Impact of a multidimensional infection control strategy on catheter-associated urinary tract infection rates in the adult intensive care units of 15 developing countries: findings of the International Nosocomial Infection Control Consortium (INICC)

Rosenthal, Víctor D.; Todi, Subhash; Álvarez-Moreno, Carlos; Pawar, Mandakini; Karlekar, Anil; Zeggwagh, Amine Ali; Mitrev, Zan; Udwadia, Farokh; Navoa-Ng, Josephine Anne; Chakravarthy, Murali; Salomão, Reinaldo; Sahu, Samir; Dilek, Ahmet; Kanj, Souha S.; Garcell, Humberto Guanche; Cuéllar, Luis; Ersöz, Gülden; Yalcin, Ata Nevzat; Jaggi, Namita; Medeiros, Eduardo Alexandrino; Ye, G.; Akan, Özay Arıkan; Mapp, Trudell; Castaneda-Sabogal, Alex; Matta-Cortés, Lorena; Sırmatel, Fatma; Olarte, Narda; Torres-Hernández, Héctor; Barahona-Guzmán, Nayide; Fernández-Hidalgo, Rosalía; Villamil-Gómez, Wilmer E.; Sztokhamer, D.; Forciniti, S.; Berba, Regina; Turgut, H.; Cao, Bin; Yang, Yun; Pérez-Serrato, Irma; Lastra, Carlos Esteban; Singh, Sanjeev; Özdemir, Davut; Ulusoy, Sercan; Members, Inicc

doi:10.1007/s15010-012-0278-x

Cited by 92 publications

(52 citation statements)

References 26 publications

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“…2,24 First, catheters are sometimes placed solely to obtain a urine sample for analysis or culture. In such cases, a patient who cannot provide a clean urine sample should be temporarily catheterized for a sample ("straight cath").…”

Section: Discussionmentioning

confidence: 99%

Urinary Catheter Use and Appropriateness in U.S. Emergency Departments, 1995–2010

Schuur

Chambers

Hou

2014

Academic Emergency Medicine

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Objectives: Catheter-associated urinary tract infection (CAUTI) is the most prevalent hospital-acquired infection, yet little is known about emergency department (ED) use of urinary catheters. The objective was to describe use of urinary catheters in U.S. EDs and determine the proportion that was potentially avoidable.Methods: The National Hospital Ambulatory Medical Care Survey (NHAMCS), a weighted probability sample of U.S. ED visits, was analyzed from 1995 through 2010 for use of urinary catheters in adults. Use of a urinary catheter was a specific chart review element and was classified as potentially avoidable if none of the Centers for Disease Control and Prevention (CDC) list of appropriate indications were met by ED visit diagnoses or patient disposition. Annual frequency of urinary catheter use and appropriateness were calculated. Predictors of ED-placed urinary catheters for admitted patients were assessed with multivariate logistic regression. Results:The annual rate of ED-placed urinary catheters varied from 2.2 to 3.3 per 100 adult ED visits. Among admitted patients, 8.5% (95% confidence interval [CI] = 8.0% to 9.1%) received urinary catheters; 64.9% (95% CI = 56.9% to 72.9%) were potentially avoidable. Among discharged patients 1.6% (95% CI = 1.5% to 1.7%) received urinary catheters. There was no significant trend over time in the use of urinary catheters or potentially avoidable urinary catheters (PAUCs). Predictors of catheter use in admitted patients included indicators of patient severity, female sex, and race/ethnicity. Hospital characteristics predicting catheter use included region, ownership type, and urban location. Predictors of potentially avoidable urinary catheter use were lower patient severity, female sex, care by a midlevel practitioner, and nonurban location.Conclusions: Reducing use of urinary catheters outside of CDC guideline criteria in ED patients is a promising strategy to reduce CAUTIs.ACADEMIC EMERGENCY MEDICINE 2014; 21:292-300

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Section: Discussionmentioning

confidence: 99%

Urinary Catheter Use and Appropriateness in U.S. Emergency Departments, 1995–2010

