aguiar-Leitao, F., Assuncao-Ponte, G., Dos Anjos-Lima, J., Olszewski, J., Harten Pinto Coelho, K., Alves De Lima, L.F., Mendonca, M., Maciel-Canuto Amaral, M.L., Tenorio, M.T., Gerah, S., Andrade-Oliveira-Reis, M., Moreira, M., Ximenes-Rocha Batista, M., Campos-Uchoa, R.S., Rocha-Vasconcelos Carneiro, R., Amaral De Moraes, R., Do Nascimento, S.C., Moreira-Matos, T., Lima-De Barros Araujo, T.M., De Jesus Pinheiro-Bandeira, T., Machado-Silva, V.L., Santos Monteiro, W.M., Hristozova, E., Kostadinov, E.D., Angelova, K., Velinova, V.A., Dicheva, V.J., Guo, X., Ye, G., Li, R., Song, L., Liu, K., Liu, T., Song, G., Wang, C., Yang, X., Yu, H., Yang, Y., Martínez, A., Vargas-García, A.R., Lagares-Guzmán, A., González, A.P., Linares, C., Ávila-Acosta, C., Santofimio, D., Yepes-Gomez, D., Marin-Tobar, D.A., Mazo-Elorza, D.P., Chapeta- Parada, E.G., Camacho-Moreno, G., Roncancio-Vill, G.E., Valderrama-Marquez, I.A., Ruiz-Gallardo, J.E., Ospina-Martínez, J.O., Osorio, J., Marín-Uribe, J.I., López, J.C., Gualtero, S., Rojas, J.R., Gomez- Nieto, K., Rincon, L.Y.M., Meneses-Ovallos, L., Canas-Giraldo, L.M., Burgos-Florez, L.D., Amaral- Almeida Costa, M., Rodriguez, M., Barahona- Guzmán, N., Mancera-Paez, O., Rios-Arana, P.A., Ortega, R., Romero-Torres, S.L., Pulido-Leon, S.M., Valderrama, S., Moreno-Mejia, V.M., Raigoza- Martinez, W., Villamil-Gomez, W., Pardo-Lopez, Y.A., Argüello-Ruiz, A., Solano-Chinchilla, A., Muñoz-Gutierrez, G.A., Calvo-Hernández, I., Maroto-Vargas, L., Zuniga, M.A., Valverde- Hernandez, M., Chavarria-Ugalde, O., Herrera, B., Díaz, C., Bovera, M.M., Cevallos, C., Pelaez, C., Jara, E., Delgado, V., Coello-Gordon, E.E., Picoita, F., Guerrero-Toapant, F.M., Valencia, F., Santacruz, G., Gonzalez, H., Pazmino, L.N., Garcia, M.F.,

International Journal of Caring Sciences September-December 2018 Volume 11 | Issue 3| Page1931

www.internationaljournalofcaringsciences.org

Arboleda, M., Lascano, M., Alquinga, N., Ramírez, V., Yousef, R.H.A., Moustafa, A.E.M., Ahmed, A., Elansary, A.M., Ali, A.M., Hasanin, A., Messih, A.A., Ramadan, A., El Awady, B.A., Hassan, D.M., Abd El Aziz, D., Hamza, H., Agha, H.M., Ghazi, I.A., ElKholy, J., Fattah, M.A., Elanany, M., Mansour, M., Haleim, M.M.A., Fouda, R., El-Sherif, R.H., Bekeit, S., Bayani, V., Elkholy, Y.S., Abdelhamid, Y.M., Salah, Z., Rivera, D.M., Chawla, A., Manked, A.N., Azim, A., Mubarak, A., Thakur, A., Dharan, A.V., Patil, A., Sasidharan, A., Bilolikar, A.K., Anirban Karmakar, A., Mathew, A.M., Kulkarni, A., Agarwal, A., Sriram, A., Dwivedy, A., Dasgupta, A., Bhakta, A., Suganya, A.R., Poojary, A., Mani, A.K., Sakle, A., Abraham, B.K., Padmini, B., Ramachandran, B., Ray, B., Pati, B.K., Chaudhury, B.N., Mishra, B.M., Biswas, S., Saibala, M.B., Jawadwala, B.Q., Rodrigues, C., Modi, C., Patel, C., Khanna, D.K., Devaprasad, D., Divekar, D., Aggarwal, D.G., Divatia, J.V., Zala, D., Pathrose, E., Abubakar, F., Chacko, F., Gehlot, G.S., Khanna, G., Sale, H.K., Roy, I., Shelgaonkar, J., Sorabjee, J., Eappen, J., Mathew, J., Pal, J., Varma, K., Joshi, K.L., Sandhu, K., Kelkar, R., Ranganathan, L., Pushparaj, L., Lavate, M., Latha, M., Suryawanshi, M., Bhattacharyya, M., Kavathekar, M., Agarwal, M.K., Patel, M., Shah, M., Sivakumar, M.N., Kharbanda, M., Bej, M., Potdar, M., Chakravarthy, M., Karpagam, M., Myatra, S.N., Gita, N., Rao, N.P., Sen, N., Ramakrishnan, N., Jaggi, N., Saini, N., Pawar, N.K., Modi, N., Pandya, N., Mohanty, N., Thakkar, P., Joshi, P., Sahoo, P.K., Nair, P.K., Kumar, P.S., Patil, P., Mukherjee, P., Mathur, P., Shah, P., Sukanya, R., Arjun, R., Chawla, R., Gopalakrishnan, R., Venkataraman, R., Raut, S., Krupanandan, R., Tejam, R., Misra, R., Debroy, R., Saranya, S., Narayanan, S., Mishra, S., Saseedharan, S., Sengupta, S., Patnaik, S.K., Sinha, S., Blessymole, S., Rohra, S., Rajagopal, S., Mukherjee, S., Sengupta, S., John, S., Bhattacharya, S., Sijo, Bhattacharyya, S., Singh, S., Sohanlal, T., Vadi, S., Dalal, S.S., Todi, S.K., Kumar, S., Kansal, S., Misra, S., Bhattacharyya, S., Nirkhiwale, S., Purkayastha, S.K., Mukherjee, S., Singh, S., Sahu, S., Sharma, S., Kumar, S., Basu, S., Shetty, S., Shah, S., Singhal, T., Francis, T., Anand, T., Venkateshwar, V., Thomas, V., Kothari, V., Velupandi, Kantroo, V., Sitohang, G., Kadarsih, R., Sanaei, A., Maghsudi, B., Sabetian, G., Masjedi, M., Alebouyeh, M., Sherafat, S.J., Mohamed, Y.K., Al Khamis, A., Alsaadi, A.S., Al- Jarie, A.A., Mutwalli, A.H., Rillorta, A.S.K., Thomas, A., Kelany, A., Manao, A., Alamri, D.M., Santiago, E.B., Cruzpero, E.P., Sawan, F.A., Al Qasmah, F.A., Alabdaly, H., Al-Dossary, H.A., Ahmed, H., Roshdi, H., Al-Alkami, H.Y., Hanafi,

H., Ammari, H.E., Hani, H.M. Al, Asiri, I.A.M.A., Mendoza, J.A., Philipose, J., Selga, J.O., Kehkashan, Ghalilah, K.M., Redito, L.S., Josph, L., Al-Alawi, M., Al-Gethamy, M.M., Madco, M., Manuel, M.G., Girvan, M., Aldalaton, M., De Guzman, M., Alkhamaly, M., Masfar, M., Karrar, M.A.A., Al Azmi, M.M., Quisai, M.L., Torres, M.M., Al- Abdullah, N., Tawfic, N.A., Elsayed, N., Abdulkhalik, N.S., Bugis, N.A., Ariola, N.C., Gad, N., Alghosn, N., Tashkandi, N., Zharani, N. Al, De Vera, P.A., Krishnan, R., Al Shehri, R.H., Jaha, R.N.A., Thomas, R., Cresencia, R.L., Penuliar, R., Lozada, R.V., Al Qahtani, S., Twfik, S., Al Faraj, S.H., El-Sherbiny, S., Alih, S.J.B., Briones, S., Bukhari, S.Z., Alotaibi, T.S.A., Gopal, U., Nair, U., Abdulatif, W.A., Hussain, W.M., Demotica, W.M., Spahija, G., Baftiu, N., Gashi, A., Omar, A.A., Mohamed, A.M., Rebello, F.M., Almousa, H.H., Abdo, N.M., George, S.M., Khamis, S., Thomas, S., Ahmad Zaatari, A., Anwar Al Souheil, A., Ayash, H., Zeid, I., Tannous, J., Zahreddine, N.K., Ahmadieh, R., Mahfouz, T., Kardas, T., Tanzi, V., Kanafani, Z., Hammoud, Z., Dagys, A., Grinkeviciute, D., Kevalas, R., Kondratas, T., Petrovska, M., Popovska, K., Mitrev, Z., Miteva, Z.B., Jankovska, K., Guroska, S.T., Gan, C.S., Othman, A.A., Yusof, A.M., Abidin, A.S.Z., Aziz, F.A., Weng, F.K., Zainol, H., Bakar, K.B.A., Lum, L.C.S., Mansor, M., Zaman, M.K., Jamaluddin, M.F.H., Hasan, M.S., Rahman, R.A., Zaini, R.H.M., Zhazali, R., Sri Ponnampala, S.S. La, Chuah, S.L., Shukeri, W.F.W.M., Hassan, W.N.W., Yusoff, W.N.W., Mat, W.R.W., Cureno-Diaz, M.A., Aguirre-Avalos, G., Flores-Alvarado, A., Cerero- Gudino, A., Zamores-Pedroza, A., Cano-Munoz, B., Hernandez-Chena, B.E., Carreon-Martinez, C.C., Coronado-Magana, H., Corona-Jimenez, F., Rodriguez-Noriega, E., Alcala-Martinez, E., Gonzalez-Diaz, E., Guerra-Infante, F.M., Arteaga- Troncoso, G., Martinez-Falcon, G., Leon-Garnica, G., Delgado-Aguirre, H.A., Perez-Gomez, H.R., Sosa-Gonzalez, I.E., Galindo-Olmeda, J.A., Ayala- Gaytan, J.J., Rodriguez-Pacheco, J., Zamorano- Flores, L., Lopez-Pulgarin, J.A., Miranda-Novales, M.G., Ramírez, M., Lopez-Hurtado, M., Lozano, M., Gomez, M.E., Sanchez-Castuera, M.E., Kasten- Monges, M., Gonzalez-Martinez, M., Sanchez- Vargas, M., Culebro-Burguet, M.C., Altuzar- Figueroa, M.A., Mijangos-Mendez, J.C., Ramires, O.G., Espinosa, O.S., De Leon-Escobedo, R., Salas- Flores, R., Ruiz-Rendon, R., Petersen-Morfin, S., Aguirre-Diaz, S.A., Esparza-Ahumada, S., Vega- Gonzalez, S., Gaona-Flores, V., Monroy-Colin, V.A., Cruz-Rivera, Z., Bat-Erdene, A., Narankhuu, B., Choijamts, B., Tuvdennyam, B., Batkhuu, B., Chuluunchimeg, K.H., Enkhtsetseg, D., Batjargal,

