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