Impact of Outcome and Process Surveillance on Catheter-Associated Urinary Tract Infection Rates in 10 ICUs of Turkey: INICC Findings

Background: Catheter-associated urinary tract infections (CAUTIs) account for 40% of all healthcare-associated infections (HAI).  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: We report the impact on CAUTI rates of process and outcome surveillance of device-associated infection (DAI) rates in 10 Turkish ICUs (Medical Surgical,4; Medical, 2; Pediatric, 1; Surgical 1; Respiratory, 1; Reanimation 1), 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 collecting systems with 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 collecting bags 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.

The definitions of the CDC NHSN were applied to record CAUTI rates. Data were collected in the ICUs, and uploaded and analyzed at the INICC headquarters.

Pooled CAUTI rates within the ICU during the first 3 months (baseline) of participation in INICC were compared with the rates at the subsequent intervention period during the following 2 years (intervention).

 

Results: During the baseline period, 526 ICU patients were enrolled, and 3,559 during the intervention period. Patients’ characteristics were similar over the two periods (patient gender, P: 0.0944; endocrine disease, P: 0.1991; angina pectoris, P: 0.968; hepatic insufficiency, P: 0.066; cardiac surgery, P: 0.1795; abdominal surgery, P: 0.2060; thoracic surgery, P: 0.9082; trauma, P: 0.1269).

The CAUTI rate per 1,000 catheter days during the intervention period was significantly lower than during the baseline period, 10.9 (47/4,301) vs. 5.5 (202/36,892) CAUTIs per 1000 catheter days (RR, 0.50; 95% CI, 0.36-0.69; P: 0.0001).

Conclusions: Ongoing process and outcome surveillance was associated with a 50% reduction in the incidence of CAUTI rate.