Impact of Outcome and Process Surveillance on Catheter-Associated Urinary Tract Infection Rates in 4 ICUs of Brazil: INICC Findings

Background: Catheter-associated urinary tract infections (CAUTIs) account for 40% of all healthcare-associated infections (HAIs).  Recent publications report rates of CAUTI that range from 3.1 to 7.4 cases per 1,000 catheter-days in intensive care units (ICUs) of developed countries, but CAUTI rates are higher in developing countries. The results of quality improvement initiatives suggest that many cases of CAUTI can be prevented with careful attention to the process of care.   

 

Objective: To report the impact on CAUTI rates of process and outcome surveillance of device-associated infection (DAI) rates in 4 Brazilian Medical Surgical ICUs members of the International Nosocomial Infection Control Consortium (INICC).

 

Methods: Process surveillance includes observation, monitoring and performance feedback of adherence to hand-hygiene guidelines, to use of urinary catheter when necessary, insert catheters by use of aseptic technique and sterile equipment, use a sterile or antiseptic solution for cleaning the urethral meatus, use the smallest and properly secure indwelling catheters, maintain a sterile closed drainage system, not to disconnect the catheter and drainage tube, replace the collecting system by use of aseptic technique, collect a urine sample by aspirating urine from the sampling port with a sterile needle and syringe after disinfecting the port, maintain unobstructed urine flow, empty the collecting bag regularly, keep the collecting bag below the level of the bladder, and routine hygiene of the meatal area.

Outcome surveillance includes measurement of patients’ characteristics, urinary catheter days, CAUTIs, length of stay, costs, mortality, microorganism profile and bacterial resistance.

CAUTI rates were registered by applying the definitions of the CDC NHSN. Data collection was performed in the participating ICU, and were uploaded and analyzed at the INICC headquarters.

Pooled CAUTI rates within the ICUs during the first 3 months (baseline) of participation in INICC were compared with the rates in the subsequent intervention period during the following 24 months (range 14 to 28 months) (intervention).

 

Results: During the baseline period, 242 ICU patients were enrolled, and 1,499 during the intervention period. Patient’s characteristics were similar over the two periods (patient gender, P: 0.7134; age, P: 0.568; ASIS score, P: 0.460; cardiac failure, P: 0.7236; angina pectoris, P: 0.5807; cardiac surgery, P: 0.0874; thoracic surgery, P: 0.5239,; Immunocompromise, P: 0.1145).

The CAUTI rate per 1,000 catheter days in the intervention period was significantly lower than in the baseline period, 10.3 (24/2,322) vs 6.1 (77/12,611) CAUTI per 1000 catheter days (RR, 0.59, 95% CI, 0.37-0.93, P: 0.0227).

Conclusions: Ongoing process and outcome surveillance was associated with a 41% reduction in the incidence of CAUTI rate.