International Journal of Caring Sciences September-December 2018 Volume 11 | Issue 3| Page1932

www.internationaljournalofcaringsciences.org

G., Bayasgalan, G., Dorj, M., Mendsaikhan, N., Baatar, O., Suvderdene, P., Baigalmaa, S., Khajidmaa, T., Begzjav, T., Tsuyanga, Ariyasuren, Z., Zeggwagh, A.A., Berechid, K., Abidi, K., Madani, N., Abouqal, R., Koirala, A., Giri, R., Sainju, S., Acharya, S.P., Ahmed, A., Raza, A., Parveen, A., Sultan, F., Khan, M., Paul, N., Daud, N., Yusuf, S., Nizamuddin, S., Garcia-Mayorca, E., Castaño, E.G., Moreno-Castillo, J.L., Ballinas- Aquino, J.M., Lara, L., Vargas, M., Rojas-Bonilla, M.I., Ramos, S.J., Mapp, T., De Iturrado, V., La Hoz Vergara, C.E., Linares-Calderon, C.F., Moreno, D., Ramirez, E., Ramírez Wong, F.M., Montenegro- Orrego, G.M., Sandoval-Castillo, H.R., Pichilingue- Chagray, J., Mueras-Quevedo, J., Aibar-Yaranga, K.F., Castillo-Bravo, L.I., Santivanez-Monge, L.M., Mayorga-Espichan, M.J., Rosario-Tueros, M.L.G., Changano-Rodriguez, M.V., Salazar-Ramirez, N.E., Marquez-Mondalgo, V.A., Tajanlangit, A.L.N., Tamayo, A.S., Llames, C.M.J.P., Labro, E., Dy, A.P., Fortin, J.D., Bergosa, L.D., Salvio, L.G., Bermudez, V., Sg-Buenaflor, M.C., Trajano, M.F., Mendoza, M.T., Javellana, O.P., Maglente, R.R., Arreza-Galapia, Y., Navoa-Ng, J.A., Kubler, A., Barteczko-Grajek, B., Dragan, B., Zurawska, M., Mikaszewska-Sokolewicz, M., Zielinska, M., Ramos-Ortiz, G.Y., Florin-Rogobete, A., Vlad, C.D., Muntean, D., Sandesc, D., Papurica, M., Licker, M., Bedreag, O.H., Popescu, R., Grecu, S.D., Dumitrascu, V., Molkov, A., Galishevskiy, D., Furman, M., Simic, A., Lekic, D., Ristic, G., Eremija, J., Kojovic, J., Nikolic, L., Bjelovic, M., Lesnakova, A., Hlinkova, S., Gamar-Elanbya, M.O., Supa, N., Prasan, P., Pimathai, R., Wanitanukool, S., Somabutr, S., Ben-Jaballah, N., Borgi, A., Bouziri, A., Dilek, A., Oncul, A., Kaya, A., Demiroz, A.P., Gunduz, A., Ozgultekin, A., Inan, A., Yalcin, A.N., Ramazanoglu, A., Engin, A., Willke, A., Meco, B.C., Aygun, C., Bulut, C., Uzun, C., Becerik, C., Hatipoglu, C.A., Guclu, C.Y., Ozdemir, D., Yildizdas, D., Ugurcan, D., Azak, E., Guclu, E., Yilmaz, E.M., Sebnem-Erdinc, F., Sirmatel, F., Ulger, F., Sari, F., Kizilates, F., Usluer, G., Ceylan, G., Ersoz, G., Kaya, G., Ertem, G.T., Senol, G., Agin, H., Cabadak, H., Yilmaz, H., Sungurtekin, H., Zengin, H., Turgut, H., Ozgunes, I., Devrim, I., Erdem, I., Işcanlı, I.G.E., Bakir, M.M., Geyik, M.F., Oral, M., Meric, M., Cengiz, M., Ozcelik, M., Altindis, M., Sunbul, M., Elaldi, N., Kuyucu, N., Unal, N., Oztoprak, N., Yasar, N., Erben, N., Bayram, N., Dursun, O., Karabay, O., Coskun, O., Horoz, O.O., Turhan, O., Sandal, O.S., Tekin, R., Esen, S., Erdogan, S.Y., Unal, S., Karacorlu, S., Sen, S., Sen, S., Sacar, S., Yarar, V., Oruc, Y., Sahip, Y., Kaya, Z., Philip, A., Elhoufi, A., Alrahma, H., Sachez, E., Perez, F., Empaire, G.D., Vidal, H.,

Montes-Bravo, L., Guzman Siritt, M.E., Orozco, N., Navarrete, N., Ruiz, Y., De Anez, Z.D.-G., Van Trang, D.T., Minh, D.Q., Co, D.X., Anh, D.P.P., Thu, L.T.A., Tuyet, L.T.D., Nguyet, L.T.T., Chau, N. uy, Binh, N.G., Tien, N.P., Anh, N.Q., Hang, P.T., Hanh, T.T.M., Hang, T.T.T., Thu, T.A., Thoa, V.T.H., (2016). International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module. Am. J. Infect. Control 44, 1495–1504.

Rosenthal, V.D., Bijie, H., Maki, D.G., Mehta, Y., Apisarnthanarak, A., Medeiros, E.A., Leblebicioglu, H., Fisher, D., Álvarez-Moreno, C., Khader, I.A., Del Rocío González Martínez, M., Cuellar, L.E., Navoa-Ng, J.A., Abouqal, R., Guanche Garcell, H., Mitrev, Z., Pirez García, M.C., Hamdi, A., Dueñas, L., Cancel, E., Gurskis, V., Rasslan, O., Ahmed, A., Kanj, S.S., Ugalde, O.C., Mapp, T., Raka, L., Yuet Meng, C., Thu, L.T.A., Ghazal, S., Gikas, A., Narváez, L.P., Mejía, N., Hadjieva, N., Gamar Elanbya, M.O., Guzmán Siritt, M.E., Jayatilleke, K., INICC members, (2012). International Nosocomial Infection Control Consortium (INICC) report, data summary of 36 countries, for 2004-2009. Am. J. Infect. Control 40, 396–407.

Rosenthal, V.D., Maki, D.G., Mehta, Y., Leblebicioglu, H., Memish, Z.A., Al-Mousa, H.H., Balkhy, H., Hu, B., Alvarez-Moreno, C., Medeiros, E.A., Apisarnthanarak, A., Raka, L., Cuellar, L.E., Ahmed, A., Navoa-Ng, J.A., El-Kholy, A.A., Kanj, S.S., Bat-Erdene, I., Duszynska, W., Van Truong, N., Pazmino, L.N., See-Lum, L.C., Fernández- Hidalgo, R., Di-Silvestre, G., Zand, F., Hlinkova, S., Belskiy, V., Al-Rahma, H., Luque-Torres, M.T., Bayraktar, N., Mitrev, Z., Gurskis, V., Fisher, D., Abu-Khader, I.B., Berechid, K., Rodríguez-Sánchez, A., Horhat, F.G., Requejo-Pino, O., Hadjieva, N., Ben-Jaballah, N., García-Mayorca, E., Kushner- Dávalos, L., Pasic, S., Pedrozo-Ortiz, L.E., Apostolopoulou, E., Mejía, N., Gamar-Elanbya, M.O., Jayatilleke, K., de Lourdes-Dueñas, M., Aguirre-Avalos, G., International Nosocomial Infection Control Consortium, Maurizi, D.M., Montanini, A., Spadaro, M.L., Marcos, L.S., Botta, P., Jerez, F.M., Chavez, M.C., Ramasco, L., Colqui, M.I., Olivieri, M.S., Rearte, A.S., Correa, G.E., Juarez, P.D., Gallardo, P.F., Brito, M.P., Mendez, G.H., Valdez, J.R., Cardena, L.P., Harystoy, J.M., Chaparro, G.J., Rodriguez, C.G., Toomey, R., Caridi, M., Viegas, M., Bernan, M.L., Romani, A., Dominguez, C.B., Davalos, L.K., Richtmann, R., Silva, C.A., Rodrigues, T.T., Filho, A.M., Seerig Palme, E.D., Besen, A., Lazzarini, C., Cardoso, C.B., Azevedo, F.K., Pinheiro, A.P.F., Camacho, A., De Carvalho, B.M., De Assis, M.J.M., Carneiro, A.P.V., Canuto, M.L.M., Pinto Coelho, K.H.,

International Journal of Caring Sciences September-December 2018 Volume 11 | Issue 3| Page1933

www.internationaljournalofcaringsciences.org

Moreira, T., Oliveira, A.A., Sousa Colares, M.M., De Paula Bessa, M.M., Gomes Bandeira, T.D.J.P., De Moraes, R.A., Campos, D.A., De Barros Araújo, T.M.L., Freitas Tenório, M.T., Amorim, S., Amaral, M., Da Luz Lima, J., Pino Da Silva Neta, L., Batista, C., De Lima Silva, F.J., Ferreira De Souza, M.C., Arruda Guimaraes, K., Marcia Maluf Lopes, J., Nogueira Napoles, K.M., Neto Avelar, L.L.S., Vieira, L.A., Gustavo De Oliveira Cardo, L., Takeda, C.F.V., Ponte, G.A., Eduardo Aguiar Leitão, F., De Souza Kuchenbecker, R., Pires Dos Santos, R., Maria Onzi Siliprandi, E., Fernando Baqueiro Freitas, L., Martins, I.S., Casi, D., Maretti Da Silva, M.A., Blecher, S., Villins, M., Salomao, R., Oliveira Castro, S.R., Da Silva Escudero, D. V., Andrade Oliveira Reis, M., Mendonca, M., Furlan, V., Claudio do Amaral Baruzzi, A., Sanchez, T.E., Moreira, M., Vasconcelos de Freitas, W., Passos de Souza, L., Velinova, V.A., Hadjieva, N., Petrov, M.M., Karadimov, D.G., Kostadinov, E.D., Dicheva, V.J., Wang, C., Guo, X., Geng, X., Wang, S., Zhang, J., Zhu, L., Zhuo, S., Guo, C., Lili, T., Ruisheng, L., Kun, L., Yang, X., Yimin, L., Pu, M., Changan, L., Shumei, Y., Kangxiong, W., Meiyi, L., Ye, G., Ziqin, X., Yao, S., Liqiang, S., Marino Cañas Giraldo, L., Margarita Trujillo Ramirez, E., Rios, P.A., Carlos Torres Millan, J., Giovanny Chapeta Parada, E., Eduardo Mindiola Rochel, A., Corchuelo Martinez, A.H., Marãa Perez Fernandez, A., Guzman, N.B., Guzman, A.L., Ferrer, M.R., Vega, Y.L., Munoz, H.J., Moreno, G.C., Romero Torres, S.L., Hernandez, H.T., Valderrama MarquezClaudia Linares, I.A., Valencia, M.E., Corrales, L.S., Bonilla, S.M., Ivan Marin Uribe, J., Gomez, D.Y., Martinez, J.O., Dary Burgos Florez, L., Osorio, J., Santofimio, D., Cortes, L.M., Villamil-Gomez, W., Gutierrez, G.M., Ruiz, A.A., Fuentes, C.G., Chinchilla, A.S., Hernandez, I.C., Ugalde, O.C., Garcell, H.G., Perez, C.M., Bardak, S., Ozkan, S., Mejia, N., Puello Guerrero Glenny Mirabal, A.M., Delgado, M., Severino, R., Lacerda, E., Tolari, G., Bovera, M.M., Pinto, D.B., González, P.F., Santacruz, G., Alquinga, N., Zaruma, C., Remache, N., Morocho, D., Arboleda, M., Zapata, M.C., Garcia, M.F.M.M., Picoita, F., Velez, J., Valle, M., Yepez, E.S., Tutillo, D.M., Mora, R.A., Padilla, A.P., Chango, M., Cabezas, K., Tenorio López, S., Lucía Bonilla Escudero, A., Sánchez, G.T., Alberto Gonzalez Flores, H., Garcia, M.F.M.M., Ghazi, I.A., Hassan, M., Ismail, G.A., Hamed, R., Abdel-Halim, M.M., El-Fattah, M.A., Abdel-Aziz, D., Seliem, Z.S., Elsherif, R.H., Dewdar, R.A., Mohmed, A.A., Abdel-Fatteh Ahmed, L., De Jesus Machuca, L., Bran De Casares, C., Kithreotis, P., Daganou, M., Veldekis, D., Kartsonaki, M., Gikas, A., Luque Torres, M.T., Padgett, D., Rivera, D.M., Jaggi, N.,

