Effectiveness of multifaceted hospitalwide quality improvement programs featuring an intervention to remove unnecessary urinary catheters at a tertiary care center in Thailand.
OBJECTIVE
To evaluate the efficacy of a multifaceted hospitalwide quality improvement program that featured an intervention to remind physicians to remove unnecessary urinary catheters.


METHODS
A hospitalwide preintervention-postintervention study was conducted over 2 years (July 1, 2004, through June 30, 2006). The intervention consisted of nurse-generated daily reminders that were used by an intervention team to remind physicians to remove unnecessary urinary catheters, beginning 3 days after insertion. Clinical, microbiological, pharmaceutical, and cost data were collected.


RESULTS
A total of 2,412 patients were enrolled in the study. No differences were found in the demographic and/or clinical characteristics of patients between the preintervention and postintervention periods. After the intervention, reductions were found in the rate of inappropriate urinary catheterization (mean rate, preintervention vs postintervention, 20.4% vs 11% [P=.04]), the rate of catheter-associated urinary tract infection (CA-UTI) (mean rate, 21.5 vs 5.2 infections per 1,000 catheter-days [P<.001]), the duration of urinary catheterization (mean, 11 vs 3 days [P<.001]), and the total length of hospitalization (mean, 16 vs 5 days [P<.001]). A linear relationship was seen between the monthly average duration of catheterization and the rate of CA-UTI (r=0.89; P<.001). The intervention had the greatest impact on the rate of CA-UTI in the intensive care units (mean rate, preintervention vs postintervention, 23.4 vs 3.5 infections per 1,000 catheter-days [P=.01]). The monthly hospital costs for antibiotics to treat CA-UTI were reduced by 63% (mean, $3,739 vs $1,378 [P<.001]), and the hospitalization cost for each patient during the intervention was reduced by 58% (mean, $366 vs $154 [P<.001]).


CONCLUSIONS
This study suggests that a multifaceted intervention to remind physicians to remove unnecessary urinary catheters can significantly reduced the duration of urinary catheterization and the CA-UTI rate in a hospital in a developing country.
Apisarnthanarak
Anucha
A
Division of Infectious Diseases, Faculty of Medicine, Thammasart University Hospital, Pratumthani, Thailand. anapisarn@yahoo.com
Thongphubeth
Kanokporn
K
Sirinvaravong
Sirinaj
S
Kitkangvan
Danai
D
Yuekyen
Chananart
C
Warachan
Boonyasit
B
Warren
David K
DK
Fraser
Victoria J
VJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000191:economics / Q000382:microbiology / Q000517:prevention & control; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology / Q000706:statistics & numerical data; D003428:Cross Infection / Q000191:economics / Q000517:prevention & control*; D005260:Female; D006761:Hospitals / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D011785:Quality Assurance, Health Care; D017010:Reminder Systems; D013785:Thailand; D014546:Urinary Catheterization / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D014552:Urinary Tract Infections / Q000191:economics / Q000382:microbiology / Q000517:prevention & control*