2352. Analysis of National Infection Prevention and Control Programs on Sepsis Incidence: An Ecological Study
Authors: Hsueh Leon , Ikuta Kevin 
Published: December 2022

Abstract

Background
Annually, the World Health Organization (WHO), World Organization for Animal Health, and the Food and Agriculture Organization of the United Nations jointly administer the Tripartite Antimicrobial Resistance (AMR) country self-assessment survey (TrACSS), which asks participating countries to evaluate themselves on their progress in implementing policies to prevent and control AMR. Question 8.1 in the survey asks whether there is a functional national infection prevention and control (IPC) program or plan in human healthcare (question 8.1 in the survey). Our aim was to evaluate whether having an IPC plan correlates with a reduction in a country’s sepsis incidence.

Methods
We used 2017 estimates of total sepsis incidence per 100,000 people published previously by Rudd et al. We matched this data to a country’s respective response to question 8.1 of the 2016–2017 TrACSS. Table 1 lists the potential answers to question 8.1. Additional details about the survey methodology are available on the WHO TrACSS website. We compared the sepsis incidence in countries where IPC plans were implemented nationwide (answer D or E) to countries that did not implement a nationwide IPC plan (answer A, B, or C).

Results
154 countries were surveyed, 140 of which responded to question 8.1 and had available sepsis data. 47 countries (33.6%) had nationwide implementation of IPC plans and 93 (66.4%) did not. Globally, countries who implemented nationwide IPC plans had lower sepsis incidence with less inter-country variability (median: 201, interquartile range [IQR]: 165–272) compared to countries who did not implement an IPC plan (439, IQR: 290–682). (Figure 1). Similar trends were observed when broken down by each individual WHO region (Figure 2). Multivariate Poisson regression adjusting for region found that countries who implemented nationwide IPC plans had a 37.2% (95% CI 35.7–38.9%, p &lt; 0.001) lower incidence of sepsis.
The height of the box represents the interquartile range (IQR). The solid line within each box represents the median. The whiskers represent the minimum and maximum for each respective group, excluding outliers. Outliers are defined as any data point that is greater or less than 1.5 x IQR from the third or first quartile, respectively. Outliers are depicted as individual data points outside of each box and whiskers. The red box represents countries that answered either a, b, or c. The turquoise box includes countries that answered either d or e.
Box plot parameters are similar to that of figure 1. Each pair of red (countries answering a, b, or c) and turquoise boxes (countries answering d or e) represent a different WHO region, as listed on the x-axis. AFRO is the African Region. AMRO is the Region of the Americas. EMRO is the Eastern Mediterranean Region. EURO is the European Region. SEARO is the South-East Asian Region and WPRO is the Western Pacific Region.

Conclusion
This ecological study suggests that broad implementation of an IPC plan is associated with lower sepsis incidence. Additional time-series analysis and adjusting for gross domestic product would be important next steps to ascertain the true benefit of implementing a national IPC plan on rates of sepsis.

Disclosures
All Authors: No reported disclosures.