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Impact of a multidimensional infection control strategy on catheter-associated urinary tract infection rates in the adult intensive care units of 15 developing countries: findings of the International Nosocomial Infection Control Consortium (INICC)

  • Clinical and Epidemiological Study
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Abstract

Purpose

We aimed to evaluate the impact of a multidimensional infection control strategy for the reduction of the incidence of catheter-associated urinary tract infection (CAUTI) in patients hospitalized in adult intensive care units (AICUs) of hospitals which are members of the International Nosocomial Infection Control Consortium (INICC), from 40 cities of 15 developing countries: Argentina, Brazil, China, Colombia, Costa Rica, Cuba, India, Lebanon, Macedonia, Mexico, Morocco, Panama, Peru, Philippines, and Turkey.

Methods

We conducted a prospective before–after surveillance study of CAUTI rates on 56,429 patients hospitalized in 57 AICUs, during 360,667 bed-days. The study was divided into the baseline period (Phase 1) and the intervention period (Phase 2). In Phase 1, active surveillance was performed. In Phase 2, we implemented a multidimensional infection control approach that included: (1) a bundle of preventive measures, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of CAUTI rates, and (6) feedback of performance. The rates of CAUTI obtained in Phase 1 were compared with the rates obtained in Phase 2, after interventions were implemented.

Results

We recorded 253,122 urinary catheter (UC)-days: 30,390 in Phase 1 and 222,732 in Phase 2. In Phase 1, before the intervention, the CAUTI rate was 7.86 per 1,000 UC-days, and in Phase 2, after intervention, the rate of CAUTI decreased to 4.95 per 1,000 UC-days [relative risk (RR) 0.63 (95 % confidence interval [CI] 0.55–0.72)], showing a 37 % rate reduction.

Conclusions

Our study showed that the implementation of a multidimensional infection control strategy is associated with a significant reduction in the CAUTI rate in AICUs from developing countries.

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Acknowledgments

The authors thank the many health care professionals at each member hospital who assisted with the conduct of the surveillance in their hospital, including the surveillance nurses, clinical microbiology laboratory personnel, and the physicians and nurses providing care for the patients during the study; without their cooperation and generous assistance, this INICC would not be possible; Mariano Vilar, Debora Lopez Burgardt, and Alejo Ponce de Leon, who work at the INICC headquarters in Buenos Aires, Argentina, for their hard work and commitment to achieve the INICC goals; the INICC country coordinators (Altaf Ahmed, Carlos A. Álvarez-Moreno, Apisarnthanarak Anucha, Luis E. Cuéllar, Bijie Hu, Hakan Leblebicioglu, Eduardo A. Medeiros, Yatin Mehta, Lul Raka, Toshihiro Mitsuda, and Virgilio Bonilla Sanchez); the INICC Advisory Board (Carla J. Alvarado, Nicholas Graves, William R. Jarvis, Patricia Lynch, Dennis Maki, Russell N. Olmsted, Didier Pittet, Wing Hong Seto, and William Rutala), who have so generously supported this unique international infection control network; and Patricia Lynch, who inspired and supported us to follow our dreams, despite obstacles.

Conflict of interest

The authors declare that they did not receive any personal funding, and the funding for the activities carried out at the INICC headquarters were provided by the corresponding author, Victor D. Rosenthal, and Foundation to Fight against Nosocomial Infections. The authors state that they do not have any conflicts of interest to declare. Every hospital’s Institutional Review Board agreed to the study protocol, and patient confidentiality was protected by codifying the recorded information, making it only identifiable to the infection control team (ICT).

