Surveillance and identification of risk factors of catheter-associated urinary tract infection in medical / surgical wards of a tertiary care hospital in Karachi, Pakistan

Background: Health care associated infections (HCAIs) always become significant threat to patients safety. Urinary tract infections (UTI) are the most common form of HCAI. the most general predisposing factor for UTI is catherization. Catheter associated urinary tract infection(CA-UTI) have a significant effect on patient and hospital systems such as morbidity, mortality and financial burden. 
Objective: We sought to measure the baseline incidence rate of catheter-associated urinary tract infections (CAUTIs), identify risk factors associated with acquiring the infections; and identify the inteventional strategies to reduce the rates associated with CAUTIs in the medical/surgical unit a tertiary care hospital in Karachi, Pakistan.

Methods: Prospective active surveillance of CAUTIs was conducted in medical and surgical units in the month of April 2009 in tertiary care hospital in Karachi, Pakistan using the standard Centers for Disease Control National Healthcare Safety Network 2008 (CDC; NHSN) case definitions. Rates were expressed as the number of infections per 1000 catheter days. Identified infections by Infection control nurse was individually discusses and verified by infectious disease consultant. Risk factors were assessed with the help of a tool prepared by infection control nurses approved by infection control committee of the hospital.  
Results: During the period, 355 patients were assessed after the admission, with either existing indwelling urinary catheters (214), or got catheters inserted after the admission in the ward (141), for a total duration of 1930 patient days, and 1540 patient catheter days. A total of 12 episodes of infection were diagnosed, for an overall rate of 33.8% CAUTIs per 1000 catheter days. Important risk factors associated with acquiring CAUTI were female gender, using same urine jugs for collection of urine, placement of Foleys bag on the floor, compromised catheter care and prolonged hospital stay. Furthermore, audit results also reveal compromised practices related to CA-UTI were not well understood by the (HCW’s).
Conclusions: In an effort to decrease the incidence of CA-UTI, Using the identified risk factors, tailored intervention strategies such as sessions for HCWs, on line module certification course was kept medatory for all HCWs and surprise audits are now being implemented to reduce the rates of CAUTIs in these wards.