Rodrigues, C., Shah, B., Parikh, K., Patel, J., Thakkar, R., Chakravarthy, M., Gokul, B.N., Sukanya, R., Pushparaj, L., Vini, T., Rangaswamy, S., Patnaik, S.K., Venkateshwar, V., John, B., Dalal, S., Sahu, S.S., Sahu, S.S., Ray, B., Misra, S., Mohanty, N., Mishra, B.B.M., Sahoo, P., Parmar, N., Mishra, S., Pati, B.S.B.K., Singh, S.S.S., Pati, B.S.B.K., Panda, A., Banergee, S., Padhihari, D., Samal, S., Sahu, S.S., Varma, K., Suresh Kumar, V.P., Gopalakrishnan, R., Ramakrishnan, N., Abraham, B.K., Rajagopal, S., Venkatraman, R., Mani, A.K., Devaprasad, D., Ranganathan, L., Francis, T., Cherain, K.M., Ramachandran, B., Krupanandan, R., Muralidharan, S., Karpagam, M., Padmini, B., Saranya, S., Kumar, S.S.S., Pandya, N., Kakkar, R., Zompa, T., Saini, N., Samavedam, S., Jagathkar, G., Nirkhiwale, S., Gehlot, G.S., Bhattacharya, S.S., Sood, S., Singh, S.S.S., Singh, S.S.S., Todi, S.K., Bhattacharyya, M., Bhakta, A., Basu, S., Agarwal, A., Agarwal, M., Kharbanda, M., Sengupta, S., Karmakar, A., Gupta, D., Sarkar, A.K., Dey, R., Bhattacharya, C., Chandy, M., Ramanan, V.R., Mahajan, A., Roy, M., Bhattacharya, S.S., Sinha, S., Roy, I., Gupta, U., Mukherjee, S., Bej, M., Mukherjee, P., Baidya, S., Azim, A., Sakle, A.S., Sorabjee, J.S., Potdar, M.S., Subhedar, V.R., Udwadia, F.E., Francis, H., Dwivedy, A., Binu, S., Shetty, S., Nair, P.K., Khanna, D.K., Chacko, F., Blessymole, S., Mehta, P.R., Singhal, T., Shah, S., Kothari, V., Naik, R., Patel, M.H., Aggarwal, D.G., Jawadwala, B.Q., Pawar, N.K., Kardekar, S.N., Manked, A.N., Myatra, S.N., Divatia, J.V., Kelkar, R., Biswas, S.K., Raut, V., Sampat, S., Thool, A., Karlekar, A., Nandwani, S., Gupta, S., Singhal, S., Gupta, M., Mathur, P., Kumar, S.S.S., Sandhu, K., Dasgupta, A., Raha, A., Raman, P., Wadhera, A., Badyal, B., Juneja, S., Mishra, B.B.M., Sharma, S., Mehrotra, M., Shelgaonkar, J., Padbidri, V., Dhawale, R., Sibin, S.M., Mane, D., Sale, H.K., Mukhit Abdul Gaffar Kazi, M., Chabukswar, S., Mathew, A., Gaikwad, D., Harshe, A., Nadimpalli, G., Bhamare, S., Thorat, S., Sarda, O., Nadimpalli, P., Mendonca, A., Malik, S., Kamble, A., Kumari, N., Arora, S., Munshi, N., Divekar, D.G., Kavathekar, M.S., Kulkarni, A.K., Kavathekar, M.S., Suryawanshi, M.V., Bommala, M.L., Bilolikar, A., Joshi, K.L., Pamnani, C., Wasan, H., Khamkar, S., Steephen, L., Rajalakshmi, A., Thair, A., Mubarak, A., Sathish, S., Kumar, S.S.S., Sunil, H., Sujith, S., Dinesh, Sen, N., Thool, A., Shinde, N., Alebouyeh, M., Jahani-Sherafat, S., Zali, M.R., Sarbazi, M.R., Mansouri, N., Tajeddin, E., Razaghi, M., Seyedjavadi, S., Tajeddin, E., Rashidan, M., Razaghi, M., Masjedi, M., Maghsudi, B., Sabetian, G., Sanaei, A., Yousefipour, A., Alebouyeh, M., Assiri, A.M., Furukawa-Cinquini, E.M., Alshehri,

International Journal of Caring Sciences September-December 2018 Volume 11 | Issue 3| Page1934

www.internationaljournalofcaringsciences.org

A.D., Giani, A.F., Demaisip, N.L., Cortez, E.L., Cabato, A.F., Gonzales Celiz, J.M., Al-Zaydani Asiri, I.A.M., Mohammed, Y.K., Abdullah Al Raey, M., Omer Abdul Aziz, A., Ali Al Darani, S., Aziz, M.R., Basri, R.H., Al-Awadi, D.K., Bukhari, S.Z., Aromin, R.G., Ubalde, E.B., Molano, A.M., Abdullah Al Enizy, H., Baldonado, C.F., Al Adwani, F.M., Marie Casuyon Pahilanga, A., Tan, A.M., Joseph, S., Nair, D.S., Al-Abdullah, N.A., Sindayen, G., Malificio, A.A., Mohammed, D.A., Mesfer Al Ghamdi, H., Silo, A.C., Valisto, M.B. V., Foteinakis, N., Ghazal, S.S., Joseph, M. V., Hakawi, A., Hasani, A., Jusufi, I., Spahija, G., Baftiu, N., Gecaj-Gashi, A., Aly, N.Y., El-Dossoky Noweir, M., Varghese, S.T., Ramapurath, R.J., Mohamed, A.M., George, S.M., Kurian, A., Sayed, A.F., Salama, M.F., Omar, A.A., Rebello, F.M., Narciso, D.M., Zahreddine, N.K., Kanafani, Z., Kardas, T., Molaeb, B., Jurdi, L., Al Souheil, A., Ftouni, M., Ayash, H., Mahfouz, T., Kondratas, T., Grinkeviciute, D., Kevalas, R., Gailiene, G., Dagys, A., Petrovska, M., Popovska, K., Bogoevska- Miteva, Z., Jankovska, K., Guroska, S.T., Anguseva, T., Wan Yusoff, W.N., Shiham Zainal Abidin, A., Gan, C.S., Zainol, H., Rai, V., Kwong, W.K., Hasan, M.S., Sri La Sri Ponnampala, S., Veerakumaran, J., Assadian, O., Phuong, D.M., Binh, N.G., Kaur, K., Lim, J., Tan, L.-H., Manikavasagam, J., Cheong, Y.- M., Magaña, H.C., Cesar Mijangos Méndez, J., Jiménez, F.C., Esparza-Ahumada, S., Morfin-Otero, R., Rodriguez-Noriega, E., Gutierrez-Martinez, S., Perez-Gomez, H.R., León-Garnica, G., Mendoza- Mujica, C., Cecilia Culebro Burguet, M., Portillo- Gallo, J.H., Almazán, F.A., Miramontes, G.I., Olivas, M. del R.V., Aguilar Angel, L.A., Vargas, M.S., Orlando Flores Alvarado, A., Carlos Mares Morales, R., Carlos Fernandez Alvarez, L., Armando Rincon Leon, H., Navarro Fuentes, K.R., Mariela Perez Hernandez, Y., Falcon, G.M., Vargas, A.G., Trujillo Juarez, M.A., Mulia, A.M., Alma Ulloa Camacho, P., Martinez-Marroquin, M.Y., Garcia, M.F.M.M., Martinez, A.M., Sanchez, E.L., Flores, G.G., Martínez, M. del R.G., Alfonso Galindo Olmeda, J., Olivarez, G., Rodriguez, E.B., Magdalena Gutierrez Castillo, M., Guadalupe Villa González, M., Beatriz Sauceda Castañeda, I., Rodriguez, J.M., Baatar, O., Batkhuu, B., Meryem, K., Amina, B., Abouqal, R., Zeggwagh, A.A., Dendane, T., Abidi, K., Madani, N., Mahmood, S.F., Memon, B.A., Bhutto, G.H., Paul, N., Parveen, A., Raza, A., Mahboob, A., Nizamuddin, S., Sultan, F., Nazeer, H., Khan, A.A., Hafeez, A., Lara, L., Mapp, T., Alvarez, B., Rojas-Bonilla, M.I., Castano, E., De Moros, D.A., Atarama, R.E., Calisto Pazos, M.E., Paucar, A., Ramos, M.T., Jurado, J., Moreno, D., Cruz Saldarriaga, M.E., Ramirez, E., La Hoz

Vergara, C.E., Enrique Prudencio Leon, W., Isidro Castillo Bravo, L., Fernanda Aibar Yaranga, K., Pichilingue Chagray, J.E., Marquez Mondalgo, V.A., Zegarra, S.T., Astete, N.S., Guevara, F.C., Pastrana, J.S., Enrique Prudencio Leon, W., Linares Calderon, C.F., Jesus Mayorga Espichan, M., Martin Santivanez Monge, L., Changano Rodriguez, M. V., Rosa Diaz Tavera, Z., Martin Ramirez Wong, F., Chavez, S.M., Rosa Diaz Tavera, Z., Martin Ramirez Wong, F., Atencio-Espinoza, T., Villanueva, V.D., Blanco-Abuy, M.T., Tamayo, A.S., Bergosa, L.D., Llames, C.M.J.P., Trajano, M.F., Bunsay, S.A., Amor, J.C., Berba, R., Sg Buenaflor, M.C., Labro, E., Mendoza, M.T., Javellana, O.P., Salvio, L.G., Rayco, R.G., Bermudez, V., Kubler, A., Zielinska, M., Kosmider- Zurawska, M., Barteczko-Grajek, B., Szewczyk, E., Dragan, B., Mikaszewska-Sokolewicz, M.A., Lazowski, T., Cancel, E., Licker, M.S., Dragomirescu, L.A., Dumitrascu, V., Sandesc, D., Bedreag, O., Papurica, M., Muntean, D., Kotkov, I., Kretov, V., Shalapuda, V., Molkov, A., Puzanov, S., Utkin, I., Tchekulaev, A., Tulupova, V., Nikolic, L., Ristic, G., Eremija, J., Kojovic, J., Lekic, D., Vasiljevic, S., Lesnakova, A., Marcekova, A., Furova, K., Gamar Elanbya, M.O., Ali, M.A., Kadankunnel, S.K., Somabutr, S., Pimathai, R., Wanitanukool, S., Luxsuwong, M., Supa, N., Prasan, P., Thamlikitkul, V., Jamulitrat, S., Suwalak, N., Phainuphong, P., Asma, B., Aida, B., Sarra, B.H., Ammar, K., Ertem, G.T., Bulut, C., Hatipoglu, C.A., Erdinc, F.S., Demiroz, A.P., Ozcelik, M., Meco, B.C., Oral, M., Unal, N., Guclu, C.Y., Kendirli, T., İnce, E., Çiftçi, E., Yaman, A., Ödek, Ç., Karbuz, A., Kocabaş, B.A., Altın, N., Cesur, S., Atasay, B., Erdeve, O., Akduman, H., Kahvecioglu, D., Cakir, U., Yildiz, D., Kilic, A., Arsan, S., Arman, D., Unal, S., Gelebek, Y., Zengin, H., Sen, S., Cabadak, H., Erbay, A., Yalcin, A.N., Turhan, O., Cengiz, M., Dursun, O., Gunasan, P., Kaya, S., Ramazanoglu, A., Ustun, C., Yasayacak, A., Akdeniz, H., Sirmatel, F., Otkun, A.M., Sacar, S., Sener, A., Turgut, H., Sungurtekin, H., Ugurcan, D., Necan, C., Yilmaz, C., Ozdemir, D., Geyik, M.F., Ince, N., Danis, A., Erdogan, S.Y., Erben, N., Usluer, G., Ozgunes, I., Uzun, C., Oncul, O., Gorenek, L., Erdem, H., Baylan, O., Ozgultekin, A., Inan, A., Bolukcu, S., Senol, G., Ozdemir, H., Gokmen, Z., Ozdemir, S.I., Kaya, A., Ersoz, G., Kuyucu, N., Karacorlu, S., Kaya, Z., Guclu, E., Kaya, G., Karabay, O., Esen, S., Aygun, C., Ulger, F., Dilek, A., Yilmaz, H., Sunbul, M., Engin, A., Bakir, M., Elaldi, N., Koksal, I., Yildizdas, D., Horoz, O.O., Willke, A., Koç, M.M., Azak, E., Elahi, N., Annamma, P., El Houfi, A., Pirez Garcia, M.C., Vidal, H., Perez, F., Empaire, G.D., Ruiz, Y., Hernandez, D., Aponte, D., Salinas,

