Catheter-Associated Urinary Tract Infections (CAUTIs) frequently occur in the ICU and are correlated with a significant burden.
We implemented a strategy involving a 9-element bundle, education, surveillance of CAUTI rates and clinical outcomes, monitoring compliance with bundle components, feedback of CAUTI rates and performance feedback. This was executed in 299 ICUs across 32 low- and middle-income countries (LMICs). The dependent variable was CAUTI per 1,000-UC-days, assessed at baseline and throughout the intervention, in the 2nd month, 3rd month, 4-15 months, 16-27 months, and 28-39 months. Comparisons were made using a two-sample t-test, and the exposure-outcome relationship was explored using a generalized linear mixed model with a Poisson distribution.
Over the course of 978,364 patient-days, 150,258 patients utilized 652,053 UC-days. The rates of CAUTI per 1,000 UC-days were measured. The rates decreased from 14.89 during the baseline period to 5.51 in the 2nd month (RR=0.37; 95% CI= 0.34-0.39; P<0.001), 3.79 in the 3rd month (RR=0.25; 95% CI= 0.23-0.28; P<0.001), 2.98 in the 4-15 months (RR=0.21; 95% CI=0.18-0.22; P<0.001), 1.86 in the 16-27 months (RR=0.12; 95% CI=0.11-0.14; P<0.001), and 1.71 in the 28-39 months (RR=0.11; 95% CI=0.09-0.13; P<0.001).
Our intervention, without substantial costs or additional staffing, achieved an 89% reduction in CAUTI incidence in ICUs across 32 countries, demonstrating feasibility in ICUs of LMICs.
American journal of infection control. 2024 Mar 02 [Epub ahead of print]
Victor Daniel Rosenthal, Ruijie Yin, Zhilin Jin, Valentina Perez, Matthew Adam Kis, Safaa Abdulaziz-Alkhawaja, Sandra Liliana Valderrama-Beltran, R N Katherine Gomez, Claudia Milena Henao Rodas, Amal El-Sisi, Suneeta Sahu, Mohit Kharbanda, Camilla Rodrigues, Sheila Nainan Myatra, Rajesh Chawla, Kavita Sandhu, Yatin Mehta, Prasad Rajhans, Rajalakshmi Arjun, Chian-Wern Tai, Arpita Bhakta, Mohd-Basri Mat Nor, Guadalupe Aguirre-Avalos, Alejandro Sassoe-Gonzalez, Ider Bat-Erdene, Subhash P Acharya, Daisy Aguilar-de-Moros, Nilton Yhuri Carreazo, Wieslawa Duszynska, Sona Hlinkova, Dincer Yildizdas, Esra Kaya Kılıc, Oguz Dursun, Caglar Odek, Suna Secil Ozturk Deniz, Ertugrul Guclu, Iftihar Koksal, Eduardo Alexandrino Medeiros, Michael M Petrov, Lili Tao, Estuardo Salgado, Lourdes Dueñas, Mohammad Abdellatif Daboor, Lul Raka, Abeer Aly Omar, Aamer Ikram, George Horhat-Florin, Ziad A Memish, Eric Christopher Brown
Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; INICC Foundation, International Nosocomial Infection Control Consortium, Miami, USA, Miami, USA. Electronic address: ., Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, USA., Department of Biological Sciences, Florida International University, Miami, USA., Salmaniya Medical Complex, Manama, Bahrain., Pontificia Universidad Javeriana Hospital Universitario San Ignacio, Bogota, Colombia., Clinica Sebastian de Belalcazar, Cali, Colombia., Fundacion Hospital San Jose De Buga, Guadalajara de Buga, Colombia., Department of Pediatric Cardiac ICU, Cairo University Specialized Pediatric Hospital, Cairo, Egypt., Apollo Hospital Bhubaneswar, Bhubaneswar, India., Desun Hospital, Kolkata, India., Pd Hinduja National Hospital And Medical Research Centre, Mumbai, India., Tata Memorial Hospital Homi Bhabha National Institute, Mumbai, India., Indraprastha Apollo Hospital Delhi, New Delhi, India., Max Super Speciality Hospital Saket Delhi, New Delhi, India., Medanta The Medicity, New Delhi, India., Deenanath Mangeshkar Hospital And Research Center Erandwane Pune, Pune, India., Kerala Institute Of Med Sciences Thiruvananthapuram, Thiruvananthapuram, India., Department of Critical Care, Universiti Kebangsaan Malaysia Specialist Children's Hospital, Kuala Lumpur, Malaysia., University Malaya Medical Centre Pediatric Intensive Care, Kuala Lampur, Malaysia., International Islamic University Malaysia Department of Anesthesia and Critical Care, Kuantan, Malaysia., Hospital Civil De Guadalajara Fray Antonio Alcalde Terapia Intensiva, Guadalajara, Mexico., Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca, Mexico., Intermed Hospital, Ulaanbaatar, Mongolia., Grande International Hospital, Kathamandu, Nepal., Hospital del Nino Dr Jose Renan Esquivel de Panama, Panama, Panama., Universidad Peruana de Ciencias Aplicadas Hospital de Emergencias Pediatricas, Lima, Peru., Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland., Catholic University In Ruzomberok, Faculty of Health, Central Military Hospital SNP Ruzomberok, Ruzomberok, Slovakia., Balcali Hospital Pediatric Intensive Care Unit, Adana, Turkey., Ankara Training And Research Hospital, Ankara, Turkey., Akdeniz University Medical School, Antalya, Turkey., Uludag University Faculty of Medicine, Bursa, Turkey., Pamukkale University Hospital, Denizli, Turkey., Sakarya University Training And Research Hospital, Sakarya, Turkey., Karadeniz Technical University School of Medicine, Trabzon, Turkey., Hospital Sao Paulo, Universidade Federal de Sao Paulo, Sao Paulo, Brazil., Department of Microbiology, Faculty of Pharmacy, Medical University of Plovdiv, Plovdiv, Bulgaria., Department of Pneumonology, Zhongshan Hospital, Fudan University, Shanghai, China., Hospital Marie Curie, Quito, Ecuador., Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador., King Hussein Cancer Center, Amman, Jordan., National Institute For Public Health, Prishtina, Kosovo., Infection Control Directorate. Ministry of Health, Kuwait City, Kuwait., Armed Forces Institute of Urology, Rawalpindi, Pakistan., University of Medicine and Pharmacy Victor Babes Timisoara Emergency Clinical County Hospital Romania,Timisoara, Romania., King Saud Medical City, Ministry of Health, Ryhad, Saudi Arabia.