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Findings of the International Nosocomial Infection Control Consortium (INICC), Part I: Effectiveness of a Multidimensional Infection Control Approach on Catheter-Associated Urinary Tract Infection Rates in Pediatric Intensive Care Units of 6 Developing Countries

Published online by Cambridge University Press:  02 January 2015

Victor D. Rosenthal ,
Bala Ramachandran ,
Lourdes Dueñas ,
Carlos Álvarez-Moreno ,
J. A. Navoa-Ng ,
Alberto Armas-Ruiz ,
Gulden Ersoz ,
Lorena Matta-Cortés ,
Mandakini Pawar  and
Ata Nevzat-Yalcin
...Show all authors
Victor D. Rosenthal*
Affiliation:
International Nosocomial Infection Control Consortium, Buenos Aires, Argentina
Bala Ramachandran
Affiliation:
KK Childs Trust Hospital, Chennai, India
Lourdes Dueñas
Affiliation:
Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
Carlos Álvarez-Moreno
Affiliation:
Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogota, Colombia
J. A. Navoa-Ng
Affiliation:
St. Luke's Medical Center, Quezon City, Philippines
Alberto Armas-Ruiz
Affiliation:
Centro Médico La Raza IMSS, Mexico City, Mexico
Gulden Ersoz
Affiliation:
Mersin University, Faculty of Medicine, Mersin, Turkey
Lorena Matta-Cortés
Affiliation:
Corporación Comfenalco Valle- Universidad Libre, Santiago de Cali, Colombia
Mandakini Pawar
Affiliation:
Pushpanjali Crosslay Hospital, Ghaziabad, India
Ata Nevzat-Yalcin
Affiliation:
Akdeniz University, Antalya, Turkey
Marena Rodriguez-Ferrer
Affiliation:
Universidad Simón Bolivar, Barranquilla, Colombia
Ana Concepción Bran de Casares
Affiliation:
Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
Claudia Linares
Affiliation:
Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogota, Colombia
Victoria D. Villanueva
Affiliation:
St. Luke's Medical Center, Quezon City, Philippines
Roberto Campuzano
Affiliation:
Centro Médico La Raza IMSS, Mexico City, Mexico
Ali Kaya
Affiliation:
Mersin University, Faculty of Medicine, Mersin, Turkey
Luis Fernando Rendon-Campo
Affiliation:
Corporación Comfenalco Valle- Universidad Libre, Santiago de Cali, Colombia
Amit Gupta
Affiliation:
Pushpanjali Crosslay Hospital, Ghaziabad, India
Ozge Turhan
Affiliation:
Akdeniz University, Antalya, Turkey
Nayide Barahona-Guzmán
Affiliation:
Universidad Simón Bolivar, Barranquilla, Colombia
Lilian de Jesús-Machuca
Affiliation:
Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
María Corazon V. Tolentino
Affiliation:
St. Luke's Medical Center, Quezon City, Philippines
Jorge Mena-Brito
Affiliation:
Centro Médico La Raza IMSS, Mexico City, Mexico
Necdet Kuyucu
Affiliation:
Mersin University, Faculty of Medicine, Mersin, Turkey
Yamileth Astudillo
Affiliation:
Corporación Comfenalco Valle- Universidad Libre, Santiago de Cali, Colombia
Narinder Saini
Affiliation:
Pushpanjali Crosslay Hospital, Ghaziabad, India
Nurgul Gunay
Affiliation:
Akdeniz University, Antalya, Turkey
Guillermo Sarmiento-Villa
Affiliation:
Universidad Simón Bolivar, Barranquilla, Colombia
Eylul Gumus
Affiliation:
Akdeniz University, Antalya, Turkey
Alfredo Lagares-Guzmán
Affiliation:
Universidad Simón Bolivar, Barranquilla, Colombia
Oguz Dursun
Affiliation:
Akdeniz University, Antalya, Turkey
*
Avenue Corrientes 4580, Piso 12, “D”, Buenos Aires (C1195AAR), Argentina (victor_rosenthal@inicc.org)
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Abstract

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Design.

A before-after prospective surveillance study to assess the impact of a multidimensional infection control approach for the reduction of catheter-associated urinary tract infection (CAUTI) rates.

Setting.

Pediatric intensive care units (PICUs) of hospital members of the International Nosocomial Infection Control Consortium (INICC) from 10 cities of the following 6 developing countries: Colombia, El Salvador, India, Mexico, Philippines, and Turkey.

Patients.

PICU inpatients.

Methods.

We performed a prospective active surveillance to determine rates of CAUTI among 3,877 patients hospitalized in 10 PICUs for a total of 27,345 bed-days. The study was divided into a baseline period (phase 1) and an intervention period (phase 2). In phase 1, surveillance was performed without the implementation of the multidimensional approach. In phase 2, we implemented a multidimensional infection control approach that included outcome surveillance, process surveillance, feedback on CAUTI rates, feedback on performance, education, and a bundle of preventive measures. The rates of CAUTI obtained in phase 1 were compared with the rates obtained in phase 2, after interventions were implemented.

Results.

During the study period, we recorded 8,513 urinary catheter (UC) days, including 1,513 UC-days in phase 1 and 7,000 UC-days in phase 2. In phase 1, the CAUTI rate was 5.9 cases per 1,000 UC-days, and in phase 2, after implementing the multidimensional infection control approach for CAUTI prevention, the rate of CAUTI decreased to 2.6 cases per 1,000 UC-days (relative risk, 0.43 [95% confidence interval, 0.21–1.0]), indicating a rate reduction of 57%.

