Findings of the International Nosocomial Infection Control Consortium (INICC), Part I: Effectiveness of a multidimensional infection control approach on catheter-associated urinary tract infection rates in pediatric intensive care units of 6 developing countries.
METHODS
A before-after prospective surveillance study to assess the impact of a multidimensional infection control approach for the reduction of catheter-associated urinary tract infection (CAUTI) rates.


METHODS
Pediatric intensive care units (PICUs) of hospital members of the International Nosocomial Infection Control Consortium (INICC) from 10 cities of the following 6 developing countries: Colombia, El Salvador, India, Mexico, Philippines, and Turkey.


METHODS
PICU inpatients.


METHODS
We performed a prospective active surveillance to determine rates of CAUTI among 3,877 patients hospitalized in 10 PICUs for a total of 27,345 bed-days. The study was divided into a baseline period (phase 1) and an intervention period (phase 2). In phase 1, surveillance was performed without the implementation of the multidimensional approach. In phase 2, we implemented a multidimensional infection control approach that included outcome surveillance, process surveillance, feedback on CAUTI rates, feedback on performance, education, and a bundle of preventive measures. The rates of CAUTI obtained in phase 1 were compared with the rates obtained in phase 2, after interventions were implemented.


RESULTS
During the study period, we recorded 8,513 urinary catheter (UC) days, including 1,513 UC-days in phase 1 and 7,000 UC-days in phase 2. In phase 1, the CAUTI rate was 5.9 cases per 1,000 UC-days, and in phase 2, after implementing the multidimensional infection control approach for CAUTI prevention, the rate of CAUTI decreased to 2.6 cases per 1,000 UC-days (relative risk, 0.43 [95% confidence interval, 0.21-1.0]), indicating a rate reduction of 57%.


CONCLUSIONS
Our findings demonstrated that implementing a multidimensional infection control approach is associated with a significant reduction in the CAUTI rate of PICUs in developing countries.
International Nosocomial Infection Control Consortium, Avenue Corrientes4580,Buenos Aires, Argentina. victor_rosenthal@inicc.org
Victor D
VD
Rosenthal
Bala
B
Ramachandran
Lourdes
L
Dueñas
Carlos
C
Alvarez-Moreno
J A
JA
Navoa-Ng
Alberto
A
Armas-Ruiz
Gulden
G
Ersoz
Lorena
L
Matta-Cortés
Mandakini
M
Pawar
Ata
A
Nevzat-Yalcin
Marena
M
Rodríguez-Ferrer
Ana Concepción
AC
Bran de Casares
Claudia
C
Linares
Victoria D
VD
Villanueva
Roberto
R
Campuzano
Ali
A
Kaya
Luis Fernando
LF
Rendon-Campo
Amit
A
Gupta
Ozge
O
Turhan
Nayide
N
Barahona-Guzmán
Lilian
L
de Jesús-Machuca
María Corazon V
MC
Tolentino
Jorge
J
Mena-Brito
Necdet
N
Kuyucu
Yamileth
Y
Astudillo
Narinder
N
Saini
Nurgul
N
Gunay
Guillermo
G
Sarmiento-Villa
Eylul
E
Gumus
Alfredo
A
Lagares-Guzmán
Oguz
O
Dursun
D055499:Catheter-Related Infections / Q000517:prevention & control*; D003226:Congresses as Topic; D003428:Cross Infection / Q000517:prevention & control*; D003906:Developing Countries; D019983:Guideline Adherence; D006235:Hand Disinfection; D006786:Hospitals, Urban; D006801:Humans; D006920:Hygiene; D015278:Intensive Care Units, Pediatric; D011159:Population Surveillance; D011446:Prospective Studies; D014552:Urinary Tract Infections / Q000209:etiology* / Q000517:prevention & control*