International Journal of Caring Sciences September-December 2018 Volume 11 | Issue 3| Page1935

www.internationaljournalofcaringsciences.org

E., Diaz, C., Guzmán Siritt, M.E., Gil De Añez, Z.D., Bravo, L.M., Orozco, N., Mejías, E., Hung, N.V., Anh, N.Q., Chau, N.Q., Thu, T.A., Phuong, D.M., Binh, N.G., Thi Diem Tuyet, L., Thi Van Trang, D., Hong Thoa, V.T., Tien, N.P., Anh Thu, L.T., Hang, P.T., My Hanh, T.T., Thuy Hang, T.T., Phuong Anh, D.P., (2014). International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device- associated module. Am. J. Infect. Control 42, 942– 956.

Salgado Yepez, E., Bovera, M.M., Rosenthal, V.D., González Flores, H.A., Pazmiño, L., Valencia, F., Alquinga, N., Ramirez, V., Jara, E., Lascano, M., Delgado, V., Cevallos, C., Santacruz, G., Pelaéz, C., Zaruma, C., Barahona Pinto, D., (2017). Device- associated infection rates, mortality, length of stay and bacterial resistance in intensive care units in Ecuador: International Nosocomial Infection Control Consortium’s findings. World J. Biol. Chem. 8, 95. https://doi.org/10.4331/wjbc.v8.i1.95

Singh, S., Chaturvedi, R., Garg, S.M., Datta, R., Kumar, A., (2013). Incidence of healthcare associated infection in the surgical ICU of a tertiary care hospital. Med. journal, Armed Forces India 69, 124– 9.

Talaat, M., El-Shokry, M., El-Kholy, J., Ismail, G., Kotb, S., Hafez, S., Attia, E., Lessa, F.C., (2016). National surveillance of health care–associated infections in Egypt: Developing a sustainable program in a resource-limited country. Am. J. Infect. Control 44, 1296–1301.

Tao, L., Hu, B., Rosenthal, V.D., Gao, X., He, L., (2011).Device-associated infection rates in 398 intensive care units in Shanghai, China: International Nosocomial Infection Control Consortium (INICC) findings. Int. J. Infect. Dis. 15, e774-80.

Tigen, E.T., Dogru, A., Koltka, E.N., Unlu, C., Gura, M., (2014). Device-Associated Nosocomial Infection Rates and Distribution of Antimicrobial Resistance in a Medical-Surgical Intensive Care Unit in Turkey. Jpn. J. Infect. Dis. 67, 5–8.

United Nations Development Programme, (2016). Human development report 2016, United Nations Development Programme. https://doi.org/eISBN: 978-92-1-060036-1

Vanhems, P., Bénet, T., Voirin, N., Januel, J.-M., Lepape, A., Allaouchiche, B., Argaud, L., Chassard, D., Guérin, C., Study Group, Lehot, J.-J., Robert, M.-O., Fournier, G., Jacques, D., Artru, F., Gueugniaud, P.-Y., Chassard, D., Girard, R., Cêtre, J.-C., Nicolle, M.-C., Metzger, M.-H., Grando, J., (2011). Early-onset ventilator-associated pneumonia incidence in intensive care units: a surveillance- based study. BMC Infect. Dis. 11, 236. https://doi.org/10.1186/1471-2334-11-236

Velasquez, T., Mackey, G., Lusk, J., Kyle, U.G., Fontenot, T., Marshall, P., Shekerdemian, L.S., Coss-Bu, J.A., Nishigaki, A., Yatabe, T., Tamura, T., Yamashita, K., Yokoyama, M., Ruiz-Rodriguez, J.C., Encina, B., Belmonte, R., Troncoso, I., Tormos, P., Riveiro, M., Baena, J., Sanchez, A., Bañeras, J., Cordón, J., Duran, N., Ruiz, A., Caballero, J., Nuvials, X., Riera, J., Serra, J., Rutten, A.M.F., van Ieperen, S.N.M., Der Kinderen, E.P.H.M., Van Logten, T., Kovacikova, L., Skrak, P., Zahorec, M., Kyle, U.G., Akcan-Arikan, A., Silva, J.C., Mackey, G., Lusk, J., Goldsworthy, M., Shekerdemian, L.S., Coss-Bu, J.A., Wood, D., Harrison, D., Parslow, R., Davis, P., Pappachan, J., Goodwin, S., Ramnarayan, P., Chernyshuk, S., Yemets, H., Zhovnir, V., Pulitano’, S.M., De Rosa, S., Mancino, A., Villa, G., Tosi, F., Franchi, P., Conti, G., Patel, B., Khine, H., Shah, A., Sung, D., Singer, L., Haghbin, S., Inaloo, S., Serati, Z., Idei, M., Nomura, T., Yamamoto, N., Sakai, Y., Yoshida, T., Matsuda, Y., Yamaguchi, Y., Takaki, S., Yamaguchi, O., Goto, T., Longani, N., Medar, S., Abdel-Aal, I.R., El Adawy, A.S., Mohammed, H.M.E.H., Mohamed, A.N., Parry, S.M., Knight, L.D., Denehy, L., De Morton, N., Baldwin, C.E., Sani, D., Kayambu, G., da Silva, V.Z.M., Phongpagdi, P., Puthucheary, Z.A., Granger, C.L., Rydingsward, J.E., Horkan, C.M., Christopher, K.B., McWilliams, D., Jones, C., Reeves, E., Atkins, G., Snelson, C., Aitken, L.M., Rattray, J., Kenardy, J., Hull, A.M., Ullman, A., Le Brocque, R., Mitchell, M., Davis, C., Macfarlane, B., Azevedo, J.C., Rocha, L.L., De Freitas, F.F.M., Cavalheiro, A.M., Lucinio, N.M., Lobato, M.S., Ebeling, G., Kraegpoeth, A., Laerkner, E., De Brito-Ashurst, I., White, C., Gregory, S., Forni, L.G., Flowers, E., Curtis, A., Wood, C.A., Siu, K., Venkatesan, K., Muhammad, J.B.H., Ng, L., Seet, E., Baptista, N., Escoval, A., Tomas, E., Agrawal, R., Mathew, R., Varma, A., Dima, E., Charitidou, E., Perivolioti, E., Pratikaki, M., Vrettou, C., Giannopoulos, A., Zakynthinos, S., Routsi, C., Atchade, E., Houzé, S., Jean-Baptiste, S., Thabut, G., Genève, C., Tanaka, S., Lortat-Jacob, B., Augustin, P., Desmard, M., Montravers, P., de Molina, F.J.G., Barbadillo, S., Alejandro, R., Álvarez-Lerma, F., Vallés, J., Catalán, R.M., Palencia, E., Jareño, A., Granada, R.M., Ignacio, M.L., Cui, N., Liu, D., Wang, H., Su, L., Qiu, H., Li, R., Jaffal, K., Rouzé, A., Poissy, J., Sendid, B., Nseir, S., Paramythiotou, E., Rizos, M., Frantzeskaki, F., Antoniadou, A., Vourli, S., Zerva, L., Armaganidis, A., Riera, J., Gottlieb, J., Greer, M., Wiesner, O., Martínez, M., Acuña, M., Rello, J., Welte, T., Atchade, E., Mignot, T., Houzé, S., Jean- Baptiste, S., Thabut, G., Lortat-Jacob, B., Tanaka, S., Augustin, P., Desmard, M., Montravers, P.,

International Journal of Caring Sciences September-December 2018 Volume 11 | Issue 3| Page1936

www.internationaljournalofcaringsciences.org

Soussi, S., Dudoignon, E., Ferry, A., Chaussard, M., Benyamina, M., Alanio, A., Touratier, S., Chaouat, M., Lafaurie, M., Mimoun, M., Mebazaa, A., Legrand, M., Sheils, M.A., Patel, C., Mohankumar, L., Akhtar, N., Noriega, S.K.P., Aldana, N.N., León, J.L.Á., Baquero, J.D., Bernal, F.F., Ahmadnia, E., Hadley, J.S., Millar, M., Hall, D., Hewitt, H., Yasuda, H., Sanui, M., Komuro, T., Kawano, S., Andoh, K., Yamamoto, H., Noda, E., Hatakeyama, J., Saitou, N., Okamoto, H., Kobayashi, A., Takei, T., Matsukubo, S., Rotzel, H.B., Lázaro, A.S., Prada, D.A., Gimillo, M.R., Barinas, O.D., Cortes, M.L.B., Franco, J.F., Roca, J.M.S., Carratalá, A., Gonçalves, B., Turon, R., Mendes, A., Miranda, F., Mata, P.J., Cavalcanti, D., Melo, N., Lacerda, P., Kurtz, P., Righy, C., Rosario, L.E. de la C., Lesmes, S.P.G., Romero, J.C.G., Herrera, A.N.G., Pertuz, E.D.D., Sánchez, M.J.G., Sanz, E.R., Hualde, J.B., Hernández, A.A., Irazabal, J.M.G., Spatenkova, V., Bradac, O., Suchomel, P., Urli, T., Lazzeri, E.H., Aspide, R., Zanello, M., Perez-Borrero, L., Garcia- Alvarez, J.M., Arias-Verdu, M.D., Aguilar-Alonso, E., Rivera-Fernandez, R., Mora-Ordoñez, J., De La Fuente-Martos, C., Castillo-Lorente, E., Guerrero- Lopez, F., Lesmes, S.P.G., Rosario, L.E.D. la C., Pertuz, E.D.D., Hernández, A.A., Romero, J.C.G., Sánchez, M.J.G., Herrera, A.N.G., Ramírez, J.R., Sanz, E.R., Hualde, J.B., León, J.P.T., Navarro- Guillamón, L., Cordovilla-Guardia, S., Iglesias- Santiago, A., Guerrero-López, F., Fernández- Mondéjar, E., Vidal, A., Perez, M., Juez, A., Arias, N., Colino, L., Perez, J.L., Pérez, H., Calpe, P., Alcala, M.A., Robaglia, D., Perez, C., Lan, S.K., Cunha, M.M., Moreira, T., Santos, F., Lafuente, E., Fernandes, M.J., Silva, J.G., Rosario, L.E. de la C., Lesmes, S.P.G., Herrera, A.N.G., Romero, J.C.G., Pertuz, E.D.D., Sánchez, M.J.G., Sanz, E.R., Echeverría, J.G.A., Hernández, A.A., Hualde, J.B., Podlepich, V., Sokolova, E., Alexandrova, E., Lapteva, K., Kurtz, P., Shuinotsuka, C., Rabello, L., Vianna, G., Reis, A., Cairus, C., Salluh, J., Bozza, F., Torres, J.C.B., Araujo, N.J.F., García-Olivares, P., Keough, E., Dalorzo, M., Tang, L.K., De Sousa, I., Díaz, M., Marcos-Zambrano, L.J., Guerrero, J.E., Gomez, S.E.Z., Lopez, G.D.H., Cuellar, A.I.V., Nieto, O.R.P., Gonzalez, J.A.C., Bhasin, D., Rai, S., Singh, H., Gupta, O., Bhattal, M.K., Sampley, S., Sekhri, K., Nandha, R., Aliaga, F.A., Olivares, F., Appiani, F., Farias, P., Alberto, F., Hernández, A., Pons, S., Sonneville, R., Bouadma, L., Neuville, M., Mariotte, E., Radjou, A., Lebut, J., Chemam, S., Voiriot, G., Dilly, M.P., Mourvillier, B., Dorent, R., Nataf, P., Wolff, M., Timsit, J.F., Ediboglu, O., Ataman, S., Ozkarakas, H., Kirakli, C., Vakalos, A., Avramidis, V., Obukhova, O., Kurmukov, I.A., Kashiya, S., Golovnya, E., Baikova, V.N., Ageeva,

