Infection

, Volume 40, Issue 5, pp 517–526 | Cite as

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)

  • V. D. Rosenthal
  • S. K. Todi
  • C. Álvarez-Moreno
  • M. Pawar
  • A. Karlekar
  • A. A. Zeggwagh
  • Z. Mitrev
  • F. E. Udwadia
  • J. A. Navoa-Ng
  • M. Chakravarthy
  • R. Salomao
  • S. Sahu
  • A. Dilek
  • S. S. Kanj
  • H. Guanche-Garcell
  • L. E. Cuéllar
  • G. Ersoz
  • A. Nevzat-Yalcin
  • N. Jaggi
  • E. A. Medeiros
  • G. Ye
  • Ö. A. Akan
  • T. Mapp
  • A. Castañeda-Sabogal
  • L. Matta-Cortés
  • F. Sirmatel
  • N. Olarte
  • H. Torres-Hernández
  • N. Barahona-Guzmán
  • R. Fernández-Hidalgo
  • W. Villamil-Gómez
  • D. Sztokhamer
  • S. Forciniti
  • R. Berba
  • H. Turgut
  • C. Bin
  • Y. Yang
  • I. Pérez-Serrato
  • C. E. Lastra
  • S. Singh
  • D. Ozdemir
  • S. Ulusoy
  • INICC Members
Clinical and Epidemiological Study

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.

Keywords

Health care-acquired infection Device-associated infection Catheter-associated urinary tract infection Developing countries Intensive care unit Hand hygiene 

