Impact of a multidimensional infection control strategy on catheter-associated urinary tract infection rates in the adult intensive care units of 15 developing countries: findings of the International Nosocomial Infection Control Consortium (INICC).
OBJECTIVE
We aimed to evaluate the impact of a multidimensional infection control strategy for the reduction of the incidence of catheter-associated urinary tract infection (CAUTI) in patients hospitalized in adult intensive care units (AICUs) of hospitals which are members of the International Nosocomial Infection Control Consortium (INICC), from 40 cities of 15 developing countries: Argentina, Brazil, China, Colombia, Costa Rica, Cuba, India, Lebanon, Macedonia, Mexico, Morocco, Panama, Peru, Philippines, and Turkey.


METHODS
We conducted a prospective before-after surveillance study of CAUTI rates on 56,429 patients hospitalized in 57 AICUs, during 360,667 bed-days. The study was divided into the baseline period (Phase 1) and the intervention period (Phase 2). In Phase 1, active surveillance was performed. In Phase 2, we implemented a multidimensional infection control approach that included: (1) a bundle of preventive measures, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of CAUTI rates, and (6) feedback of performance. The rates of CAUTI obtained in Phase 1 were compared with the rates obtained in Phase 2, after interventions were implemented.


RESULTS
We recorded 253,122 urinary catheter (UC)-days: 30,390 in Phase 1 and 222,732 in Phase 2. In Phase 1, before the intervention, the CAUTI rate was 7.86 per 1,000 UC-days, and in Phase 2, after intervention, the rate of CAUTI decreased to 4.95 per 1,000 UC-days [relative risk (RR) 0.63 (95% confidence interval [CI] 0.55-0.72)], showing a 37% rate reduction.


CONCLUSIONS
Our study showed that the implementation of a multidimensional infection control strategy is associated with a significant reduction in the CAUTI rate in AICUs from developing countries.
International Nosocomial Infection Control Consortium, Buenos Aires, Argentina. victor_rosenthal@inicc.org
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Rosenthal
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Todi
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Álvarez-Moreno
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Pawar
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Karlekar
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Zeggwagh
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Mitrev
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Udwadia
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Chakravarthy
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Salomao
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Sahu
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Dilek
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Kanj
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Guanche-Garcell
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Cuéllar
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Nevzat-Yalcin
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Jaggi
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Medeiros
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Akan
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Mapp
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Castañeda-Sabogal
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Matta-Cortés
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Sirmatel
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Olarte
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Torres-Hernández
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Barahona-Guzmán
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Fernández-Hidalgo
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Villamil-Gómez
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Sztokhamer
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Forciniti
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Berba
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Turgut
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Bin
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Yang
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Pérez-Serrato
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Lastra
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Singh
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Ozdemir
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Ulusoy
D000569:Americas / Q000453:epidemiology; D001208:Asia / Q000453:epidemiology; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000517:prevention & control; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control; D003906:Developing Countries / Q000706:statistics & numerical data; D005060:Europe / Q000453:epidemiology; D005260:Female; D063373:Hand Hygiene / Q000706:statistics & numerical data; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009018:Morocco / Q000453:epidemiology; D015397:Program Evaluation; D011446:Prospective Studies; D062885:Urinary Catheters / Q000706:statistics & numerical data; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000517:prevention & control