title: Impact of a multidimensional infection control approach on catheter-associated urinary tract infection rates in adult intensive care units in 10 cities of Turkey: International Nosocomial Infection Control Consortium findings (INICC).
abstract: BACKGROUND
  We evaluate the effectiveness of a multidimensional infection control approach for the reduction of catheter-associated urinary tract infections (CAUTIs) in 13 intensive care units (ICUs) in 10 hospital members of the International Nosocomial Infection Control Consortium (INICC) from 10 cities of Turkey.
  
  
  METHODS
  A before-after prospective active surveillance study was used to determine rates of CAUTI. The study was divided into baseline (phase 1) and intervention (phase 2). In phase 1, surveillance was performed applying the definitions of the Centers for Disease Control and Prevention/National Healthcare Safety Network. In phase 2, we implemented a multidimensional approach that included bundle of infection control interventions, education, surveillance and feedback on CAUTI rates, process surveillance, and performance feedback. We used random effects Poisson regression to account for clustering of CAUTI rates across time periods.
  
  
  RESULTS
  The study included 4,231 patients, hospitalized in 13 ICUs, in 10 hospitals, in 10 cities, during 49,644 patient-days. We recorded a total of 41,871 urinary catheter (UC)-days: 5,080 in phase 1 and 36,791 in phase 2. During phase 1, the rate of CAUTI was 10.63 per 1,000 UC-days and was significantly decreased by 47% in phase 2 to 5.65 per 1,000 UC-days (relative risk, 0.53; 95% confidence interval: 0.4-0.7; P value = .0001).
  
  
  CONCLUSIONS
  Our multidimensional approach was associated with a significant reduction in the rates of CAUTI in Turkey.
authors.affiliation: Ondokuz Mayis University Medical School, Samsun, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Leblebicioglu
authors.forename: Gulden
authors.initials: G
authors.lastname: Ersoz
authors.forename: Victor Daniel
authors.initials: VD
authors.lastname: Rosenthal
authors.forename: Ata Nevzat
authors.initials: AN
authors.lastname: Yalcin
authors.forename: Ozay Arıkan
authors.initials: OA
authors.lastname: Akan
authors.forename: Fatma
authors.initials: F
authors.lastname: Sirmatel
authors.forename: Huseyin
authors.initials: H
authors.lastname: Turgut
authors.forename: Davut
authors.initials: D
authors.lastname: Ozdemir
authors.forename: Emine
authors.initials: E
authors.lastname: Alp
authors.forename: Cengiz
authors.initials: C
authors.lastname: Uzun
authors.forename: Sercan
authors.initials: S
authors.lastname: Ulusoy
authors.forename: Saban
authors.initials: S
authors.lastname: Esen
authors.forename: Fatma
authors.initials: F
authors.lastname: Ulger
authors.forename: Ahmet
authors.initials: A
authors.lastname: Dilek
authors.forename: Hava
authors.initials: H
authors.lastname: Yilmaz
authors.forename: Ali
authors.initials: A
authors.lastname: Kaya
authors.forename: Necdet
authors.initials: N
authors.lastname: Kuyucu
authors.forename: Ozge
authors.initials: O
authors.lastname: Turhan
authors.forename: Nurgul
authors.initials: N
authors.lastname: Gunay
authors.forename: Eylul
authors.initials: E
authors.lastname: Gumus
authors.forename: Oguz
authors.initials: O
authors.lastname: Dursun
authors.forename: Melek
authors.initials: M
authors.lastname: Tulunay
authors.forename: Mehmet
authors.initials: M
authors.lastname: Oral
authors.forename: Necmettin
authors.initials: N
authors.lastname: Unal
authors.forename: Mustafa
authors.initials: M
authors.lastname: Cengiz
authors.forename: Leyla
authors.initials: L
authors.lastname: Yilmaz
authors.forename: Suzan
authors.initials: S
authors.lastname: Sacar
authors.forename: Hülya
authors.initials: H
authors.lastname: Sungurtekin
authors.forename: Doğaç
authors.initials: D
authors.lastname: Uğurcan
authors.forename: Mehmet Faruk
authors.initials: MF
authors.lastname: Geyik
authors.forename: Ahmet
authors.initials: A
authors.lastname: Sahin
authors.forename: Selvi
authors.initials: S
authors.lastname: Erdogan
authors.forename: Bilgehan
authors.initials: B
authors.lastname: Aygen
authors.forename: Bilgin
authors.initials: B
authors.lastname: Arda
authors.forename: Feza
authors.initials: F
authors.lastname: Bacakoglu
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; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D014421:Turkey / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000517:prevention & control*
keywords: Bundle; Catheter-related urinary tract infections; Critical care; Developing countries; Device-associated infection; Emerging countries; Hand hygiene; Handwashing; Health care-acquired infection; Hospital infection; Incidence density; Limited resources countries; Low-income countries; Nosocomial infection; Surveillance; Urinary catheter