title: Catheter-associated urinary tract infection after cardiovascular surgery: Impact of a multifaceted intervention.
abstract: BACKGROUND
  The aims of this study were to assess the impact of a multifaceted intervention on the incidence of catheter-associated urinary tract infection (CAUTI) and on the urinary catheter utilization (UCU) ratio, evaluating adherence to recommendations for the use of indwelling urinary catheters (IUCs).
  
  
  METHODS
  This prospective, before-and-after interventional study was conducted in three 6-month phases: preintervention (phase 1), intervention (phase 2), and postintervention (phase 3). We observed IUC insertion technique, maintenance care, and removal/nonremoval practices; provided training on CAUTI prevention measures; evaluated professional knowledge; provided adherence feedback; determined the incidence of CAUTI, and calculating the UCU ratio.
  
  
  RESULTS
  Between phases 1 and 3, CAUTI incidence fell from 11.42 to 4.40 cases/1000 catheter-days (P = .216), whereas the UCU ratio remained constant. The risk of CAUTI was 2.6-fold higher in phase 1 than in phase 3. Adherence to hand hygiene (before and after IUC insertion) improved significantly, as did adherence to attaching the IUC to the patient and maintenance care guidelines. The reasons for IUC use (including inappropriate reasons) did not differ significantly. Professional knowledge improved significantly after training.
  
  
  CONCLUSIONS
  A multifaceted intervention effectively reduced CAUTI incidence and improved the quality of care.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Edivete Regina
authors.initials: ER
authors.lastname: Andrioli
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Guilherme H Campos
authors.initials: GH
authors.lastname: Furtado
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil. Electronic address: edubalaccih@gmail.com.
authors.forename: Eduardo Alexandrino
authors.initials: EA
authors.lastname: Medeiros
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D003131:Combined Modality Therapy; D065187:Controlled Before-After Studies; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014546:Urinary Catheterization / Q000009:adverse effects*; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000517:prevention & control; D055815:Young Adult
keywords: Catheter-associated infection; Infection control; Urinary tract infection