Preventing catheter-associated urinary tract infection in the zero-tolerance era

被引:41
作者
Marra, Alexandre R. [1 ]
Sampaio Camargo, Thiago Zinsly [1 ]
Goncalves, Priscila [2 ]
Sogayar, Ana Maria Cristina B. [1 ]
Moura, Denis Faria, Jr. [1 ]
Guastelli, Luciana Reis [1 ]
Alves Rosa, Carla Andrea C. [1 ]
Victor, Elivane da Silva [3 ]
Pavao dos Santos, Oscar Fernando [1 ]
Edmond, Michael B. [4 ]
机构
[1] Hosp Israelita Albert Einstein, Intens Care Unit, BR-05651901 Sao Paulo, Brazil
[2] Hosp Israelita Albert Einstein, Infect Control Unit, BR-05651901 Sao Paulo, Brazil
[3] Inst Israelita Ensino & Pesquisa, Dept Stat, Sao Paulo, Brazil
[4] Virginia Commonwealth Univ, Sch Med, Dept Internal Med, Richmond, VA USA
关键词
Health care-associated infection prevention; urinary catheter; intensive care; step-down unit; NOSOCOMIAL INFECTIONS; ADVERSE EVENTS; SURVEILLANCE; COST;
D O I
10.1016/j.ajic.2011.01.013
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background: Catheter-associated urinary tract infection (CAUTI) is one of the most common health care. associated infections in the critical care setting. Methods: A quasi-experimental study involving multiple interventions to reduce the incidence of CAUTI was conducted in a medical-surgical intensive care unit (ICU) and in 2 step-down units (SDUs). Between June 2005 and December 2007 (phase 1), we implemented some Centers for Disease Control and Prevention. recommended evidence-based practices. Between January 2008 and July 2010 (phase 2), we intervened to improve compliance with these practices at the same time that performance monitoring was being done at the bedside, and we implemented the Institute for Healthcare Improvement's bladder bundle for all ICU and SDU patients requiring urinary catheters. Results: There was a statistically significant reduction in the rate of CAUTI in the ICU, from 7.6 per 1,000 catheter-days (95% confidence interval [CI], 6.6-8.6) before the intervention to 5.0 per 1,000 catheter-days (95% CI, 4.2-5.8; P < .001) after the intervention. There also was a statistically significant reduction in the rate of CAUTI in the SDUs, from 15.3 per 1,000 catheter-days (95% CI, 13.9-16.6) before the intervention to 12.9 per 1,000 catheter-days (95% CI, 11.6-14.2) after the intervention (P = .014). Conclusion: Our findings suggest that reducing CAUTI rates in the ICU setting is a complex process that involves multiple performance measures and interventions that can be applied to SDU settings as well.
引用
收藏
页码:817 / 822
页数:6
相关论文
共 20 条
[1]  
[Anonymous], 2009, GUIDELINE PREVENTION
[2]   Initial inappropriate urinary catheters use in a tertiary-care center: Incidence, risk factors, and outcomes [J].
Apisarnthanarak, Anucha ;
Rutjanawech, Sasinuj ;
Wichansawakun, Sanit ;
Ratanabunjerdkul, Hataiwan ;
Patthranitima, Patarawin ;
Thongphubeth, Kanokporn ;
Suwannakin, Akeruetai ;
Warren, David K. ;
Fraser, Victoria J. .
AMERICAN JOURNAL OF INFECTION CONTROL, 2007, 35 (09) :594-599
[3]   Eliminating catheter-related bloodstream infections in the intensive care unit [J].
Berenholtz, SM ;
Pronovost, PJ ;
Lipsett, PA ;
Hobson, D ;
Earsing, K ;
Farley, JE ;
Milanovich, S ;
Garrett-Mayer, E ;
Winters, BD ;
Rubin, HR ;
Dorman, T ;
Perl, TM .
CRITICAL CARE MEDICINE, 2004, 32 (10) :2014-2020
[4]   Getting to Zero: Is It Safe? [J].
Edmond, Michael B. .
INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY, 2009, 30 (01) :74-76
[5]   CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting [J].
Horan, Teresa C. ;
Andrus, Mary ;
Dudeck, Margaret A. .
AMERICAN JOURNAL OF INFECTION CONTROL, 2008, 36 (05) :309-332
[6]   Decline in ICU adverse events, nosocomial infections and cost through a quality improvement initiative focusing on teamwork and culture change [J].
Jain, M. ;
Miller, L. ;
Belt, D. ;
King, D. ;
Berwick, D. M. .
QUALITY & SAFETY IN HEALTH CARE, 2006, 15 (04) :235-239
[7]   Systematic review: Antimicrobial urinary catheters to prevent catheter-associated urinary tract infection in hospitalized patients [J].
Johnson, JR ;
Kuskowski, MA ;
Wilt, TJ .
ANNALS OF INTERNAL MEDICINE, 2006, 144 (02) :116-126
[8]   A randomized crossover study of silver-coated urinary catheters in hospitalized patients [J].
Karchmer, TB ;
Giannetta, ET ;
Muto, CA ;
Strain, BA ;
Farr, BM .
ARCHIVES OF INTERNAL MEDICINE, 2000, 160 (21) :3294-3298
[9]  
Lo Evelyn, 2008, Infect Control Hosp Epidemiol, V29 Suppl 1, pS41, DOI 10.1086/591066
[10]   Successful prevention of ventilator-associated pneumonia in an intensive care setting [J].
Marra, Alexandre R. ;
Rodrigues Cal, Ruy Guilherme ;
Silva, Claudia Vallone ;
Caserta, Raquel Afonso ;
Paes, Angela Tavares ;
Moura, Denis Faria, Jr. ;
Pavao dos Santos, Oscar Fernando ;
Edmond, Michael B. ;
Durao, Marcelino Souza .
AMERICAN JOURNAL OF INFECTION CONTROL, 2009, 37 (08) :619-625