Author information

Authors and Affiliations

  1. International Nosocomial Infection Control Consortium, Buenos Aires, Argentina

    V. D. Rosenthal

  2. AMRI Hospitals, Kolkata, India

    S. K. Todi

  3. Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogota, Colombia

    C. Álvarez-Moreno

  4. Pushpanjali Crosslay Hospital, Ghaziabad, India

    M. Pawar

  5. Escorts Heart Institute and Research Centre, New Delhi, India

    A. Karlekar

  6. Ibn Sina, Medical ICU, Rabat, Morocco

    A. A. Zeggwagh

  7. Filip II Special Hospital for Surgery, Skopje, Macedonia

    Z. Mitrev

  8. Breach Candy Hospital Trust, Mumbai, India

    F. E. Udwadia

  9. St. Luke’s Medical Center, Quezon City, Philippines

    J. A. Navoa-Ng

  10. Wockhardt Hospitals—Fortis Hospitals, Bangalore, India

    M. Chakravarthy

  11. Hospital Santa Marcelina, São Paulo, Brazil

    R. Salomao

  12. Kalinga Hospital, Bhubaneswar, India

    S. Sahu

  13. Ondokuz Mayis University Medical School, Samsun, Turkey

    A. Dilek

  14. American University of Beirut Medical Center, Beirut, Lebanon

    S. S. Kanj

  15. Hospital Docente Clínico Quirúrgico “Joaquín Albarrán Domínguez”, Havana, Cuba

    H. Guanche-Garcell

  16. Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru

    L. E. Cuéllar

  17. Faculty of Medicine, Mersin University, Mersin, Turkey

    G. Ersoz

  18. Akdeniz University, Antalya, Turkey

    A. Nevzat-Yalcin

  19. Artemis Health Institute, New Delhi, India

    N. Jaggi

  20. Hospital São Paulo, São Paulo, Brazil

    E. A. Medeiros

  21. Yangpu Hospital, Shanghai, China

    G. Ye

  22. Ankara University School of Medicine Ibni-Sina Hospital, Ankara, Turkey

    Ö. A. Akan

  23. Clínica Hospital San Fernando, Panama City, Panama

    T. Mapp

  24. Hospital Victor Lazarte Echegaray, Trujillo, Peru

    A. Castañeda-Sabogal

  25. Corporación Comfenalco Valle—Universidad Libre, Santiago de Cali, Colombia

    L. Matta-Cortés

  26. Faculty of Medicine, Harran University, Sanliurfa, Turkey

    F. Sirmatel

  27. Hospital El Tunal ESE, Bogota, Colombia

    N. Olarte

  28. Hospital General de Irapuato, Irapuato, Peru

    H. Torres-Hernández

  29. Universidad Simón Bolívar, Barranquilla, Colombia

    N. Barahona-Guzmán

  30. Hospital Clínica Bíblica, San Jose, Costa Rica

    R. Fernández-Hidalgo

  31. Clínica Santa María, Sucre, Colombia

    W. Villamil-Gómez

  32. Clínica Estrada, Buenos Aires, Argentina

    D. Sztokhamer

  33. Hospital Interzonal General de Agudos Pedro Fiorito, Avellaneda, Argentina

    S. Forciniti

  34. Philippine General Hospital, Manila, Philippines

    R. Berba

  35. Pamukkale University, Denizli, Turkey

    H. Turgut

  36. Chaoyang Hospital, Beijing, China

    C. Bin

  37. The First Hospital Shanxi Medical University, Tai Yuan, China

    Y. Yang

  38. Hospital General de la Celaya, Celaya, Mexico

    I. Pérez-Serrato

  39. Hospital Narciso López, Lanús, Argentina

    C. E. Lastra

  40. Amrita Institute of Medical Sciences & Research Center, Kochi, India

    S. Singh

  41. Department of Infectious Diseases and Clinical Microbiology, Duzce University Medical School, Duzce, Turkey

    D. Ozdemir

  42. Ege University Medical Faculty, Izmir, Turkey

    S. Ulusoy

  43. Corrientes Ave. #4580, Floor 12, Apt. D, Buenos Aires, 1195, Argentina

    V. D. Rosenthal

Authors
  1. V. D. Rosenthal
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  2. S. K. Todi
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  3. C. Álvarez-Moreno
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  4. M. Pawar
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  5. A. Karlekar
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  6. A. A. Zeggwagh
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  7. Z. Mitrev
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  8. F. E. Udwadia
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  9. J. A. Navoa-Ng
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  10. M. Chakravarthy
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  11. R. Salomao
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  12. S. Sahu
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  13. A. Dilek
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  14. S. S. Kanj
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  15. H. Guanche-Garcell
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  16. L. E. Cuéllar
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  17. G. Ersoz
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  18. A. Nevzat-Yalcin
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  19. N. Jaggi
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  20. E. A. Medeiros
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  21. G. Ye
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  24. A. Castañeda-Sabogal
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  25. L. Matta-Cortés
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  26. F. Sirmatel
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  27. N. Olarte
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  28. H. Torres-Hernández
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  29. N. Barahona-Guzmán
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  30. R. Fernández-Hidalgo
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  31. W. Villamil-Gómez
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  32. D. Sztokhamer
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  33. S. Forciniti
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  34. R. Berba
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  35. H. Turgut
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  36. C. Bin
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  37. Y. Yang
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  38. I. Pérez-Serrato
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  39. C. E. Lastra
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  40. S. Singh
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  41. D. Ozdemir
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  42. S. Ulusoy
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Consortia

INICC Members

Corresponding author

Correspondence to V. D. Rosenthal.

Additional information

Members of the INICC are given in the “Appendix”.

Appendix: remaining INICC members, co-authors of this study

Appendix: remaining INICC members, co-authors of this study

Argentina Sandra Guzman, Ariel Boglione, Oscar Migone (Centro Médico Bernal, Buenos Aires); Marta Blasco, Carmen B. Lezcano (Hospital Interzonal General de Agudos Pedro Fiorito, Avellaneda).

Brazil Maria Ângela Maretti da Silva, Clélia Heloísa de Jesus Silva, Margarete Vilins, Sergio Blecher (Hospital Santa Marcelina, São Paulo); Daniela Bicudo-Angelieri (Hospital São Paulo, São Paulo).