T., Haritydi, T., Kulaga, E. V., Rios-Toro, J.J., Perez-Borrero, L., Aguilar-Alonso, E., Arias-Verdu, M.D., Garcia-Alvarez, J.M., Lopez-Caler, C., De La Fuente-Martos, C., Rodriguez-Fernandez, S., Sanchez-Orézzoli, M.G., Martin-Gallardo, F., Nikhilesh, J., Joshi, V., Villarreal, E., Ruiz, J., Gordon, M., Quinza, A., Gimenez, J., Piñol, M., Castellanos, A., Ramirez, P., Jeon, Y.D., Jeong, W.Y., Kim, M.H., Jeong, I.Y., Ahn, M.Y., Ahn, J.Y., Han, S.H., Choi, J.Y., Song, Y.G., Kim, J.M., Ku, N.S., Shah, H., Kellner, F., Rezai, F., Mistry, N., Yodice, P., Ovnanian, V., Fless, K., Handler, E., Alejos, R.M., Romeu, J.D.M., Antón, D.G., Quinart, A., Martí, A.T., Llaurado-Serra, M., Lobo-Civico, A., Ventura-Rosado, A., Piñol-Tena, A., Pi- Guerrero, M., Paños-Espinosa, C., Peralvo-Bernat, M., Marine-Vidal, J., Gonzalez-Engroba, R., Montesinos-Cerro, N., Treso-Geira, M., Valeiras- Valero, A., Martinez-Reyes, L., Sandiumenge, A., Jimenez-Herrera, M.F., Helyar, S., Riozzi, P., Noon, A., Hallows, G., Cotton, H., Keep, J., Hopkins, P.A., Taggu, A., Renuka, S., Sampath, S., Rood, P.J.T., Frenzel, T., Verhage, R., Bonn, M., Pickkers, P., van der Hoeven, J.G., van den Boogaard, M., Corradi, F., Melnyk, L., Moggia, F., Pienovi, R., Adriano, G., Brusasco, C., Mariotti, L., Lattuada, M., Bloomer, M.J., Coombs, M., Ranse, K., Endacott, R., Maertens, B., Blot, K., Blot, S., Amerongen, M.P. van N., van der Heiden, E.S., Twisk, J.W.R., Girbes, A.R.J., Spijkstra, J.J., Riozzi, P., Helyar, S., Cotton, H., Hallows, G., Noon, A., Bell, C., Peters, K., Feehan, A., Keep, J., Hopkins, P.A., Churchill, K., Hawkins, K., Brook, R., Paver, N., Endacott, R., Maistry, N., van Wijk, A., Rouw, N., van Galen, T., Evelein-Brugman, S., Taggu, A., Krishna, B., Sampath, S., Putzu, A., Fang, M., Berto, M.B., Belletti, A., Cassina, T., Cabrini, L., Mistry, M., Alhamdi, Y., Welters, I., Abrams, S.T., Toh, C.H., Han, H.S., Gil, E.M., Lee, D.S., Park, C.M., Winder- Rhodes, S., Lotay, R., Doyle, J., Ke, M.W., Huang, W.C., Chiang, C.H., Hung, W.T., Cheng, C.C., Lin, K.C., Lin, S.C., Chiou, K.R., Wann, S.R., Shu, C.W., Kang, P.L., Mar, G.Y., Liu, C.P., Dubó, S., Aquevedo, A., Jibaja, M., Berrutti, D., Labra, C., Lagos, R., García, M.F., Ramirez, V., Tobar, M., Picoita, F., Peláez, C., Carpio, D., Alegría, L., Hidalgo, C., Godoy, K., Bakker, J., Hernández, G., Sadamoto, Y., Katabami, K., Wada, T., Ono, Y., Maekawa, K., Hayakawa, M., Sawamura, A., Gando, S., Marin-Mateos, H., Perez-Vela, J.L., Garcia-Gigorro, R., Peiretti, M.A.C., Lopez-Gude, M.J., Chacon-Alves, S., Renes-Carreño, E., Montejo-González, J.C., Parlevliet, K.L., Touw, H.R.W., Beerepoot, M., Boer, C., Elbers, P.W.G., Tuinman, P.R., Abdelmonem, S.A., Helmy, T.A., El Sayed, I., Ghazal, S., Akhlagh, S.H., Masjedi, M.,

International Journal of Caring Sciences September-December 2018 Volume 11 | Issue 3| Page1937

www.internationaljournalofcaringsciences.org

Hozhabri, K., Kamali, E., Zýková, I., Paldusová, B., Sedlák, P., Morman, D., Youn, A.M., Ohta, Y., Sakuma, M., Bates, D., Morimoto, T., Su, P.L., Chang, W.Y., Lin, W.C., Chen, C.W., Facchin, F., Zarantonello, F., Panciera, G., De Cassai, A., Venrdramin, A., Ballin, A., Tonetti, T., Persona, P., Ori, C., Del Sorbo, L., Rossi, S., Vergani, G., Cressoni, M., Chiumello, D., Chiurazzi, C., Brioni, M., Algieri, I., Tonetti, T., Guanziroli, M., Colombo, A., Tomic, I., Colombo, A., Crimella, F., Carlesso, E., Gasparovic, V., Gattinoni, L., Neto, A.S., Schmidt, M., Pham, T., Combes, A., de Abreu, M.G., Pelosi, P., Schultz, M.J., Katira, B.H., Engelberts, D., Giesinger, R.E., Ackerley, C., Yoshida, T., Zabini, D., Otulakowski, G., Post, M., Kuebler, W.M., McNamara, P.J., Kavanagh, B.P., Pirracchio, R., Rigon, M.R., Carone, M., Chevret, S., Annane, D., Eladawy, S., El-Hamamsy, M., Bazan, N., Elgendy, M., De Pascale, G., Vallecoccia, M.S., Cutuli, S.L., Di Gravio, V., Pennisi, M.A., Conti, G., Antonelli, M., Andreis, D.T., Khaliq, W., Singer, M., Hartmann, J., Harm, S., Carmona, S.A., Almudevar, P.M., Abellán, A.N., Ramos, J.V., Pérez, L.P., Valbuena, B.L., Sanz, N.M., Simón, I.F., Arrigo, M., Feliot, E., Deye, N., Cariou, A., Guidet, B., Jaber, S., Leone, M., Resche- Rigon, M., Baron, A.V., Legrand, M., Gayat, E., Mebazaa, A., Balik, M., Kolnikova, I., Maly, M., Waldauf, P., Tavazzi, G., Kristof, J., Herpain, A., Su, F., Post, E., Taccone, F., Vincent, J.L., Creteur, J., Lee, C., Hatib, F., Jian, Z., Buddi, S., Cannesson, M., Fileković, S., Turel, M., Knafelj, R., Gorjup, V., Stanić, R., Gradišek, P., Cerović, O., Mirković, T., Noč, M., Tirkkonen, J., Hellevuo, H., Olkkola, K.T., Hoppu, S., Lin, K.C., Hung, W.T., Chiang, C.C., Huang, W.C., Juan, W.C., Lin, S.C., Cheng, C.C., Lin, P.H., Fong, K.Y., Hou, D.S., Kang, P.L., Wann, S.R., Chen, Y.S., Mar, G.Y., Liu, C.P., Paul, M., Bougouin, W., Geri, G., Dumas, F., Champigneulle, B., Legriel, S., Charpentier, J., Mira, J.P., Sandroni, C., Cariou, A., Zimmerman, J., Sullivan, E., Noursadeghi, M., Fox, B., Sampson, D., McHugh, L., Yager, T., Cermelli, S., Seldon, T., Bhide, S., Brandon, R.A., Brandon, R.B., Zwaag, J., Beunders, R., Pickkers, P., Kox, M., Gul, F., Arslantas, M.K., Genc, D., Zibandah, N., Topcu, L., Akkoc, T., Cinel, I., Greco, E., Lauretta, M.P., Andreis, D.T., Singer, M., Garcia, I.P., Cordero, M., Martin, A.D., Pallás, T.A., Montero, J.G., Rey, J.R., Malo, L.R., Montoya, A.A.T., Martinez, A.D.C.A., Ayala, L.Y.D., Zepeda, E.M., Granillo, J.F., Sanchez, J.A., Alejo, G.C., Cabrera, A.R., Montenegro, A.P., Pham, T., Beduneau, G., Schortgen, F., Piquilloud, L., Zogheib, E., Jonas, M., Grelon, F., Runge, I., Terzi, N., Grangé, S., Barberet, G., Guitard, P.G., Frat, J.P., Constan, A., Chrétien, J.M., Mancebo, J.,

Mercat, A., Richard, J.C.M., Brochard, L., Soilemezi, E., Koco, E., Savvidou, S., Nouris, C., Matamis, D., Di Mussi, R., Spadaro, S., Volta, C.A., Mariani, M., Colaprico, A., Antonio, C., Bruno, F., Grasso, S., Rodriguez, A., Martín-Loeches, I., Díaz, E., Masclans, J.R., Gordo, F., Solé-Violán, J., Bodí, M., Avilés-Jurado, F.X., Trefler, S., Magret, M., Reyes, L.F., Marín-Corral, J., Yebenes, J.C., Esteban, A., Anzueto, A., Aliberti, S., Restrepo, M.I., Larsson, J.S., Redfors, B., Ricksten, S.E., Haines, R., Powell-Tuck, J., Leonard, H., Ostermann, M., Berthelsen, R.E., Itenov, T.S., Perner, A., Jensen, J.U., Ibsen, M., Jensen, A.E.K., Bestle, M.H., Bucknall, T., Dixon, J., Boa, F., MacPhee, I., Philips, B.J., Doyle, J., Saadat, F., Samuels, T., Huddart, S., McCormick, B., DeBrunnar, R., Preece, J., Swart, M., Peden, C., Richardson, S., Forni, L., Kalfon, P., Baumstarck, K., Estagnasie, P., Geantot, M.A., Berric, A., Simon, G., Floccard, B., Signouret, T., Boucekine, M., Fromentin, M., Nyunga, M., Sossou, A., Venot, M., Robert, R., Follin, A., Renault, A., Garrouste, M., Collange, O., Levrat, Q., Villard, I., Thévenin, D., Pottecher, J., Patrigeon, R.G., Revel, N., Vigne, C., Mimoz, O., Auquier, P., Pawar, S., Jacques, T., Deshpande, K., Pusapati, R., Wood, B., Pulham, R.A., Wray, J., Brown, K., Pierce, C., Nadel, S., Ramnarayan, P., Azevedo, J.R., Montenegro, W.S., Rodrigues, D.P., Sousa, S.C., Araujo, V.F., Leitao, A.L., Prazeres, P.H., Mendonca, A. V., Paula, M.P., Das Neves, A., Loudet, C.I., Busico, M., Vazquez, D., Villalba, D., Lischinsky, A., Veronesi, M., Emmerich, M., Descotte, E., Juliarena, A., Bisso, M.C., Grando, M., Tapia, A., Camargo, M., Ulla, D.V., Corzo, L., dos Santos, H.P., Ramos, A., Doglia, J.A., Estenssoro, E., Carbonara, M., Magnoni, S., Donald, C.L. Mac, Shimony, J.S., Conte, V., Triulzi, F., Stretti, F., Macrì, M., Snyder, A.Z., Stocchetti, N., Brody, D.L., Podlepich, V., Shimanskiy, V., Savin, I., Lapteva, K., Chumaev, A., Tjepkema-Cloostermans, M.C., Hofmeijer, J., Beishuizen, A., Hom, H., Blans, M.J., van Putten, M.J.A.M., Longhi, L., Frigeni, B., Curinga, M., Mingone, D., Beretta, S., Patruno, A., Gandini, L., Vargiolu, A., Ferri, F., Ceriani, R., Rottoli, M.R., Lorini, L., Citerio, G., Pifferi, S., Battistini, M., Cordolcini, V., Agarossi, A., Di Rosso, R., Ortolano, F., Stocchetti, N., Lourido, C.M., Cabrera, J.L.S., Santana, J.D.M., Alzola, L.M., del Rosario, C.G., Pérez, H.R., Torrent, R.L., Eslami, S., Dalhuisen, A., Fiks, T., Schultz, M.J., Hanna, A.A., Spronk, P.E., Wood, M., Maslove, D., Muscedere, J., Scott, S.H., Saha, T., Hamilton, A., Petsikas, D., Payne, D., Boyd, J.G., Puthucheary, Z.A., McNelly, A.S., Rawal, J., Connolly, B., McPhail, M.J., Sidhu, P., Rowlerson, A., Moxham, J., Harridge, S.D., Hart,

