title: A multifaceted intervention to reduce rates of catheter-associated urinary tract infections in a resource-limited setting.
abstract: BACKGROUND
  Health care-associated infections such as catheter-associated urinary tract infections (CAUTIs) are prevalent in resource-limited settings. This study was carried out to determine whether a multifaceted intervention targeting health care personnel would reduce CAUTI rates in a public hospital located in a resource-limited setting.
  
  
  METHODS
  A one group, pretest-posttest study was carried out from March to July 2012 in a public district hospital in Nairobi, Kenya. Patients admitted to adult medical wards, and who received urinary catheters, were evaluated for symptomatic CAUTIs using a modified definition by the Centers for Disease Control and Prevention. After collecting baseline CAUTI rates for 8 weeks, a multifaceted intervention consisting of lectures, reminder signs, and infection prevention rounds (week 9) was implemented. The postintervention rate of CAUTIs was measured over 7 subsequent weeks. Bivariable analysis was performed to determine whether the intervention was associated with reduced CAUTIs.
  
  
  RESULTS
  A total of 125 patients received urinary catheters, with 82 preintervention and 43 postintervention. Mean duration of catheterization did not change between phases (6.9 vs 5.6 days, respectively, P = .322), but catheter utilization ratio decreased from 0.14 to 0.09 (P < .001). There were 13 preintervention CAUTIs (for 30.4 infections per 1,000 catheter-days) and no postintervention CAUTIs (P = .002).
  
  
  CONCLUSIONS
  In this resource-limited setting, the baseline rate of CAUTIs was high. A low-cost, multifaceted intervention resulted in decreased urinary catheter use and CAUTI rates.
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, PA. Electronic address: gayani.tillekeratne@dm.duke.edu.
authors.forename: L Gayani
authors.initials: LG
authors.lastname: Tillekeratne
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Darren R
authors.initials: DR
authors.lastname: Linkin
authors.affiliation: School of Medicine, University of Nairobi, Nairobi, Kenya.
authors.forename: Mariah
authors.initials: M
authors.lastname: Obino
authors.affiliation: School of Medicine, University of Nairobi, Nairobi, Kenya.
authors.forename: Afua
authors.initials: A
authors.lastname: Omar
authors.affiliation: School of Medicine, University of Nairobi, Nairobi, Kenya.
authors.forename: Mary
authors.initials: M
authors.lastname: Wanjiku
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: David
authors.initials: D
authors.lastname: Holtzman
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cohn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001521:Behavior Therapy; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000517:prevention & control*; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control*; D003906:Developing Countries; D005260:Female; D006282:Health Personnel; D006779:Hospitals, Public; D006801:Humans; D015994:Incidence; D007630:Kenya; D008297:Male; D008875:Middle Aged; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000517:prevention & control*; D055815:Young Adult
keywords: Developing settings; Health care-associated infections; Infection surveillance and prevention; Quality improvement interventions