Assessment of a multi-modal intervention for the prevention of catheter-associated urinary tract infections

Vega, Hugo Guillermo Ternavasio-de la; Ventura, A. Barbosa; Castaño-Romero, F.; Sauchelli, F.D.; Acosta, Alejandro; Alcázar, F.J. Rodríguez; Sánchez, Alejandro; Antúnez, Emilia Ruiz; Marcos, Miguel; Laso, Jesús de la Torre

doi:10.1016/j.jhin.2016.07.011

Cited by 17 publications

(12 citation statements)

References 29 publications

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“…However, nurse/bed ratio was lower than that in some countries e.g. USA (35), (36) Germany 37, Turkey (26), Spain (38), Kuwait (39) and Saudi Arabia (40) where nurse/bed ratio was 1:1.…”

Section: Discussionmentioning

confidence: 77%

Effect of Infection Control Program on Catheter Associated Urinary Tract Infection in Intensive Care Units at Zagazig University Hospital

Selim¹,

El-Seoud²,

Mohamed³

et al. 2018

Zagazig University Medical Journal

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Background: Catheter-associated urinary tract infection produces substantial morbidity in hospitalized patients including discomfort, fever, malaise and unnecessary antibiotic use, which may become an important source of antibiotic resistant organisms. Further, the catheterized urinary tract acts as a reservoir for the dissemination of these drug resistant organisms to other patients. Aim of the study: was to improve the safety of intensive care unit (ICU) patients with urinary catheter via decreasing the incidence of catheter-associated urinary tract infection (CAUTI) at Zagazig University Hospital through assessment of knowledge and practice of ICU staff about catheter associated infection and assessment of the incidence of CAUTI among ICU patients in Zagazig University Hospital and implementation of Infection Control Program in the selected ICUs. Subjects and methods: An interventional study (one-group pre-test post-test design) was conducted during the period from 2016 to 2018 at Zagazig university Hospital in two ICUs; surgical and emergency intensive care units. The study was carried out through two phases; the first included the followings: active electronic surveillance for (CAUTI); assessment of health care providers' knowledge about CAUTI before and after intervention through constructed questionnaire and assessment of health care providers' practice before and after intervention by using performance observation checklist. The second phase, included implementation of infection control program based on the conceptual model of Comprehensive Unit-based Safety Program (CUSP). Results: There was a high statistical significant increase in knowledge of resident physicians and nurses about guidelines for prevention of catheter associated urinary tract infection in the studied intensive care units after intervention (P ˂0.01). There was high statistical significant improvement in urinary catheterization practice in the studied intensive care units after intervention (P ˂0.01). Regarding incidence of CAUTI, before intervention, CAUTI incidence was 10.6 per 1000 urinary catheter days. After intervention, CAUTI incidence significantly dropped to 5.4 per 1000 urinary catheter days. Risk of CAUTI before intervention was approximately twice that after intervention. The intervention reduced risk of CAUTI by 49.1%. Regarding isolated pathogens associated with reported CAUTI, the most frequent isolated pathogens were Klebsiella spp. (31.4%), followed by Candida albicans (21.4%), Pseudomonas spp. (14.3%) and E. coli (12.9%) Conclusion: At Zagazig university hospitals' ICUs, implementation of infection control program on CAUTI was noticed to be associated with improvement in healthcare providers' knowledge and practice and decrease in CAUTI incidence. Sustainability is required to maintain such improvement. So. It is recommended to keep continuous training of ICU staff and upgrade ICU protocols according to recent guidelines.

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“…However, nurse/bed ratio was lower than that in some countries e.g. USA (35), (36) Germany 37, Turkey (26), Spain (38), Kuwait (39) and Saudi Arabia (40) where nurse/bed ratio was 1:1.…”

Section: Discussionmentioning

confidence: 77%

Effect of Infection Control Program on Catheter Associated Urinary Tract Infection in Intensive Care Units at Zagazig University Hospital

Selim¹,

El-Seoud²,

Mohamed³

et al. 2018

Zagazig University Medical Journal

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“…50 Data from 18 before-and-after studies were available for meta-analysis. 20,26,32,46,52,58,61,71,78,79,83,102,116,129,135,137,142,149 Compared to standard of care, multifaceted interventions were associated with a pooled IRR of 0.543 (95% CI, 0.445-0.662), with overall heterogeneity of I 2 = 78.9%. Significant reductions in CAUTI incidence could be observed in all country economic income groups, although differences between subgroups could not be explored due to high heterogeneity (Fig.…”

Section: Study Selectionmentioning

confidence: 99%

The preventable proportion of healthcare-associated infections 2005–2016: Systematic review and meta-analysis

Schreiber

Sax

Wolfensberger

et al. 2018

Infect. Control Hosp. Epidemiol.