International Journal of Caring Sciences September-December 2018 Volume 11 | Issue 3| Page1938

www.internationaljournalofcaringsciences.org

N., Montgomery, H.E., Jovaisa, T., Thomas, B., Gupta, D., Wijayatilake, D.S., Shum, H.P., King, H.S., Chan, K.C., Tang, K.B., Yan, W.W., Arias, C.C., Latorre, J., De La Rica, A.S., Garrido, E.M., Feijoo, A.M., Gancedo, C.H., Tofiño, A.L., Rodríguez, F.G., Gemmell, L.K., Campbell, R., Doherty, P., MacKay, A., Singh, N., Vitaller, S., Nagib, H., Prieto, J., Del Arco, A., Zayas, B., Gomez, C., Tirumala, S., Pasha, S.A., Kumari, B.K., Martinez-Lopez, P., Puerto-Morlán, A., Nuevo- Ortega, P., Pujol, L.M., Dolset, R.A., González, B.S., Riera, S.Q., Álvarez, J.T., Quintana, S., Martínez, L., Algarte, R., Sánchez, B., Trenado, J., Tomas, E., Brock, N., Viegas, E., Filipe, E., Cottle, D., Traynor, T., Martínez, M.V.T., Márquez, M.P., Gómez, L.C., Martínez, N.A., Muñoz, J.M.M., Bellver, B.Q., Varea, M.M., Llorente, M.Á.A., Calvo, C.P., Hillier, S.D., Faulds, M.C., Hendra, H., Lawrence, N., Maekawa, K., Hayakawa, M., Ono, Y., Kodate, A., Sadamoto, Y., Tominaga, N., Mizugaki, A., Murakami, H., Yoshida, T., Katabami, K., Wada, T., Sawamura, A., Gando, S., Silva, S., Kerhuel, L., Malagurski, B., Citerio, G., Chabanne, R., Laureys, S., Puybasset, L., Nobile, L., Pognuz, E.R., Rossetti, A.O., Verginella, F., Gaspard, N., Creteur, J., Ben-Hamouda, N., Oddo, M., Taccone, F.S., Ono, Y., Hayakawa, M., Iijima, H., Maekawa, K., Kodate, A., Sadamoto, Y., Mizugaki, A., Murakami, H., Katabami, K., Wada, T., Sawamura, A., Gando, S., Kodate, A., Katabami, K., Wada, T., Ono, Y., Maekawa, K., Hayakawa, M., Sawamura, A., Gando, S., Andersen, L.W., Raymond, T., Berg, R., Nadkarni, V., Grossestreuer, A., Kurth, T., Donnino, M., Krüger, A., Ostadal, P., Janotka, M., Vondrakova, D., Kongpolprom, N., Cholkraisuwat, J., Pekkarinen, P.T., Ristagno, G., Masson, S., Latini, R., Bendel, S., Ala-Kokko, T., Varpula, T., Vaahersalo, J., Hoppu, S., Tiainen, M., Mion, M.M., Plebani, M., Pettilä, V., Skrifvars, M.B., Son, Y., Kim, K.S., Suh, G.J., Kwon, W.Y., Ko, J.I., Park, M.J., Cavicchi, F.Z., Iesu, E., Nobile, L., Vincent, J.L., Creteur, J., Taccone, F.S., Tanaka, H., Otani, N., Ode, S., Ishimatsu, S., Martínez, L., Algarte, R., Sánchez, B., Romero, I., Martínez, F., Quintana, S., Trenado, J., Vondrakova, D., Ostadal, P., Kruger, A., Janotka, M., Malek, F., Neuzil, P., Yeh, Y.C., Chen, Y.S., Wang, C.H., Huang, C.H., Chao, A., Lee, C.T., Lai, C.H., Chan, W.S., Cheng, Y.J., Sun, W.Z., Kaese, S., Horstmann, C., Lebiedz, P., Mourad, M., Gaudard, P., Eliet, J., Zeroual, N., Colson, P., Ostadal, P., Mlcek, M., Hrachovina, M., Kruger, A., Vondrakova, D., Janotka, M., Mates, M., Hala, P., Kittnar, O., Neuzil, P., Jacky, A., Rudiger, A., Spahn, D.R., Bettex, D.A., Kara, A., Akin, S., Dos reis Miranda, D., Struijs, A., Caliskan, K., van Thiel, R.J., Dubois, E.A., de Wilde, W., Zijlstra, F.,

Gommers, D., Ince, C., Marca, L., Xini, A., Mongkolpun, W., Cordeiro, C.P.R., Leite, R.T., Lheureux, O., Bader, A., Rincon, L., Santacruz, C., Preiser, J.C., Chao, A., Chao, A.S., Chen, Y.S., Kim, W., Ahn, C., Cho, Y., Lim, T.H., Oh, J., Choi, K.S., Jang, B.H., Ha, J.K., Mecklenburg, A., Stamm, J., Soeffker, G., Kubik, M., Sydow, K., Reichenspurner, H., Kluge, S., Braune, S., Bergantino, B., Ruberto, F., Magnanimi, E., Privato, E., Zullino, V., Bruno, K., Pugliese, F., Sales, G., Girotto, V., Vittone, F., Brazzi, L., Fritz, C., Kimmoun, A., Vanhuyse, F., Trifan, B., Orlowski, S., Albuisson, E., Tran, N., Levy, B., Chhor, V., Joachim, J., Follin, A., Champigneulle, B., Chatelon, J., Fave, G., Mantz, J., Pirracchio, R., Diaz, D.D., Villanova, M., Aguirregabyria, M., Andrade, G., López, L., Palencia, E., John, G., Cowan, R., Hart, R., Lake, K., Litchfield, K., Song, J.W., Lee, Y.J., Cho, Y.J., Choi, S., Vermeir, P., Vandijck, D., Blot, S., Mariman, A., Verhaeghe, R., Deveugele, M., Vogelaers, D., Chok, L., Bachli, E.B., Bettex, D., Cottini, S.R., Keller, E., Maggiorini, M., Schuepbach, R., Fiks, T., Stiphout, C., Grevelink, M., Vaneker, I., Ruijter, A., Buise, M., Spronk, P.E., Tena, S.A., Barrachina, L.G., Portillo, J.H.R., Aznar, G.P., Campos, L.M., Sellés, M.D.F., Tomás, M.A., Muncharaz, A.B., Skinner, L., Monsalvo, S., Olavarria, E., Stümpfle, R., Na, S.J., Park, J., Chung, C.R., Park, C.M., Suh, G.Y., Yang, J.H., Witter, T., Brousseau, C., Butler, M.B., Erdogan, M., Dougall, P.C. Mac, Green, R.S., Abbott, T.E.F., Torrance, H.D.T., Cron, N., Vaid, N., Emmanuel, J., Siddiqui, S.S., Prabu, N., Chaudhari, H.K., Patil, V.P., Divatia, J. V., Solanki, S., Kulkarni, A.P., Gutierrez, L.A.R., Bader, A., Brasseur, A., Lheureux, O., Vincent, J.L., Creteur, J., Taccone, F.S., Hempel, D., Stauffert, N., Recker, F., Schröder, T., Reusch, S., Schleifer, J., Breitkreutz, R., Sjövall, F., Perner, A., Møller, M.H., Moraes, R.B., Borges, F.K., Guillen, J.A. V., Zabaletta, W.J.C., Ruiz-Ramos, J., Ramirez, P., Marqués-Miñana, M.R., Villarreal, E., Gordon, M., Sosa, M., Concha, P., Castellanos, A., Menendez, R., Ramírez, C.S., Santana, M.C., Balcázar, L.C., Escalada, S.H., Viera, M.A.H., Vázquez, C.F.L., Díaz, J.J.D., Campelo, F.A., Monroy, N.S., Santana, P.S., Santana, S.R., Gutiérrez-Pizarraya, A., Garnacho-Montero, J., Martin, C., Baumstarck, K., Leone, M., Martín- Loeches, I., Pirracchio, R., Legrand, M., Mainardi, J.L., Mantz, J., Cholley, B., Hubbard, A., Frontera, P.R., Vega, L.M.C., Miguelena, P.R. de G., Usón, M.C.V., López, A.R., Clemente, E.A., Ibañes, P.G., Aguilar, A.L.R., Palomar, M., Olaechea, P., Uriona, S., Vallverdu, M., Catalan, M., Nuvials, X., Aragon, C., Lerma, F.A., Jeon, Y.D., Jeong, W.Y., Kim, M.H., Jeong, I.Y., Ahn, M.Y., Ahn, J.Y., Han, S.H.,

