Effect of instruction and implementation of a preventive urinary tract infection bundle on the incidence of catheter associated urinary tract infection in intensive care unit patients

Abstract

Background and Objective: Catheter Associated Urinary Tract infection (CAUTI) is one of the most prevalent hospital acquired infections which causes increased medical costs, hospital stay and mortality. Patients in critical care units are in a higher risk. The main purpose of the present study is the Identification of the effect of instruction and implementation of a preventive urinary tract infection bundle on the incidence of CAUTI. Materials and Methods: This was a before-after quasi-experimental study. 330 patients were included (185 patients in before and 145 in after the intervention). In both phases, the incidence of CAUTI, compliance with principles of CAUTI prevention, urinary catheter utilization and indications of catheter insertion were evaluated. CAUTI was identified based on the Center for Disease Control and Prevention/ National Healthcare Safety Network (CDC/NHSN) criteria with the online INICC software. Interventions included the instruction of the bundle to all health care workers in selected intensive care units and implementing interventions to improve facilities required for the implementation of the bundle. Results: No significant decrease was seen in the incidence of the CAUTI after the intervention (3.2 v/s 1.36 in 1000 catheter-day, p<0.388). The most prevalent indication for urinary catheter utilization in both phases, were critical monitoring of urine output (80.16% and 72.26%, respectively). Before the intervention, 1.6 % of catheterized cases were labeled inappropriate by the physicians. This increased significantly to 5.5% after intervention (P<0.001). Before the intervention, 37.5% of the catheters which were labeled inappropriate were removed which increased to 42/4% after the intervention insignificantly (P<0/709). From the 88 hours of compliance monitoring. The number of observed noncompliance cases before the intervention, which was 1941, decreased significantly after the intervention (P<.001). Conclusion: This study revealed that although instruction and implementation of the preventive bundle reduced CAUTI, this reduction was not significant. Future studies should be conducted with larger sample sizes and in longer periods. The most prevalent criterion for urinary catheter utilization was the need for critical monitoring of urine output. Instruction of the bundle reduced noncompliance with principles of urinary tract infection control.

Efficacy of Protocol of Hygienic Care by Chlorhexidine Gluconate on the Occurrence of Catheter Associated Urinary Tract Infection among Critical Ill Patients

“…(31) . (2019) (34) . On the other hand, CAUTI was asymptomatic in critically ill patient that reported by Weiss, et al (2019) (35) Concerning blood chemistry.…”

The Effect of Implementing CAUTIs Bundle on Prevention of Hospital- Acquired Urinary Tract Infections among Critically Ill Patients

“…This is because most patients were unconscious and connected to MV which restricted their mobility. On the other hand, many studies reported that a UC is indicated for admitted patients in ICUs for fluid monitoring and management (Al meida et al, 2020;Dehghanrad et al, 2019;Fakih et al, 2010;B. Kim et al, 2017;Knill, Maduro, & Payne, 2018;Kuriyama et al, 2017;Sampathkumar, 2017).…”

“…On the contrary, the studies were carried out in the developed countries such as the American studies (Clarke et al, 2013;Davis et al, 2018;Perrin et al, 2020;Tyson et al, 2018), European studies (Düzkaya, Bozkurt, Uysal, & Yakut, 2016;Letica-Kriegel et al, 2019), a Spainian study (Lerma et al, 2019), an Asian study (Dehghanrad et al, 2019), and another international study that was applied in 15 developing countries (Rosenthal et al, 2012) reported low CAUTIs rate. This disagreement may be due to adherence to CAUTIs guidelines and the availability of resources in the developed countries.…”

Determination of Antimicrobial and Antibiofilm Activity of Combined LVX and AMP Impregnated in p(HEMA) Hydrogel

“…Gram-positive bacteria such as S. aureus and Gram-negative bacteria such as E. coli and P. aeruginosa can adhere and form biofilms on catheter device surfaces. The biofilm is a complicated structure population of microbes that produces an extracellular polymeric matrix that is adherent on a surface [1]. Urinary biofilms are documented to be of mixed microbial species [2], which makes their treatment and management challenging.…”

“…The insertion of medical devices such as urinary catheters and stents is often reported to increase the risk of developing bladder infections [1,2]. Bacteria can colonize the outer surface of the catheter and lead to bacterial escape through the bladder and cause extraluminal infection.…”