Infection Control Approach on Catheter-Associated UTI Rates
Infection Control Approach on Catheter-Associated UTI Rates
Design. A before-after prospective surveillance study to assess the impact of a multidimensional infection control approach for the reduction of catheter-associated urinary tract infection (CAUTI) rates.
Setting. Pediatric intensive care units (PICUs) of hospital members of the International Nosocomial Infection Control Consortium (INICC) from 10 cities of the following 6 developing countries: Colombia, El Salvador, India, Mexico, Philippines, and Turkey.
Patients. PICU inpatients.
Methods. We performed a prospective active surveillance to determine rates of CAUTI among 3,877 patients hospitalized in 10 PICUs for a total of 27,345 bed-days. The study was divided into a baseline period (phase 1) and an intervention period (phase 2). In phase 1, surveillance was performed without the implementation of the multidimensional approach. In phase 2, we implemented a multidimensional infection control approach that included outcome surveillance, process surveillance, feedback on CAUTI rates, feedback on performance, education, and a bundle of preventive measures. The rates of CAUTI obtained in phase 1 were compared with the rates obtained in phase 2, after interventions were implemented.
Results. During the study period, we recorded 8,513 urinary catheter (UC) days, including 1,513 UC-days in phase 1 and 7,000 UC-days in phase 2. In phase 1, the CAUTI rate was 5.9 cases per 1,000 UC-days, and in phase 2, after implementing the multidimensional infection control approach for CAUTI prevention, the rate of CAUTI decreased to 2.6 cases per 1,000 UC-days (relative risk, 0.43 [95% confidence interval, 0.21–1.0]), indicating a rate reduction of 57%.
Conclusions. Our findings demonstrated that implementing a multidimensional infection control approach is associated with a significant reduction in the CAUTI rate of PICUs in developing countries.
Over the last several decades, catheter-associated urinary tract infection (CAUTI) has been described in the scientific literature as one of the most common device-associated healthcare-associated infections (DA-HAIs) developed by patients hospitalized in the intensive care unit (ICU). The acquisition of CAUTI by critically ill patients has been associated with considerable morbidity, prolonged hospital length of stay, bacterial resistance, and greater healthcare expenditures and costs. Recently published studies show divergence in terms of its association with excess mortality, which was found to result from confounding by unmeasured variables. Most studies reporting on the effectiveness of evidence-based prevention programs in pediatric ICUs (PICUs) are from high-income countries, and there is a pressing need for implementation of prevention strategies and programs in the developing world.
The International Nosocomial Infection Control Consortium (INICC) has performed outcome and process surveillance as part of an integral program specifically designed for ICUs in developing countries since 2002. The implementation of the INICC multidimensional program for CAUTI prevention is based on the guidelines published by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA) in 2008. These guidelines describe different recommendations for CAUTI prevention in the ICU that are classified into categories based on the existing scientific evidence, the applicability of the intervention, and the prospective economic effects.
The results reported from INICC hospitals revealed that DA-HAI rates in the ICUs of countries with limited resources are 3–5 times higher than rates in the ICUs of high-income countries.
As a countervailing strategy to reduce the high rates of CAUTI in our PICUs, we implemented a multidimensional infection control model in developing countries from June 2003 through December 2010. Our approach included a specific bundle of interventions for CAUTI prevention, education, outcome surveillance, process surveillance, feedback on CAUTI rates, and performance feedback on infection control practices. This study is, to our knowledge, the first to analyze the effect of this preventive multidimensional strategy on CAUTI rates in the PICU of resource-limited countries.
Abstract and Introduction
Abstract
Design. A before-after prospective surveillance study to assess the impact of a multidimensional infection control approach for the reduction of catheter-associated urinary tract infection (CAUTI) rates.
Setting. Pediatric intensive care units (PICUs) of hospital members of the International Nosocomial Infection Control Consortium (INICC) from 10 cities of the following 6 developing countries: Colombia, El Salvador, India, Mexico, Philippines, and Turkey.
Patients. PICU inpatients.
Methods. We performed a prospective active surveillance to determine rates of CAUTI among 3,877 patients hospitalized in 10 PICUs for a total of 27,345 bed-days. The study was divided into a baseline period (phase 1) and an intervention period (phase 2). In phase 1, surveillance was performed without the implementation of the multidimensional approach. In phase 2, we implemented a multidimensional infection control approach that included outcome surveillance, process surveillance, feedback on CAUTI rates, feedback on performance, education, and a bundle of preventive measures. The rates of CAUTI obtained in phase 1 were compared with the rates obtained in phase 2, after interventions were implemented.
Results. During the study period, we recorded 8,513 urinary catheter (UC) days, including 1,513 UC-days in phase 1 and 7,000 UC-days in phase 2. In phase 1, the CAUTI rate was 5.9 cases per 1,000 UC-days, and in phase 2, after implementing the multidimensional infection control approach for CAUTI prevention, the rate of CAUTI decreased to 2.6 cases per 1,000 UC-days (relative risk, 0.43 [95% confidence interval, 0.21–1.0]), indicating a rate reduction of 57%.
Conclusions. Our findings demonstrated that implementing a multidimensional infection control approach is associated with a significant reduction in the CAUTI rate of PICUs in developing countries.
Introduction
Over the last several decades, catheter-associated urinary tract infection (CAUTI) has been described in the scientific literature as one of the most common device-associated healthcare-associated infections (DA-HAIs) developed by patients hospitalized in the intensive care unit (ICU). The acquisition of CAUTI by critically ill patients has been associated with considerable morbidity, prolonged hospital length of stay, bacterial resistance, and greater healthcare expenditures and costs. Recently published studies show divergence in terms of its association with excess mortality, which was found to result from confounding by unmeasured variables. Most studies reporting on the effectiveness of evidence-based prevention programs in pediatric ICUs (PICUs) are from high-income countries, and there is a pressing need for implementation of prevention strategies and programs in the developing world.
The International Nosocomial Infection Control Consortium (INICC) has performed outcome and process surveillance as part of an integral program specifically designed for ICUs in developing countries since 2002. The implementation of the INICC multidimensional program for CAUTI prevention is based on the guidelines published by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA) in 2008. These guidelines describe different recommendations for CAUTI prevention in the ICU that are classified into categories based on the existing scientific evidence, the applicability of the intervention, and the prospective economic effects.
The results reported from INICC hospitals revealed that DA-HAI rates in the ICUs of countries with limited resources are 3–5 times higher than rates in the ICUs of high-income countries.
As a countervailing strategy to reduce the high rates of CAUTI in our PICUs, we implemented a multidimensional infection control model in developing countries from June 2003 through December 2010. Our approach included a specific bundle of interventions for CAUTI prevention, education, outcome surveillance, process surveillance, feedback on CAUTI rates, and performance feedback on infection control practices. This study is, to our knowledge, the first to analyze the effect of this preventive multidimensional strategy on CAUTI rates in the PICU of resource-limited countries.
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