The impact of non-systematized educational programs on urinary infection rate associated with urinary catheter in a Brazilian Intensive Therapy Unit

Background: infection of the urinary tract is hospital-acquired infection of high incidence and in most of the cases is related to the use of urinary catheter. Hospitalization in intensive therapy units is also an important risk fact for nosocomial infection.

Objective: to identify the effect of one-time training events on the prevention of urinary infection related to vesical catheterization in patients of an intensive therapy unit of a Brazilian tertiary care hospital.

Methods: this longitudinal study used as indicator the urinary infection rate associated to urinary catheter through the methodology of the National Nosocomial Infections Surveillance System (NNIS). Patients hospitalized in the Adult Intensive Therapy Center from January 1999 to December 2008, period in which trainings based on recommendations of Centers for Diseases of Control and Prevention (CDC) and focused on protocols to implement and/or maintain urinary catheter were implemented, participated in the study. As problems with the implementation and/or maintenance of catheters were identified, educational programs were administered with 100% adherence of the medical and nursing teams.

Results: the rate of ITU related to urinary catheter was 15.06 infections/1000 patients day in the year before the implementation of the first protocol. After this procedure, these rates were  4.88, 5.79 and 10 urinary infection/1,000 patients day in 2000, 2001 and 2002 respectively. Between 2003 and 2006, rates varied from 9.52 to 15.6/1000 patients day, period when problems with the collector bag, which did not have a device to collect urine and led the system to open, was identified. Direct observation also identified that the majority of urinary catheters were not fixed according to recommendation or were not fixed at all. In the beginning of 2007 a comprehensive training was implemented about the indication and maintenance of urinary catheters and infection rate were 7.7 and 6.5 infections/patients day in 2007 and 2008 respectively. We observed that the urinary infection rate related to urinary catheter drastically diminished in the two years after educational programs were implemented.

Conclusions: the proposal of surveillance according to the NNISS  methodology permits a more detailed evaluation of hospital infection rates. Measures to control infections are efficient, however its effect can be temporary when not planned and introduced through ongoing and systematized educational programs.