References

  1. 1.
    Tambyah PA, Knasinski V, Maki DG. The direct costs of nosocomial catheter-associated urinary tract infection in the era of managed care. Infect Control Hosp Epidemiol. 2002;23:27–31.PubMedCrossRefGoogle Scholar
  2. 2.
    Rosenthal VD, Dwivedy A, Calderón ME, et al. Time-dependent analysis of length of stay and mortality due to urinary tract infections in ten developing countries: INICC findings. J Infect. 2011;62:136–41.PubMedCrossRefGoogle Scholar
  3. 3.
    Marra AR, Sampaio Camargo TZ, Gonçalves P, et al. Preventing catheter-associated urinary tract infection in the zero-tolerance era. Am J Infect Control. 2011;39:817–22.PubMedCrossRefGoogle Scholar
  4. 4.
    Lynch P, Rosenthal VD, Borg MA, Eremin SR. Infection control in developing countries. In: Jarvis WR, editor. Bennett and Brachman’s hospital infections. Philadelphia: Lipppincott Williams & Wilkins; 2007. p. 255.Google Scholar
  5. 5.
    Rosenthal VD, Maki DG, Graves N. The International Nosocomial Infection Control Consortium (INICC): goals and objectives, description of surveillance methods, and operational activities. Am J Infect Control. 2008;36:e1–12.PubMedCrossRefGoogle Scholar
  6. 6.
    Lo E, Nicolle L, Classen D, et al. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29:S41–50.PubMedCrossRefGoogle Scholar
  7. 7.
    Rosenthal VD, Bijie H, Maki DG, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary of 36 countries, for 2004–2009. Am J Infect Control. 2012;40:396–407.PubMedCrossRefGoogle Scholar
  8. 8.
    Edwards JR, Peterson KD, Mu Y, et al. National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control. 2009;37:783–805.PubMedCrossRefGoogle Scholar
  9. 9.
    Rosenthal VD, Maki DG, Salomao R, et al. Device-associated nosocomial infections in 55 intensive care units of 8 developing countries. Ann Intern Med. 2006;145:582–91.PubMedGoogle Scholar
  10. 10.
    Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36:309–32.PubMedCrossRefGoogle Scholar
  11. 11.
    Sax H, Allegranzi B, Chraïti MN, Boyce J, Larson E, Pittet D. The World Health Organization hand hygiene observation method. Am J Infect Control. 2009;37:827–34.PubMedCrossRefGoogle Scholar
  12. 12.
    Rosenthal VD, Lynch P, Jarvis WR, et al. Socioeconomic impact on device-associated infections in limited-resource neonatal intensive care units: findings of the INICC. Infection. 2011;39:439–50.PubMedCrossRefGoogle Scholar
  13. 13.
    Talaat M, Hafez S, Saied T, Elfeky R, El-Shoubary W, Pimentel G. Surveillance of catheter-associated urinary tract infection in 4 intensive care units at Alexandria university hospitals in Egypt. Am J Infect Control. 2010;38:222–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Salgado CD, Karchmer TB, Farr BM. Prevention of catheter-associated urinary tract infections. In: Wenzel RP, editor. Prevention and control of nosocomial infections. Baltimore: Lippincott Williams & Wilkins; 2003. p. 297–311.Google Scholar
  15. 15.
    Rosenthal VD, Guzman S, Safdar N. Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina. Am J Infect Control. 2005;33:392–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Leone M, Albanèse J, Garnier F, et al. Risk factors of nosocomial catheter-associated urinary tract infection in a polyvalent intensive care unit. Intensive Care Med. 2003;29:1077–80.PubMedCrossRefGoogle Scholar
  17. 17.
    Crouzet J, Bertrand X, Venier AG, Badoz M, Husson C, Talon D. Control of the duration of urinary catheterization: impact on catheter-associated urinary tract infection. J Hosp Infect. 2007;67:253–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Zacharias S, Dwarakanath S, Agarwal M, Sharma BS. A comparative study to assess the effect of amikacin sulfate bladder wash on catheter-associated urinary tract infection in neurosurgical patients. Indian J Crit Care Med. 2009;13:17–20.PubMedCrossRefGoogle Scholar
  19. 19.
    Yildirim M, Sahin I, Kucukbayrak A, et al. Hand carriage of Candida species and risk factors in hospital personnel. Mycoses. 2007;50:189–92.PubMedCrossRefGoogle Scholar
  20. 20.
    Suwitra K; Risnawan. Catheter associated fungal urinary tract infection. Acta Med Indones. 2004;36:97–9.PubMedGoogle Scholar
  21. 21.
    Rosenthal VD, Ramachandran B, Duenas L, et al. Findings of the International Nosocomial Infection Control Consortium (INICC), Part I: effectiveness of a multidimensional infection control approach on catheter-associated urinary tract infections rates in pediatric intensive care units of 6 developing countries. Infect Control Hosp Epidemiol. 2012;33:696–703.Google Scholar
  22. 22.
    Rosenthal VD, Guzman S, Safdar N. Effect of education and performance feedback on rates of catheter-associated urinary tract infection in intensive care units in Argentina. Infect Control Hosp Epidemiol. 2004;25:47–50.PubMedCrossRefGoogle Scholar
  23. 23.
    Rosenthal VD, Rodríguez-Calderón ME, Rodríguez-Ferrer M, et al. Findings of the International Nosocomial Infection Control Consortium (INICC), Part II: impact of a multidimensional strategy to reduce ventilator-associated pneumonia in neonatal intensive care units in 10 developing countries. Infect Control Hosp Epidemiol. 2012;33:704–10.Google Scholar
  24. 24.
    Rosenthal VD, Alvarez-Moreno C, Villamil-Gómez W, et al. Effectiveness of a multidimensional approach to reduce ventilator-associated pneumonia in pediatric intensive care units of 5 developing countries: International Nosocomial Infection Control Consortium findings. Am J Infect Control. 2011; [Epub ahead of print].Google Scholar
