American University of Beirut Medical Center, Beirut, Lebanon.
Int J Infect Dis. 2013 Sep;17(9):e686-90. doi: 10.1016/j.ijid.2013.01.020. Epub 2013 Mar 13.
The objective of this study was to assess the impact of a multidimensional infection control approach for the reduction of catheter-associated urinary tract infection (CAUTI) in an adult intensive care unit (ICU) of a hospital member of the International Nosocomial Infection Control Consortium (INICC) in Lebanon.
A before-after prospective active surveillance study was carried out to determine rates of CAUTI in 1506 ICU patients, hospitalized during 10 291 bed-days. The study period was divided into two phases: phase 1 (baseline) and phase 2 (intervention). During phase 1, surveillance was performed applying the definitions of the US Centers for Disease Control and Prevention National Healthcare Safety Network (CDC/NHSN). In phase 2, we adopted a multidimensional approach that included: (1) a bundle of infection control interventions, (2) education, (3) surveillance of CAUTI rates, (4) feedback on CAUTI rates, (5) process surveillance, and (6) performance feedback. We used random effects Poisson regression to account for clustering of CAUTI rates across time-periods.
We recorded a total of 9829 urinary catheter-days: 306 in phase 1 and 9523 in phase 2. The rate of CAUTI was 13.07 per 1000 urinary catheter-days in phase 1, and was decreased by 83% in phase 2 to 2.21 per 1000 urinary catheter-days (risk ratio 0.17; 95% confidence interval 0.06-0.5; p=0.0002).
Our multidimensional approach was associated with a significant reduction in the CAUTI rate.
本研究旨在评估针对减少医院成员成人重症监护病房（ICU）中导管相关尿路感染（CAUTI）的多维感染控制方法的效果，该医院是国际医院感染控制联盟（INICC）的成员之一。
进行了一项前后前瞻性主动监测研究，以确定在黎巴嫩的 1506 名 ICU 患者中，在 10291 个床位日期间的 CAUTI 发生率。研究期间分为两个阶段：第 1 阶段（基线）和第 2 阶段（干预）。在第 1 阶段，应用美国疾病控制与预防中心国家医疗保健安全网络（CDC/NHSN）的定义进行监测。在第 2 阶段，我们采用了一种多维方法，包括：（1）感染控制干预措施包，（2）教育，（3）CAUTI 率监测，（4）CAUTI 率反馈，（5）过程监测，和（6）绩效反馈。我们使用随机效应泊松回归来解释 CAUTI 率在时间段内的聚类。
我们共记录了 9829 个导尿管日：第 1 阶段 306 个，第 2 阶段 9523 个。第 1 阶段的 CAUTI 发生率为每 1000 个导尿管日 13.07 例，第 2 阶段下降了 83%，至每 1000 个导尿管日 2.21 例（风险比 0.17；95%置信区间 0.06-0.5；p=0.0002）。
我们的多维方法与 CAUTI 发生率的显著降低相关。
