Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-29T08:37:27.242Z Has data issue: false hasContentIssue false
  • English
  • Français

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 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

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