Major article
Impact of a multidimensional infection control approach on catheter-associated urinary tract infection rates in adult intensive care units in 10 cities of Turkey: International Nosocomial Infection Control Consortium findings (INICC)

https://doi.org/10.1016/j.ajic.2013.01.028Get rights and content

Background

We evaluate the effectiveness of a multidimensional infection control approach for the reduction of catheter-associated urinary tract infections (CAUTIs) in 13 intensive care units (ICUs) in 10 hospital members of the International Nosocomial Infection Control Consortium (INICC) from 10 cities of Turkey.

Methods

A before-after prospective active surveillance study was used to determine rates of CAUTI. The study was divided into baseline (phase 1) and intervention (phase 2). In phase 1, surveillance was performed applying the definitions of the Centers for Disease Control and Prevention/National Healthcare Safety Network. In phase 2, we implemented a multidimensional approach that included bundle of infection control interventions, education, surveillance and feedback on CAUTI rates, process surveillance, and performance feedback. We used random effects Poisson regression to account for clustering of CAUTI rates across time periods.

Results

The study included 4,231 patients, hospitalized in 13 ICUs, in 10 hospitals, in 10 cities, during 49,644 patient-days. We recorded a total of 41,871 urinary catheter (UC)-days: 5,080 in phase 1 and 36,791 in phase 2. During phase 1, the rate of CAUTI was 10.63 per 1,000 UC-days and was significantly decreased by 47% in phase 2 to 5.65 per 1,000 UC-days (relative risk, 0.53; 95% confidence interval: 0.4-0.7; P value = .0001).

Conclusion

Our multidimensional approach was associated with a significant reduction in the rates of CAUTI in Turkey.

Section snippets

Setting and study design

We implemented an active, prospective outcome and process surveillance before-after study in 13 adult ICUs in 10 hospitals members of the INICC in 10 cities of Turkey from September 2003 to June 2011. The participating ICUs have an infection control team (ICT) composed of infection control professionals (ICPs) and at least 1 medical doctor with formal education and background in internal medicine, critical care, infectious diseases, and/or hospital epidemiology. The INICC headquarters' team in

Results

During the whole study, a total of 4,231adult inpatients was hospitalized in 13 ICUs in 10 hospitals, in 10 cities, during 49,644 patient-days, amounting to 41,871 UC-days. Participating hospitals were classified according to type of hospital, type of ICU, number of ICUs, and number of patients in each ICU. The first ICUs to participate in the study were enrolled in September 2003, and the most updated data included our analysis date from June 2011. Twelve of the 13 participating hospitals were

Discussion

If compared with rates of developed countries, the baseline rate of CAUTI found in this study (10.63 per 1,000 UC-days) was 10-fold higher than the 1.5 CAUTI rate per 1,000 UC-days determined by the CDC/NSHN for ICUs in the United States22 and higher than the 2.5 CAUTI rate determined by KISS (Krankenhaus Infektions Surveillance System, by its name in German) in Europe.23 In comparison with pooled CAUTI rates from developing countries, our CAUTI baseline rate was similar to the international

Conclusion

This study is the first multicenter study to report a substantial reduction in CAUTI rates in the ICU setting of Turkey, proving this kind of infection control approach successful. Although some patients' intrinsic risks were higher during the intervention period, a multidimensional approach including improved compliance with CAUTI preventive measures resulted in significant reductions in the CAUTI incidence rate. These systematically collected data serve to guide ICPs in their strategies for

Acknowledgment

The authors thank the many health care professionals at each member hospital who assisted with the conduct of surveillance in their hospital, including the surveillance nurses, the 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, Débora López Burgardt, Santiago Suárez, Denise Brito, Julieta Sayar, Eugenia Manfredi, Luciana

References (27)

  • V.D. Rosenthal et al.

    Time-dependent analysis of length of stay and mortality due to urinary tract infections in ten developing countries: INICC findings

    J Infect

    (2010)
  • P.A. Tambyah et al.

    The direct costs of nosocomial catheter-associated urinary tract infection in the era of managed care

    Infect Control Hosp Epidemiol

    (2002)
  • C. Chant et al.

    Relationship of catheter-associated urinary tract infection to mortality and length of stay in critically ill patients: a systematic review and meta-analysis of observational studies

    Crit Care Med

    (2011)
  • Cited by (0)

    Funding for the activities carried out at INICC headquarters were provided by the corresponding author, Victor D. Rosenthal, and the Foundation to Fight against Nosocomial Infections.

    Author contributions: Idea, conception, and design: V.D. Rosenthal. Software development: V.D. Rosenthal. Assembly of data: V.D. Rosenthal. Analysis and interpretation of the data: V.D. Rosenthal. Epidemiological analysis: V.D. Rosenthal. Statistical analysis: V.D. Rosenthal. Administrative, technical, and logistic support: V.D. Rosenthal. Drafting of the article: V.D. Rosenthal. Critical revision of the article for important intellectual content: All authors. Final approval of the article: All authors. Provision of study patients: All authors. Collection of data: All authors. Funding: Victor D. Rosenthal and the Foundation to Fight against Nosocomial Infections funds all the activities at INICC head quarters (www.inicc.org).

    Conflicts of interest: None to report.

    View full text