International Nosocomial Infection Control Consortium, Avenue Corrientes4580,Buenos Aires, Argentina.
Infect Control Hosp Epidemiol. 2012 Jul;33(7):696-703. doi: 10.1086/666341. Epub 2012 May 24.
A before-after prospective surveillance study to assess the impact of a multidimensional infection control approach for the reduction of catheter-associated urinary tract infection (CAUTI) rates.
Pediatric intensive care units (PICUs) of hospital members of the International Nosocomial Infection Control Consortium (INICC) from 10 cities of the following 6 developing countries: Colombia, El Salvador, India, Mexico, Philippines, and Turkey.
PICU inpatients.
We performed a prospective active surveillance to determine rates of CAUTI among 3,877 patients hospitalized in 10 PICUs for a total of 27,345 bed-days. The study was divided into a baseline period (phase 1) and an intervention period (phase 2). In phase 1, surveillance was performed without the implementation of the multidimensional approach. In phase 2, we implemented a multidimensional infection control approach that included outcome surveillance, process surveillance, feedback on CAUTI rates, feedback on performance, education, and a bundle of preventive measures. The rates of CAUTI obtained in phase 1 were compared with the rates obtained in phase 2, after interventions were implemented.
During the study period, we recorded 8,513 urinary catheter (UC) days, including 1,513 UC-days in phase 1 and 7,000 UC-days in phase 2. In phase 1, the CAUTI rate was 5.9 cases per 1,000 UC-days, and in phase 2, after implementing the multidimensional infection control approach for CAUTI prevention, the rate of CAUTI decreased to 2.6 cases per 1,000 UC-days (relative risk, 0.43 [95% confidence interval, 0.21-1.0]), indicating a rate reduction of 57%.
Our findings demonstrated that implementing a multidimensional infection control approach is associated with a significant reduction in the CAUTI rate of PICUs in developing countries.
一项前后瞻性监测研究，旨在评估一种多维感染控制方法对降低导管相关性尿路感染（CAUTI）率的影响。
该研究在来自六个发展中国家的 10 个城市的国际医院感染控制联盟（INICC）成员的儿科重症监护病房（PICU）进行，这些国家包括哥伦比亚、萨尔瓦多、印度、墨西哥、菲律宾和土耳其。
PICU 住院患者。
我们进行了前瞻性主动监测，以确定在 10 个 PICU 中住院的 3877 名患者的 CAUTI 发生率，总共有 27345 个床位日。该研究分为基线期（第 1 阶段）和干预期（第 2 阶段）。在第 1 阶段，在未实施多维方法的情况下进行监测。在第 2 阶段，我们实施了多维感染控制方法，包括结局监测、过程监测、CAUTI 发生率反馈、绩效反馈、教育和一整套预防措施。在实施干预措施后，将第 1 阶段获得的 CAUTI 率与第 2 阶段获得的 CAUTI 率进行比较。
在研究期间，我们记录了 8513 个导尿管（UC）日，其中第 1 阶段有 1513 个 UC 日，第 2 阶段有 7000 个 UC 日。在第 1 阶段，CAUTI 发生率为每 1000 个 UC 日 5.9 例，在第 2 阶段，实施多维感染控制方法预防 CAUTI 后，CAUTI 发生率降至每 1000 个 UC 日 2.6 例（相对风险，0.43[95%置信区间，0.21-1.0]），表明发生率降低了 57%。
我们的研究结果表明，在发展中国家实施多维感染控制方法与显著降低 PICU 的 CAUTI 率相关。