International Journal of Caring Sciences September-December 2018 Volume 11 | Issue 3| Page1939

www.internationaljournalofcaringsciences.org

Choi, J.Y., Song, Y.G., Kim, J.M., Ku, N.S., Bassi, G.L., Xiol, E.A., Senussi, T., Idone, F.A., Motos, A., Chiurazzi, C., Travierso, C., Fernández-Barat, L., Amaro, R., Hua, Y., Ranzani, O.T., Bobi, Q., Rigol, M., Torres, A., Fernández, I.F., Soler, E.A., de Vera, A.P.R., Pastor, E.E., Hernandis, V., Ros Martínez, J., Rubio, R.J., Torner, M.M., Brugger, S.C., Eroles, A.A., Moles, S.I., Cabello, J.T., Schoenenberger, J.A., Casals, X.N., Vidal, M.V., Garrido, B.B., Martinez, M.P., Mirabella, L., Cotoia, A., Tullo, L., Stella, A., Di Bello, F., Di Gregorio, A., Dambrosio, M., Cinnella, G., Rosario, L.E. de la C., Lesmes, S.P.G., Romero, J.C.G., Herrera, A.N.G., Pertuz, E.D.D., Sánchez, M.J.G., Sanz, E.R., Hualde, J.B., Hernández, A.A., Ramirez, J.R., Takahashi, H., Kazutoshi, F., Okada, Y., Oobayashi, W., Naito, T., Baidya, D.K., Maitra, S., Anand, R.K., Ray, B.R., Arora, M.K., Ruffini, C., Rota, L., Corona, A., Sesana, G., Ravasi, S., Catena, E., Naumann, D.N., Mellis, C., Husheer, S.L., Bishop, J., Midwinter, M.J., Hutchings, S., Corradi, F., Brusasco, C., Manca, T., Ramelli, A., Lattuada, M., Nicolini, F., Gherli, T., Vezzani, A., Young, A., Carmona, A.F., Santiago, A.I., Guillamon, L.N., Delgado, M.J.G., Delgado-Amaya, M., Curiel-Balsera, E., Rivera- Romero, L., Castillo-Lorente, E., Carrero-Gómez, F., Aguayo-DeHoyos, E., Healey, A.J., Cameron, C., Jiao, L.R., Stümpfle, R., Pérez, A., Martin, S., del Moral, O.L., Toval, S., Rico, J., Aldecoa, C., Oguzhan, K., Demirkiran, O., Kirman, M., Bozbay, S., Kosuk, M.E., Asyralyyeva, G., Dilek, M., Duzgun, M., Telli, S., Aydin, M., Yilmazer, F., Hodgson, L.E., Dimitrov, B.D., Stubbs, C., Forni, L.G., Venn, R., Vedage, D., Shawaf, S., Naran, P., Sirisena, N., Kinnear, J., Dimitrov, B.D., Hodgson, L.E., Stubbs, C., Forni, L.G., Venn, R., Londoño, J.G., Cardenas, C.L., Ginés, A.S., Gubianas, C.M., Sánchez, E.C., Sirvent, J.M., Panafidina, V., Shlyk, I., Ilyina, V., Judickas, S., Kezyte, G., Urbanaviciute, I., Serpytis, M., Gaizauskas, E., Sipylaite, J., Sprung, C.L., Munteanu, G., Morales, R.C., Kasdan, H., Volker, T., Reiter, A., Cohen, Y., Himmel, Y., Meissonnier, J., Banderas-Bravo, M.E., Gómez-Jiménez, C., García-Martínez, M. V., Martínez-Carmona, J.F., Fernández-Ortega, J.F., O‘Dwyer, M.J., Starczewska, M., Wilks, M., Vincent, J.L., Torsvik, M., Gustad, L.T., Bangstad, I.L., Vinje, L.J., Damås, J.K., Solligård, E., Mehl, A., Tsunoda, M., Kang, M., Saito, M., Saito, N., Akizuki, N., Namiki, M., Takeda, M., Yuzawa, J., Yaguchi, A., Frantzeskaki, F., Tsirigotis, P., Chondropoulos, S., Paramythiotou, E., Theodorakopoulou, M., Stamouli, M., Gkirkas, K., Dimopoulou, I.K., Makiko, S., Tsunoda, M., Kang, M., Yuzawa, J., Akiduki, N., Namiki, M., Takeda, M., Yaguchi, A., Preau, S., Ambler, M., Sigurta, A.,

Saeed, S., Singer, M., Jochmans, S., Chelly, J., Vong, L.V.P., Sy, O., Serbource-Goguel, J., Rolin, N., Weyer, C.M., Abdallah, R.I., Adrie, C., Vinsonneau, C., Monchi, M., Mayr, U., Huber, W., Karsten, E., Lahmer, T., Thies, P., Henschel, B., Fischer, G., Schmid, R.M., Ediboglu, O., Ataman, S., Naz, I., Yaman, G., Kirakli, C., Su, P.L., Kou, P.S., Lin, W.C., Chen, C.W., Lozano, J.A.B., Sánchez, P.C., Francioni, J.E.B., Ferrón, F.R., Simón, J.M.S., Riad, Z., Mezidi, M., Aublanc, M., Perinel, S., Lissonde, F., Louf-Durier, A., Yonis, H., Tapponnier, R., Richard, J.C., Louis, B., Guérin, C., Mezidi, M., Yonis, H., Aublanc, M., Lissonde, F., Louf-Durier, A., Perinel, S., Tapponnier, R., Richard, J.C., Guérin, C., Marmanidou, K., Oikonomou, M., Nouris, C., Loizou, C., Soilemezi, E., Matamis, D., Somhorst, P., Gommers, D., Hayashi, K., Hirayama, T., Yumoto, T., Tsukahara, K., Iida, A., Nosaka, N., Sato, K., Ugawa, T., Nakao, A., Ujike, Y., Hirohata, S., Mojoli, F., Torriglia, F., Giannantonio, M., Orlando, A., Bianzina, S., Tavazzi, G., Mongodi, S., Pozzi, M., Iotti, G.A., Braschi, A., Jansen, D., Gadgil, S., Doorduin, J., Roesthuis, L., van der Hoeven, J.G., Heunks, L.M.A., Chen, G.Q., Sun, X.M., He, X., Yang, Y.L., Shi, Z.H., Xu, M., Zhou, J.X., Pereira, S.M., Tucci, M.R., Tonelotto, B.F.F., Simoes, C.M., Morais, C.C.A., Pompeo, M.S., Kay, F.U., Amato, M.B.P., Vieira, J.E., Suzuki, S., Mihara, Y., Hikasa, Y., Okahara, S., Morimatsu, H., Kwon, H.M., Moon, Y.J., Lee, S.H., Jung, K.W., Shin, W.J., Jun, I.G., Song, J.G., Hwang, G.S., Lee, S., Moon, Y.J., Kwon, H.M., Jung, K., Shin, W.J., Jun, I.G., Song, J.G., Hwang, G.S., Ramelli, A., Manca, T., Corradi, F., Brusasco, C., Nicolini, F., Gherli, T., Brianti, R., Fanzaghi, P., Vezzani, A., Tudor, B.A., Klaus, D.A., Lebherz-Eichinger, D., Lechner, C., Schwarz, C., Bodingbauer, M., Seemann, R., Kaczirek, K., Fleischmann, E., Roth, G.A., Krenn, C.G., Malyshev, A., Sergey, S., Yamaguchi, Y., Nomura, T., Yoshitake, E., Idei, M., Yoshida, T., Takaki, S., Yamaguchi, O., Kaneko, M., Goto, T., Tencé, N., Zaien, I., Wolf, M., Trouiller, P., Jacobs, F.M., Kelly, J.M., Veigas, P., Hollands, S., Min, A., Rizoli, S., Robles, C.M.C., de Oca Sandoval, M.A.M., Tarabrin, O., Gavrychenko, D., Mazurenko, G., Tarabrin, P., Garcia, I.P., Martin, A.D., Mendez, M.C., Orden, V.A., Noval, R.L., McCue, C., Gemmell, L., MacKay, A., Luján, J., Villa, P., Llorente, B., Molina, R., Alcázar, L., Juanas, C.A., Rogero, S., Pascual, T., Cambronero, J.A., Almudévar, P.M., Domínguez, J.P., Carmona, S.A., Castañeda, D.P., Abellán, A.N., Lucendo, A.P., Pérez, L.P., Rivas, R.F., Sanz, N.M., Ramos, J.V., Villamizar, P.R., Javadpour, S., Kalani, N., Amininejad, T., Jamali, S., Sobhanian, S., Laurent,

International Journal of Caring Sciences September-December 2018 Volume 11 | Issue 3| Page1940

www.internationaljournalofcaringsciences.org

A., Bonnet, M., Rigal, R., Aslanian, P., Hebert, P., Capellier, G., Contreras, M.R.D., Mejías, C.R., Ruiz, F.C.S., Lombardo, M.D., Perez, J.C., de Hoyos, E.A., Estella, A., Viciana, R., Fontaiña, L.P., Rico, T., Madueño, V.P., Recuerda, M., Fernández, L., Sandiumenge, A., Bonet, S., Mazo, C., Rubiera, M., Ruiz-Rodríguez, J.C., Gracia, R.M., Espinel, E., Pont, T., Kotsopoulos, A., Jansen, N., Abdo, W.F., Gopcevic, A., Gavranovic, Z., Vucic, M., Glogoski, M.Z., Penavic, L.V., Horvat, A., Martin-Villen, L., Egea-Guerero, J.J., Revuelto-Rey, J., Aldabo-Pallas, T., Correa-Chamorro, E., Gallego-Corpa, A.I., Granados, P.R. del P.-R., Faivre, V., Wildenberg, L., Huot, B., Lukaszewicz, A.C., Simsir, M., Mengelle, C., Payen, D., Sanz, N.M., Valbuena, B.L., de la Fuente, M.V., Almudena, P.M., Pérez, L.P., Carmona, S.A., Abellán, A.N., Simón, I.F., Muñoz, J.J.R., Ramos, J.V., Carmona, S.A., Almudevar, P.M., Abellan, A.N., Lucendo, M.A.P., Perez, L.P., Dominguez, J.P., Rivas, R.F., Villamizar, P.R., Wee, S., Ong, C., Lau, Y.H., Wong, Y., Banderas-Bravo, M.E., Olea-Jiménez, V., Mora-Ordóñez, J.M., Gómez-Jiménez, C., Muñoz-Muñoz, J.L., Vallejo- Báez, J., Daga-Ruiz, D., Lebrón-Gallardo, M., Rialp, G., Raurich, J.M., Morán, I., Martín, M.C., Heras, G., Mas, A., Vallverdú, I., Hraiech, S., Bourenne, J., Guervilly, C., Forel, J.M., Adda, M., Sylla, P., Mouaci, A., Gainnier, M., Papazian, L., Bauer, P.R., Kumbamu, A., Wilson, M.E., Pannu, J.K., Egginton, J.S., Kashyap, R., Gajic, O., Yoshihiro, S., Sakuraya, M., Hayakawa, M., Hirata, A., Kawamura, N., Tsutui, T., Yoshida, K., Hashimoto, Y., Chang, C.H., Hu, H.C., Chiu, L.C., Hung, C.Y., Li, S.H., Kao, K.C., Sibley, S., Drover, J., D’Arsigny, C., Parker, C., Howes, D., Moffatt, S., Erb, J., Ilan, R., Messenger, D., Ball, I., Boyd, J.G., Harrison, M., Ridi, S., Muscedere, J., Andrade, A.H., Costa, R.C., Souza, V.A., Gonzalez, V., Amorim, V., Rolla, F., Filho, C.A.C.A., Miranda, R., Atchasiri, S., Buranavanich, P., Wathanawatthu, T., Suwanpasu, S., Bureau, C., Rolland-Debord, C., Poitou, T., Clavel, M., Perbet, S., Terzi, N., Kouatchet, A., Similowski, T., Demoule, A., Diaz, P., Nunes, J., Escórcio, S., Silva, G., Chaves, S., Jardim, M., Câmara, M., Fernandes, N., Duarte, R., Jardim, J.J., Pereira, C.A., Nóbrega, J.J., Chen, C.M., Lai, C.C., Cheng, K.C., Chou, W., Lee, S.J., Cha, Y.S., Lee, W.Y., Onodera, M., Nakataki, E., Oto, J., Imanaka, H., Nishimura, M., Khadjibaev, A., Sabirov, D., Rosstalnaya, A., Akalaev, R., Parpibaev, F., Antonucci, E., Rossini, P., Gandolfi, S., Montini, E., Orlando, S., van Nes, M., Karachi, F., Hanekom, S., Andrade, A.H., Pereira, U. V., Filho, C.A.C.A., Costa, R.C., Parkin, M.S.W., Moore, M., Andrade, A.H., Costa, R.C., Carvalho, K.V.S., Filho, C.A.C.A., Min, H.J., Kim, H.J., Lee,

