title: Preventing catheter-associated urinary tract infection in the zero-tolerance era.
abstract: BACKGROUND
  Catheter-associated urinary tract infection (CAUTI) is one of the most common health care‒associated infections in the critical care setting.
  
  
  METHODS
  A quasi-experimental study involving multiple interventions to reduce the incidence of CAUTI was conducted in a medical-surgical intensive care unit (ICU) and in 2 step-down units (SDUs). Between June 2005 and December 2007 (phase 1), we implemented some Centers for Disease Control and Prevention‒recommended evidence-based practices. Between January 2008 and July 2010 (phase 2), we intervened to improve compliance with these practices at the same time that performance monitoring was being done at the bedside, and we implemented the Institute for Healthcare Improvement's bladder bundle for all ICU and SDU patients requiring urinary catheters.
  
  
  RESULTS
  There was a statistically significant reduction in the rate of CAUTI in the ICU, from 7.6 per 1,000 catheter-days (95% confidence interval [CI], 6.6-8.6) before the intervention to 5.0 per 1,000 catheter-days (95% CI, 4.2-5.8; P < .001) after the intervention. There also was a statistically significant reduction in the rate of CAUTI in the SDUs, from 15.3 per 1,000 catheter-days (95% CI, 13.9-16.6) before the intervention to 12.9 per 1,000 catheter-days (95% CI, 11.6-14.2) after the intervention (P = .014).
  
  
  CONCLUSIONS
  Our findings suggest that reducing CAUTI rates in the ICU setting is a complex process that involves multiple performance measures and interventions that can be applied to SDU settings as well.
authors.affiliation: Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil. alexmarra@einstein.br
authors.forename: Alexandre R
authors.initials: AR
authors.lastname: Marra
authors.forename: Thiago Zinsly
authors.initials: TZ
authors.lastname: Sampaio Camargo
authors.forename: Priscila
authors.initials: P
authors.lastname: Gonçalves
authors.forename: Ana Maria Cristina B
authors.initials: AM
authors.lastname: Sogayar
authors.forename: Denis Faria
authors.initials: DF
authors.lastname: Moura
authors.forename: Luciana Reis
authors.initials: LR
authors.lastname: Guastelli
authors.forename: Carla Andrea C
authors.initials: CA
authors.lastname: Alves Rosa
authors.forename: Elivane
authors.initials: E
authors.lastname: da Silva Victor
authors.forename: Oscar Fernando
authors.initials: OF
authors.lastname: Pavão Dos Santos
authors.forename: Michael B
authors.initials: MB
authors.lastname: Edmond
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000517:prevention & control*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000517:prevention & control*