title: Sustainability of a program for continuous reduction of catheter-associated urinary tract infection.
abstract: Urinary tract infections account for 8%-21% of health care-associated infections; of these, 80% are associated with the use of a urinary catheter.
  
  
  
  A quasi-experimental study was conducted in 2 medical-surgical intensive care units (ICUs) with 48 beds and 3 step-down units (SDUs) with 95 beds in a private tertiary care hospital in Sao Paulo, Brazil. The study had 3 phases over a 9-year period to determine the sustainability of a program for continuous reduction of catheter-associated urinary tract infection (CAUTI).
  
  
  
  Over the 3 phases of the study, rates of CAUTI in the ICUs fell from 7.0 to 3.5 to 0.9 infections per 1,000 catheter days. In the SDUs, CAUTI rates decreased from 14.9 to 6.6 to 1.0 per 1,000 catheter days. Comparisons of CAUTI rates in the 3 study phases, both in the ICUs and SDUs, showed significant reductions both between the 3 periods and in all possible combinations of analysis phases (all P < .001).
  
  
  
  These results suggest that it is possible to reduce CAUTI rates to near zero and sustain these rates, but it requires a multidisciplinary team with different strategies that require continuous monitoring.
authors.affiliation: Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Dejanira A
authors.initials: DA
authors.lastname: Regagnin
authors.affiliation: Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Debora Schettini
authors.initials: DS
authors.lastname: da Silva Alves
authors.affiliation: Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Ana
authors.initials: A
authors.lastname: Maria Cavalheiro
authors.affiliation: Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Thiago Zinsly
authors.initials: TZ
authors.lastname: Sampaio Camargo
authors.affiliation: Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil. Electronic address: a.marra@uol.com.br.
authors.forename: Alexandre R
authors.initials: AR
authors.lastname: Marra
authors.affiliation: Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Elivane
authors.initials: E
authors.lastname: da Silva Victor
authors.affiliation: Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Edmond
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002404:Catheterization / Q000009:adverse effects*; D005260:Female; D016304:Hospitals, Private; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000458:organization & administration*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D065228:Non-Randomized Controlled Trials as Topic; D062606:Tertiary Care Centers; D014552:Urinary Tract Infections / Q000517:prevention & control*
keywords: Catheter-associated urinary tract infection; health care–associated infection prevention; urinary catheter