Conclusions.

Our findings demonstrated that implementing a multidimensional infection control approach is associated with a significant reduction in the CAUTI rate of PICUs in developing countries.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 7 , July 2012 , pp. 696 - 703
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

References

1. Xie, DS, Lai, RP, Nie, SR Surveys of catheter-associated urinary tract infection in a university hospital intensive care unit in China. Braz J Infect Dis 2011;15(3):296–297.Google Scholar
2. Hameed, A, Chinegwundoh, F, Thwaini, A. Prevention of catheter-related urinary tract infections. Br J Hosp Med (Lond) 2010; 71(3):148-150, 151–152.Google Scholar
3. Trautner, BW. Management of catheter-associated urinary tract infection. Curr Opin Infect Dis 2010;23(1):76–82.Google Scholar
4. Rosenthal, VD, Dwivedy, A, Calderon, 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 2010;62(2):136–141.Google Scholar
5. 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(1):27–31.CrossRefGoogle ScholarPubMed
6. Chant, C, Smith, OM, Marshall, JC, Friedrich, JO. 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; 39(5):1167–1173.Google Scholar
7. Clec'h, C, Schwebel, C, Francais, A, et al. Does catheter-associated urinary tract infection increase mortality in critically ill patients? Infect Control Hosp Epidemiol 2007;28(12):1367–1373.Google Scholar
8. Bagshaw, SM, Laupland, KB. Epidemiology of intensive care unit-acquired urinary tract infections. Curr Opin Infect Dis 2006; 19(1):67–71.Google Scholar
9. Gray, M. Reducing catheter-associated urinary tract infection in the critical care unit. AACN Adv Crit Care 2010;21(3):247–257.Google ScholarPubMed
10. Marra, AR, Sampaio Camargo, TZ, Goncalves, P, et al. Preventing catheter-associated urinary tract infection in the zero-tolerance era. Am J Infect Control 2011;39:817–822.CrossRefGoogle ScholarPubMed
11. Ciavarella, DJ, Ritter, J. Strategies to prevent catheter-associated urinary tract infection. Infect Control Hosp Epidemiol 2009;30(4): 404–405; author reply 405-406.CrossRefGoogle ScholarPubMed
12. Malt, G, Robertson-Malt, S. A rapid quality control initiative to reduce the incidence of urinary tract infection in the paediatric intensive care patient-part one. Int J Nurs Pract 2007;13(6): 348–353.Google Scholar
13. 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(9):e1–e12.Google Scholar
14. 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(suppl 1):S41–S50.CrossRefGoogle ScholarPubMed
15. 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 2011. Published September 10, 2011.Google Scholar
16. 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(10): 783–805.Google Scholar
17. 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(8):582–591.Google Scholar
18. 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(5):309–332.Google Scholar
19. Sax, H, Allegranzi, B, Chraiti, MN, Boyce, J, Larson, E, Pittet, D. The World Health Organization hand hygiene observation method. Am J Infect Control 2009;37(10):827–834.CrossRefGoogle ScholarPubMed
20. 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(12):1264–1272.Google Scholar
21. 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(7):392–397.Google Scholar
22. 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(9): 2022–2027.Google Scholar
23. 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(1):47–50.Google Scholar
24. Rosenthal, VD, McCormick, RD, Guzman, S, Villamayor, C, Ore-llano, PW. Effect of education and performance feedback on handwashing: the benefit of administrative support in Argentinean hospitals. Am J Infect Control 2003;31(2):85–92.Google Scholar
25. World Bank. World Bank classification of economies. 2007. http://web.worldbank.org/WBSITE/EXTERNAL/DATASTATISTICS/0„contentMDK:20421402pagePK:64133150piPK:64133175theSitePK:239419,00.html. Accessed October 5, 2008.Google Scholar
26. 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: 439–450.Google Scholar
27. Bi, XC, Zhang, B, Ye, YK, et al. Pathogen incidence and antibiotic resistance patterns of catheter-associated urinary tract infection in children. J Chemother 2009;21(6):661–665.Google Scholar
28. Yildirim, M, Sahin, I, Kucukbayrak, A, et al. Hand carriage of Candida species and risk factors in hospital personnel. Mycoses 2007;50(3): 189–192.CrossRefGoogle ScholarPubMed
29. Mahmood, Z, Zafar, SA. Review of paediatric patients with urolithiasis, in view of development of urinary tract infection. J Pak Med Assoc 2008;58(11):653–656.Google Scholar
30. Willson, M, Wilde, M, Webb, ML, et al. Nursing interventions to reduce the risk of catheter-associated urinary tract infection: part 2: staff education, monitoring, and care techniques. J Wound Ostomy Continence Nurs 2009;36(2):137–154.Google Scholar
31. Tsuchida, T, Makimoto, K, Ohsako, S, et al. Relationship between catheter care and catheter-associated urinary tract infection at Japanese general hospitals: a prospective observational study. Int J Nurs Stud 2008;45(3):352–361.Google Scholar
32. 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(3):253–257.CrossRefGoogle ScholarPubMed
33. 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(7):405–409.CrossRefGoogle ScholarPubMed