China Li Ruisheng (Chaoyang Hospital, Beijing); Su Danxia, Hao Chunxia, Pan Wei (The First Hospital Shanxi Medical University, Tai Yuan).

Colombia Claudia Linares (Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogota); Luis Fernando Rendon-Campo; Yamileth Astudillo (Corporación Comfenalco Valle-Universidad Libre, Santiago de Cali); Alberto Valderrama (Hospital El Tunal ESE, Bogota); Marena Rodríguez-Ferrer, Guillermo Sarmiento-Villa, Alfredo Lagares-Guzmán (Universidad Simón Bolívar, Barranquilla); Luis Dajud, Mariela Mendoza, Patrick Arrieta (Clínica de la Sabana, Sucre).

Costa Rica Juan Manuel Aragón-Calzada, Gabriel Muñoz, Adela Ruiz-Argüello (Hospital Clínica Bíblica, San Jose).

Cuba Clara Morales-Pérez (Hospital Docente Clínico Quirúrgico “Joaquín Albarrán Domínguez”, Havana).

India Arpita Bhakta, Mahuya Bhattacharjee, Subhradev Sen (AMRI Hospitals, Kolkata); Amit Gupta, Narinder Saini (Pushpanjali Crosslay Hospital, Ghaziabad); Reshma Ansari, Aruna Poojary, Geeta Koppikar, Lata Bhandarkar, Shital Jadhav, Neeraj Chavan (Breach Candy Hospital Trust, Mumbai); B.N. Gokul, R. Sukanya, Leema Pushparaj (Wockhardt Hospitals-Fortis Hospitals, Bangalore); Kavitha Radhakrishnan (Amrita Institute of Medical Sciences & Research Center, Kochi).

Lebanon Nada Zahreddine, Lamia Alamuddin, Zeina Kanafani, Bassel Molaeb (American University of Beirut Medical Center, Beirut).

Macedonia Tanja Anguseva, Vilma Ampova, Snezana Tufekcievska Guroska, Zaneta Bogoevska-Miteva (Filip II Special Hospital for Surgery, Skopje).

Mexico Martha Sánchez-López (Hospital General de la Celaya, Celaya).

Morocco Rédouane Abouqal, Naoufel Madani, Khalid Abidi, Tarek Dendane (Ibn Sina, Medical ICU, Rabat).

Panama Fernando G. Alfaro, Cecilia Alvarado, Luz Marina De-León, Rodolfo Navarro, José Luis Moreno, Rigoberto Cerrud (Clínica Hospital San Fernando, Panama City).

Peru Rosa Rosales, Luis Isidro Castillo-Bravo, María Linares-Cáceres (Instituto Nacional de Enfermedades Neoplásicas [INEN], Lima); Iliana Paredes-Goicochea, Abel Arroyo-Sánchez, Guillermo Ríos-Alva, Jorge García-Ventura, Miguel Ramírez-Aguilar, Niler Segura-Plasencia, Teófilo Rodríguez (Hospital Victor Lazarte Echegaray, Trujillo); Amalia Chávez-Gómez, Jaime Rivera-Morales, Julián Enrique Valero-Rodríguez (Hospital General de Irapuato, Irapuato).

Philippines Victoria D. Villanueva, María Corazon V. Tolentino (St. Luke’s Medical Center, Quezon City); Glenn Angelo S. Genuino, Rafael J. Consunji, Jacinto Blas V. Mantaring III (Philippine General Hospital, Manila).

Turkey Hakan Leblebicioglu, Saban Esen, Fatma Ulger, Hava Yilmaz (Ondokuz Mayis University Medical School, Samsun); Ali Kaya, Necdet Kuyucu (Mersin University, Faculty of Medicine, Mersin); Ozge Turhan, Nurgul Gunay, Eylul Gumus, Oguz Dursun (Akdeniz University, Antalya); Melek Tulunay, Mehmet Oral, Necmettin Ünal (Ankara University School of Medicine Ibni-Sina Hospital, Ankara); Mustafa Cengiz, Leyla Yilmaz (Harran University, Faculty of Medicine, Sanliurfa); Suzan Sacar, Hülya Sungurtekin, Doğaç Uğurcan (Pamukkale University, Denizli); Mehmet Faruk Geyik, Mustafa Yildirim, Selvi Erdogan (Duzce University Medical School Infectious Diseases and Clinical Microbiology, Duzce); Bilgin Arda, Feza Bacakoglu (Ege University Medical Faculty, Izmir).

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Rosenthal, V.D., Todi, S.K., Álvarez-Moreno, C. et al. Impact of a multidimensional infection control strategy on catheter-associated urinary tract infection rates in the adult intensive care units of 15 developing countries: findings of the International Nosocomial Infection Control Consortium (INICC). Infection 40, 517–526 (2012). https://doi.org/10.1007/s15010-012-0278-x

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