  25. 25.
    Tao L, Hu B, Rosenthal VD, Zhang Y, Gao X, He L. Impact of a multidimensional approach on ventilator-associated pneumonia rates in a hospital of Shanghai: findings of the International Nosocomial Infection Control Consortium. J Crit Care. 2012; [Epub ahead of print].Google Scholar
  26. 26.
    Rosenthal VD, Guzman S, Crnich C. Impact of an infection control program on rates of ventilator-associated pneumonia in intensive care units in 2 Argentinean hospitals. Am J Infect Control. 2006;34:58–63.PubMedCrossRefGoogle Scholar
  27. 27.
    Rosenthal VD, Ramachandran B, Villamil-Gómez W, et al. Impact of a multidimensional infection control strategy on central line-associated bloodstream infection rates in pediatric intensive care units of five developing countries: findings of the International Nosocomial Infection Control Consortium (INICC). Infection. 2012; [Epub ahead of print].Google Scholar
  28. 28.
    Rosenthal VD, Maki DG, Rodrigues C, et al. Impact of International Nosocomial Infection Control Consortium (INICC) strategy on central line-associated bloodstream infection rates in the intensive care units of 15 developing countries. Infect Control Hosp Epidemiol. 2010;31:1264–72.PubMedCrossRefGoogle Scholar
  29. 29.
    Higuera F, Rosenthal VD, Duarte P, Ruiz J, Franco G, Safdar N. The effect of process control on the incidence of central venous catheter-associated bloodstream infections and mortality in intensive care units in Mexico. Crit Care Med. 2005;33:2022–7.PubMedCrossRefGoogle Scholar
  30. 30.
    Rosenthal VD, Guzman S, Pezzotto SM, Crnich CJ. Effect of an infection control program using education and performance feedback on rates of intravascular device-associated bloodstream infections in intensive care units in Argentina. Am J Infect Control. 2003;31:405–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • V. D. Rosenthal
    • 1
    • 43
  • S. K. Todi
    • 2
  • C. Álvarez-Moreno
    • 3
  • M. Pawar
    • 4
  • A. Karlekar
    • 5
  • A. A. Zeggwagh
    • 6
  • Z. Mitrev
    • 7
  • F. E. Udwadia
    • 8
  • J. A. Navoa-Ng
    • 9
  • M. Chakravarthy
    • 10
  • R. Salomao
    • 11
  • S. Sahu
    • 12
  • A. Dilek
    • 13
  • S. S. Kanj
    • 14
  • H. Guanche-Garcell
    • 15
  • L. E. Cuéllar
    • 16
  • G. Ersoz
    • 17
  • A. Nevzat-Yalcin
    • 18
  • N. Jaggi
    • 19
  • E. A. Medeiros
    • 20
  • G. Ye
    • 21
  • Ö. A. Akan
    • 22
  • T. Mapp
    • 23
  • A. Castañeda-Sabogal
    • 24
  • L. Matta-Cortés
    • 25
  • F. Sirmatel
    • 26
  • N. Olarte
    • 27
  • H. Torres-Hernández
    • 28
  • N. Barahona-Guzmán
    • 29
  • R. Fernández-Hidalgo
    • 30
  • W. Villamil-Gómez
    • 31
  • D. Sztokhamer
    • 32
  • S. Forciniti
    • 33
  • R. Berba
    • 34
  • H. Turgut
    • 35
  • C. Bin
    • 36
  • Y. Yang
    • 37
  • I. Pérez-Serrato
    • 38
  • C. E. Lastra
    • 39
  • S. Singh
    • 40
  • D. Ozdemir
    • 41
  • S. Ulusoy
    • 42
  • INICC Members
  1. 1.International Nosocomial Infection Control ConsortiumBuenos AiresArgentina
  2. 2.AMRI HospitalsKolkataIndia
  3. 3.Pontificia Universidad JaverianaHospital Universitario San IgnacioBogotaColombia
  4. 4.Pushpanjali Crosslay HospitalGhaziabadIndia
  5. 5.Escorts Heart Institute and Research CentreNew DelhiIndia
  6. 6.Ibn Sina, Medical ICURabatMorocco
  7. 7.Filip II Special Hospital for SurgerySkopjeMacedonia
  8. 8.Breach Candy Hospital TrustMumbaiIndia
  9. 9.St. Luke’s Medical CenterQuezon CityPhilippines
  10. 10.Wockhardt Hospitals—Fortis HospitalsBangaloreIndia
  11. 11.Hospital Santa MarcelinaSão PauloBrazil
  12. 12.Kalinga HospitalBhubaneswarIndia
  13. 13.Ondokuz Mayis University Medical SchoolSamsunTurkey
  14. 14.American University of Beirut Medical CenterBeirutLebanon
  15. 15.Hospital Docente Clínico Quirúrgico “Joaquín Albarrán Domínguez”HavanaCuba
  16. 16.Instituto Nacional de Enfermedades Neoplásicas (INEN)LimaPeru
  17. 17.Faculty of MedicineMersin UniversityMersinTurkey
  18. 18.Akdeniz UniversityAntalyaTurkey
  19. 19.Artemis Health InstituteNew DelhiIndia
  20. 20.Hospital São PauloSão PauloBrazil
  21. 21.Yangpu HospitalShanghaiChina
  22. 22.Ankara University School of Medicine Ibni-Sina HospitalAnkaraTurkey
  23. 23.Clínica Hospital San FernandoPanama CityPanama
  24. 24.Hospital Victor Lazarte EchegarayTrujilloPeru
  25. 25.Corporación Comfenalco Valle—Universidad LibreSantiago de CaliColombia
  26. 26.Faculty of MedicineHarran UniversitySanliurfaTurkey
  27. 27.Hospital El Tunal ESEBogotaColombia
  28. 28.Hospital General de IrapuatoIrapuatoPeru
  29. 29.Universidad Simón BolívarBarranquillaColombia
  30. 30.Hospital Clínica BíblicaSan JoseCosta Rica
  31. 31.Clínica Santa MaríaSucreColombia
  32. 32.Clínica EstradaBuenos AiresArgentina
  33. 33.Hospital Interzonal General de Agudos Pedro FioritoAvellanedaArgentina
  34. 34.Philippine General HospitalManilaPhilippines
  35. 35.Pamukkale UniversityDenizliTurkey
  36. 36.Chaoyang HospitalBeijingChina
  37. 37.The First Hospital Shanxi Medical UniversityTai YuanChina
  38. 38.Hospital General de la CelayaCelayaMexico
  39. 39.Hospital Narciso LópezLanúsArgentina
  40. 40.Amrita Institute of Medical Sciences & Research CenterKochiIndia
  41. 41. Department of Infectious Diseases and Clinical MicrobiologyDuzce University Medical SchoolDuzceTurkey
  42. 42.Ege University Medical FacultyIzmirTurkey
  43. 43.Buenos AiresArgentina

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