D.S., Choi, Y.Y., Lee, E.Y., Song, I., Kim, D.J., E, Y.Y., Kim, J.W., Park, J.S., Cho, Y.J., Lee, J.H., Suh, J.W., Jo, Y.H., Kim, K.S., Lee, Y.J., Ferrero- Calleja, J., Merino-Vega, D., González-Jiménez, A.I., Sigcha, M.S., Hernández-Tejedor, A., Martin- Vivas, A., Gabán-Díez, Á., Luna, R.R., De la Calle- Pedrosa, N., Temprano-Gómez, I., Afonso-Rivero, D., Pellin-Ariño, J.I., Algora-Weber, A., Fumis, R.R.L., Ferraz, A.B., Junior, J.M.V., Kirca, H., Cakin, O., Unal, M., Mutlu, H., Ramazanoglu, A., Cengiz, M., Nicolini, E.A., Pelisson, F.G.F., Nunes, R.S., da Silva, S.L., Carreira, M.M., Bellissimo- Rodrigues, F., Ferez, M.A., Basile-Filho, A., Chao, H.C., Chen, C.M., Chen, L., Hravnak, M., Clermont, G., Pinsky, M., Dubrawski, A., Varas, J.L., Montero, R.M., Sánchez-Elvira, L.A., Díaz, P.V., Delgado, C.P., Ruiz, B.L., Guerrero, A.P., Galache, J.A.C., Sherif, H., Hassanin, H., El Hossainy, R., Samy, W., Ly, H., David, H., Burtin, P., Charpentier, C., Barral, M., Courant, P., Fournel, E., Gaide-Chevronnay, L., Durand, M., Albaladejo, P., Payen, J.F., Chavanon, O., Ortiz, A.B., Pozzebon, S., Lheureux, O., Brasseur, A., Vincent, J.L., Creteur, J., Taccone, F.S., Fumagalli, F., Scala, S., Affatato, R., De Maglie, M., Zani, D., Novelli, D., Marra, C., Luciani, A., De Zani, D., Luini, M., Letizia, T., Pravettoni, D., Staszewsky, L., Masson, S., Belloli, A., Di Giancamillo, M., Scanziani, E., Latini, R., Ristagno, G., Kye, Y.C., Suh, G.J., Kwon, W.Y., Kim, K.S., Yu, K.M., Babini, G., Ristagno, G., Grassi, L., Fumagalli, F., Bendel, S., De Maglie, M., Affatato, R., Masson, S., Latini, R., Scanziani, E., Reinikainen, M., Skrifvars, M., Kappler, F., Blobner, M., Schaller, S.J., Roasio, A., Costanzo, E., Cardellino, S., Iesu, E., Cavicchi, F.Z., Fontana, V., Nobile, L., Santiago, A.I., Sáez, V.C., Ruiz-Ruano, R. de la C., González, A.S., Kunze-Szikszay, N., Wand, S., Klapsing, P., Wetz, A., Heyne, T., Schwerdtfeger, K., Troeltzsch, M., Bauer, M., Quintel, M., Moerer, O., Cook, D.J., Rutherford, W.B., Scales, D.C., Adhikari, N.K., Cuthbertson, B.H., Suzuki, T., Takei, T., Fushimi, K., Iwamoto, M., Nakagawa, S., Mendsaikhan, N., Begzjav, T., Lundeg, G., Dünser, M.W., Romero, D.G., Cabrera, J.L.S., Santana, J.D.M., Padilla, Y.S., Pérez, H.R., Torrent, R.L., Kleinpell, R., Chouris, I., Radu, V., Stougianni, M., Lavrentieva, A., Lagonidis, D., Price, R.D.T., Day, A., Arora, N., Henderson, M.A., Hickey, S., Costa, M.I.A., Carvalho, J.P., Gomes, A.A., Mergulhão, P.J., Chan, K.K.C., Shum, H.P., Yan, W.W., Maghsoudi, B., Tabei, S.H., Masjedi, M., Sabetian, G., Tabatabaei, H.R., Akbarzadeh, A., Saigal, S., Pakhare, A., Joshi, R., Pattnaik, S.K., Ray, B., Rousseau, A.F., Michel, L., Bawin, M., Cavalier, E., Reginster, J.Y., Damas, P., Bruyere, O., Zhou, J.C., Cauwenberghs, H., De Backer, A.,

International Journal of Caring Sciences September-December 2018 Volume 11 | Issue 3| Page1941

www.internationaljournalofcaringsciences.org

Neels, H., Deblier, I., Berghmans, J., Himpe, D., Barea-Mendoza, J.A., Portillo, I.P., Fernández, M.V., Gigorro, R.G., Vela, J.L.P., Mateos, H.M., Alves, S.C., Varas, G.M., Rodriguez-Biendicho, A., Carreño, E.R., González, J.C.M., Yang, J.S., Chiang, C.H., Hung, W.T., Huang, W.C., Cheng, C.C., Lin, K.C., Lin, S.C., Chiou, K.R., Wann, S.R., Lin, K.L., Kang, P.L., Mar, G.Y., Liu, C.P., Zhou, J.C., Choi, Y.J., Yoon, S.Z., Gordillo-Brenes, A., Fernandez- Zamora, M.D., Perez-Borrero, L., Arias-Verdu, M.D., Aguilar-Alonso, E., Herruzo-Aviles, A., Garcia-Delgado, M., Hinojosa-Perez, R., Curiel- Balsera, E., Rivera-Fernandez, R., Lesmes, S.P.G., Rosario, L.E.D. la C., Hernández, A.A., Herrera, A.N.G., Sanz, E.R., Sánchez, M.J.G., Hualde, J.B., Pascual, O.A., León, J.P.T., Irazabal, J.M.G., Pérez, A.G., Fernández, P.A., Amor, L.L., Albaiceta, G.M., Lesmes, S.P.G., Rosario, L.E.D. la C., Hernández, A.A., Sanz, E.R., Sánchez, M.J.G., Calvo, S.A., Herrera, A.N.G., Hualde, J.B., Pascual, O.A., León, J.P.T., Corona, A., Ruffini, C., Spazzadeschi, A., Marrazzo, F., Gandola, A., Sciurti, R., Savi, C., Catena, E., Ke, M.W., Cheng, C.C., Huang, W.C., Chiang, C.H., Hung, W.T., Lin, K.C., Lin, S.C., Wann, S.R., Chiou, K.R., Tseng, C.J., Kang, P.L., Mar, G.Y., Liu, C.P., Bertini, P., De Sanctis, F., Guarracino, F., Bertini, P., Baldassarri, R., Guarracino, F., Buitinck, S.H., van der Voort, P.H.J., Oto, J., Garcia, M., Castellana, D., Lopez, R., Barcenilla, F., Kaminsky, G.E., Carreño, R., Escribá, A., Fuentes, M., Gálvez, V., Del Olmo, R., Nieto, B., Vaquerizo, C., Alvarez, J., De la Torre, M.A., Torres, E., Bogossian, E., Nouer, S.A., Salgado, D.R., Brugger, S.C., Jiménez, G.J., Torner, M.M., Vidal, M.V., Garrido, B.B., Casals, X.N., Gaite, F.B., Cabello, J.T., Martínez, M.P., Doganci, M., Izdes, S., Besevli, S.G., Alkan, A., Kayaaslan, B., Ramírez, C.S., Balcázar, L.C., Santana, M.C., Viera, M.A.H., Escalada, S.H., Vázquez, C.F.L., Penichet, S.M.M., Campelo, F.A., López, M.A.D.L.C., Santana, P.S., Santana, S.R., Repessé, X., Artiguenave, M., Paktoris-Papine, S., Espinasse, F., Dinh, A., El Sayed, F., Charron, C., Géri, G., Vieillard-Baron, A., Marmanidou, K., Oikonomou, M., Nouris, C., Dimitroulakis, K., Soilemezi, E., Matamis, D., Ferré, A., Guillot, M., Teboul, J.L., Lichtenstein, D., Mézière, G., Richard, C., Monnet, X., Pham, T., Beduneau, G., Schortgen, F., Piquilloud, L., Zogheib, E., Jonas, M., Grelon, F., Runge, I., Terzi, N., Grangé, S., Barberet, G., Guitard, P.G., Frat, J.P., Constan, A., Chrétien, J.M., Mancebo, J., Mercat, A., Richard, J.C.M., Brochard,

L., Prīdāne, S., Sabeļņikovs, O., Mojoli, F., Orlando, A., Bianchi, I., Torriglia, F., Bianzina, S., Pozzi, M., Iotti, G.A., Braschi, A., Beduneau, G., Pham, T., Schortgen, F., Piquilloud, L., Zogheib, E., Jonas, M., Grelon, F., Runge, I., Terzi, N., Grangé, S., Barberet, G., Guitard, P.G., Frat, J.P., Constan, A., Chrétien, J.M., Mancebo, J., Mercat, A., Richard, J.C.M., Brochard, L., Kondili, E., Psarologakis, C., Kokkini, S., Amargianitakis, V., Babalis, D., Chytas, A., Chouvarda, I., Vaporidi, K., Georgopoulos, D., Trapp, O., Kalenka, A., Mojoli, F., Orlando, A., Bianchi, I., Torriglia, F., Bianzina, S., Pozzi, M., Iotti, G.A., Braschi, A., Lozano, J.A.B., Sánchez, P.C., Francioni, J.E.B., Ferrón, F.R., Simón, J.M.S., Spadaro, S., Karbing, D.S., Gioia, A., Moro, F., Corte, F.D., Mauri, T., Volta, C.A., Rees, S.E., Petrova, M. V., Mohan, R., Butrov, A. V., Beeharry, S.D., Vatsik, M. V., Sakieva, F.I., Gobert, F., Yonis, H., Tapponnier, R., Fernandez, R., Labaune, M.A., Burle, J.F., Barbier, J., Vincent, B., Cleyet, M., Richard, J.C., Guérin, C., Shinotsuka, C.R., Creteur, J., Taccone, F.S., Törnblom, S., Nisula, S., Vaara, S., Poukkanen, M., Andersson, S., Pettilä, V., Pesonen, E., Xie, Z., Liao, X., Kang, Y., Zhang, J., Kubota, K., Egi, M., Mizobuchi, S., Hegazy, S., Travieso, P.M., Bandert, A., Frithiof, R., Lipcsey, M., Smekal, D., Schlaepfer, P., Durovray, J.D., Plouhinec, V., Chiappa, C., Bellomo, R., Schneider, A.G., Mitchell, S., Durrant, J., Street, H., Dunthorne, E., Shears, J., Caballero, C.H., Hutchison, R., Schwarze, S., Ghabina, S., Thompson, E., Prowle, J.R., Kirwan, C.J., Gonzalez, C.A., Pinto, J.L., Orozco, V., Patiño, J.A., Garcia, P.K., Contreras, K.M., Rodriguez, P., Echeverri, J.E., (2016). ESICM LIVES 2016: part three. Intensive Care Med. Exp. 4, 28.

Watanabe, T., Takakura, S., Tanabe, Y., Yoshio, K., Arakawa, S., Ichiyama, S., (2011). Japan National University Hospitals Infection Control Conference (JNUHICC) report: data summary of device- associated infections. BMC Proc. 5, P213. https://doi.org/10.1186/1753-6561-5-S6-P213

World health Organization, (2015). Health care- associated infections FACT SHEET. World Heal. Organ. 4.

Worth, L.J., Spelman, T., Bull, A.L., Brett, J.A., Richards, M.J., 2015. Central line-associated bloodstream infections in Australian intensive care units: Time-trends in infection rates, etiology, and antimicrobial resistance using a comprehensive Victorian surveillance program, 2009-2013. Am. J. Infect. Control 43, 848–852.

Copyright of International Journal of Caring Sciences is the property of International Journal of Caring Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.