Schuur

Chambers

Hou

2014

Academic Emergency Medicine

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“…Improved outcomes following implementation of these programs have been reported [15,55-57]. The program for a given institution should be individualized to be relevant to local experience, population characteristics, and resources.…”

Section: Reviewmentioning

confidence: 99%

“…The development and implementation of "bundles" for prevention of catheter acquired urinary tract infections has been described. Introduction of a urinary catheter bundle which included education, catheter insertion and management guidelines, and CA-UTI surveillance, in intensive care units in 15 developing countries was followed by a 37% reduction in CA-UTI rate [15]. A state wide initiative in Michigan introduced a CA-UTI bundle with specific practical recommendations addressing implementation under the concepts of "engage and educate", "execute" and "evaluate" [59].…”

Section: Reviewmentioning

confidence: 99%

Catheter associated urinary tract infections

Nicolle

2014

Antimicrob Resist Infect Control

456

405

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Urinary tract infection attributed to the use of an indwelling urinary catheter is one of the most common infections acquired by patients in health care facilities. As biofilm ultimately develops on all of these devices, the major determinant for development of bacteriuria is duration of catheterization. While the proportion of bacteriuric subjects who develop symptomatic infection is low, the high frequency of use of indwelling urinary catheters means there is a substantial burden attributable to these infections. Catheter-acquired urinary infection is the source for about 20% of episodes of health-care acquired bacteremia in acute care facilities, and over 50% in long term care facilities. The most important interventions to prevent bacteriuria and infection are to limit indwelling catheter use and, when catheter use is necessary, to discontinue the catheter as soon as clinically feasible. Infection control programs in health care facilities must implement and monitor strategies to limit catheter-acquired urinary infection, including surveillance of catheter use, appropriateness of catheter indications, and complications. Ultimately, prevention of these infections will require technical advances in catheter materials which prevent biofilm formation.

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“…The situation is similar in Vietnam and many other resource-limited countries, where policies often exist to regulate antibiotic use but enforcement is insufficient or lacking[66]. Such unregulated antibiotic use contributes to development of antibiotic resistance [25, 44], made worse through crowded hospital and clinic conditions and low rates of hand hygiene[67–69]. …”

Section: Global Factors Contributing To Antimicrobial Resistance and mentioning

confidence: 99%

Antibiotic Use and Emerging Resistance: How Can Resource-Limited Countries Turn the Tide?

2014

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Antibiotic resistance is a global crisis driven by appropriate and inappropriate antibiotic use to treat human illness and promote animal growth. The antimicrobial resistance epidemic continues to spread due to the triple threat of unfettered access, minimal product regulation and oversight of antibiotic prescription, and lack of clinical diagnostic tools to support antibiotic de-escalation in low-resource settings. In high-resource settings, evidence-based strategies have improved appropriateness of antibiotic use, limiting the spread of drug-resistant organisms and reducing hospital-associated infections, which may also be effective to stop the spread of resistance in resource-poor countries. Current research and surveillance efforts on antimicrobial resistance and hospital-associated infections in low-resource settings are extremely limited, largely focused intensive care units. Many challenges exist to improving antibiotic use and infection control in resource-limited settings, and turning the tide requires intensifying research and surveillance, antimicrobial stewardship, and developing new bedside diagnostic tools for bacterial infections and antimicrobial susceptibility.

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Impact of a multidimensional infection control strategy on catheter-associated urinary tract infection rates in the adult intensive care units of 15 developing countries: findings of the International Nosocomial Infection Control Consortium (INICC)

Abstract: Our study showed that the implementation of a multidimensional infection control strategy is associated with a significant reduction in the CAUTI rate in AICUs from developing countries.

Cited by 92 publications

References 26 publications

Urinary Catheter Use and Appropriateness in U.S. Emergency Departments, 1995–2010

Urinary Catheter Use and Appropriateness in U.S. Emergency Departments, 1995–2010

Catheter associated urinary tract infections

Antibiotic Use and Emerging Resistance: How Can Resource-Limited Countries Turn the Tide?

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