Impact of Outcome and Process Surveillance on Catheter-Associated Urinary Tract Infection Rates in 6 ICUs of 2 Cities of Philippines: Findings of the International Nosocomial Infection Control Consortium (INICC)

Background: Catheter associated urinary tract infections (CAUTI) rates in Philippines are significantly higher that international standards of developed countries. There are no previous data from Philippines showing a successful intervention to reduce CAUTI rates.

Objective: We report a time-sequence analysis of the effectiveness of performance feedback on rates of CAUTI and process surveillance in 6 ICUs of  the Philippines that have been members of the international nosocomial infection control consortium (INICC) for at least six months.

Methods: Pooled rates of CAUTI within the member ICUs during the first three months of participation in INICC (baseline) were compared with the rates at subsequent intervention period. The results of process surveillance for hand hygiene and infection control practices at baseline were compared with data of intervention period.

Results: The baseline period included the first three months of each medical center in the study; the intervention period lasted a mean of 10 months (range 4-19 months). During the baseline period, 372 ICU patients were enrolled, and 1,328 during the intervention period. Patient’s characteristics were similar over the two periods (Patient Gender, P: 0.1778;; Endocrine disease, P: 0.1043; Hypertension, P: 0.2482; Coronary insufficiency,  P: 0.4768;  Cancer, P: 0.6031; Hepatic Failure, P: 0.2834; Abdominal <ˆï̏>Surgery, P: 0.5206; Trauma, P: 0.0544; Previous Infection, P: 0.1776; Stroke, P: 0.4563; Immunocompromise, P: 0.2834). Hand-hygiene compliance improved from baseline to intervention period (62% vs 88%; P: 0.0001]). Compliance with urinary catheter (UC) site care improved during the intervention period (UC on thigh without strangulating, 47% vs. 69% [RR = 1.47, 95% CI = 1.34 - 1.54, P-value = 0.0001]; Collecting bag hanging not allowing urine reflux, 47% vs. 80% [RR = 1.69, 95% CI = 1.55-1.85, P-value = 0.0001].  The rate of CAUTI per 1,000 catheter days during the intervention period was significantly lower than during the baseline period, 7.92 (9/1,137) vs 2.66 (11/4,137) CAUTI per 1000 catheter days (RR, 0.34; 95% CI, 0.14-0.81; P: 0.0107).

Conclusions: Ongoing education and performance feedback of CAUTI rates, and the findings of process surveillance significantly improved compliance with hand hygiene and basic infection control practices recommended for care of urinary catheters, and were associated with a 64% reduction in the incidence of CAUTI.