209

121

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ObjectiveThe preventable proportion of healthcare-associated infections (HAIs) may decrease over time as standards of care improve. We aimed to assess the proportion of HAIs prevented by multifaceted infection control interventions in different economic settings.MethodsIn this systematic review and meta-analysis, we searched OVID Medline, EMBASE, CINAHL, PubMed, and The Cochrane Library for studies published between 2005 and 2016 assessing multifaceted interventions to reduce catheter-associated urinary tract infections (CAUTIs), central-line–associated bloodstream infections (CLABSIs), surgical site infections (SSIs), ventilator-associated pneumonia (VAP), and hospital-acquired pneumonia not associated with mechanical ventilation (HAP) in acute-care or long-term care settings. For studies reporting raw rates, we extracted data and calculated the natural log of the risk ratio and variance to obtain pooled risk ratio estimates.ResultsOf the 5,226 articles identified by our search, 144 studies were included in the final analysis. Pooled incidence rate ratios associated with multifaceted interventions were 0.543 (95% confidence interval [CI], 0.445–0.662) for CAUTI, 0.459 (95% CI, 0.381–0.554) for CLABSI, and 0.553 (95% CI, 0.465–0.657) for VAP. The pooled rate ratio was 0.461 (95% CI, 0.389–0.546) for interventions aiming at SSI reduction, and for VAP reduction initiatives, the pooled rate ratios were 0.611 (95% CI, 0.414–0.900) for before-and-after studies and 0.509 (95% CI, 0.277–0.937) for randomized controlled trials. Reductions in infection rates were independent of the economic status of the study country. The risk of bias was high in 143 of 144 studies (99.3%).ConclusionsPublished evidence suggests a sustained potential for the significant reduction of HAI rates in the range of 35%–55% associated with multifaceted interventions irrespective of a country’s income level.

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“…After UC insertion, the bacteria that colonize the urethral meatus adhere to the internal and/or external surface of the catheter and can initiate biofilm formation, considered the most important factor for CAUTI. Thus, in addition to catheter removal, there is no evidence of effective methods for prevention or control of biofilm formation (17)(18)(19) .…”

Section: Discussionmentioning

confidence: 99%

“…Multiple-measure strategies have been pointed out as being possible to reduce the occurrence of CAUTIs when adopted simultaneously. However, their implementation requires changes which usually involve education, leadership commitment, and implementation of guidelines for indication and appropriate UC use (1,5,18,(20)(21) . Guaranteeing that all health care team members are aware that a patient has a UC is an important strategy for reducing CAUTI and ensuring quality in maintenance care and a daily assessment of their permanence (20)(21) .…”

Section: Discussionmentioning

confidence: 99%

Catheter-associated urinary tract infection: why do not we control this adverse event?

Mota

Oliveira

2019

Rev. esc. enferm. USP

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Objective: To identify factors related to the occurrence of urinary tract infection associated with urinary catheter use. Method: A longitudinal, retrospective cohort study carried out by analyzing the electronic medical records of patients admitted to an intensive care unit of a high-complexity hospital from July 2016 to June 2017. Demographic and clinical data were analyzed by descriptive and analytical analysis. Results: The incidence density of urinary tract infection related to urinary catheter use was 4.8 per 1000 catheters/day, the majority (80.6%) with no indication for catheter use, and there was no prescription for insertion and/or maintenance in 86.7%. The mean time between catheter insertion and infection diagnosis was 11.3 ± 6.3 days (6 to 28 days). Statistically significant factors (p < 0.001) related to urinary infection linked to catheter use were hospitalization time in the unit (16.7 ± 9 days), catheter permanence time (12.7 ± 6.9 days), and the use of antimicrobials in the intensive care unit (8.6 ± 6.3 days). Conclusion: The association of indication absence and the record of the need for maintenance possibly potentiated the occurrence of urinary tract infection associated to catheter use.

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Assessment of a multi-modal intervention for the prevention of catheter-associated urinary tract infections

Cited by 17 publications

References 29 publications

Effect of Infection Control Program on Catheter Associated Urinary Tract Infection in Intensive Care Units at Zagazig University Hospital

Effect of Infection Control Program on Catheter Associated Urinary Tract Infection in Intensive Care Units at Zagazig University Hospital

The preventable proportion of healthcare-associated infections 2005–2016: Systematic review and meta-analysis

Catheter-associated urinary tract infection: why do not we control this adverse event?

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