title: Impact of a multidimensional infection control approach on catheter-associated urinary tract infection rates in an adult intensive care unit in Lebanon: International Nosocomial Infection Control Consortium (INICC) findings.
abstract: OBJECTIVE
  The objective of this study was to assess the impact of a multidimensional infection control approach for the reduction of catheter-associated urinary tract infection (CAUTI) in an adult intensive care unit (ICU) of a hospital member of the International Nosocomial Infection Control Consortium (INICC) in Lebanon.
  
  
  METHODS
  A before-after prospective active surveillance study was carried out to determine rates of CAUTI in 1506 ICU patients, hospitalized during 10 291 bed-days. The study period was divided into two phases: phase 1 (baseline) and phase 2 (intervention). During phase 1, surveillance was performed applying the definitions of the US Centers for Disease Control and Prevention National Healthcare Safety Network (CDC/NHSN). In phase 2, we adopted a multidimensional approach that included: (1) a bundle of infection control interventions, (2) education, (3) surveillance of CAUTI rates, (4) feedback on CAUTI rates, (5) process surveillance, and (6) performance feedback. We used random effects Poisson regression to account for clustering of CAUTI rates across time-periods.
  
  
  RESULTS
  We recorded a total of 9829 urinary catheter-days: 306 in phase 1 and 9523 in phase 2. The rate of CAUTI was 13.07 per 1000 urinary catheter-days in phase 1, and was decreased by 83% in phase 2 to 2.21 per 1000 urinary catheter-days (risk ratio 0.17; 95% confidence interval 0.06-0.5; p=0.0002).
  
  
  CONCLUSIONS
  Our multidimensional approach was associated with a significant reduction in the CAUTI rate.
authors.affiliation: American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Souha S
authors.initials: SS
authors.lastname: Kanj
authors.forename: Nada
authors.initials: N
authors.lastname: Zahreddine
authors.forename: Victor Daniel
authors.initials: VD
authors.lastname: Rosenthal
authors.forename: Lamia
authors.initials: L
authors.lastname: Alamuddin
authors.forename: Zeina
authors.initials: Z
authors.lastname: Kanafani
authors.forename: Bassel
authors.initials: B
authors.lastname: Molaeb
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000517:prevention & control*; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D063373:Hand Hygiene; D006801:Humans; D017053:Infection Control / Q000379:methods; D007362:Intensive Care Units; D007861:Lebanon; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D062486:Public Health Surveillance; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000517:prevention & control*
keywords: Bundle; Catheter-associated urinary tract infection; Device-associated infection; Hand hygiene; Intensive care unit; Resource-limited countries