A multifaceted intervention to reduce rates of catheter-associated urinary tract infections in a resource-limited setting

作者：Tillekeratne L Gayani^*; Linkin Darren R; Obino Mariah; Omar Afua; Wanjiku Mary; Holtzman David; Cohn Jennifer

来源：American Journal of Infection Control, 2014, 42(1): 12-16.

DOI：10.1016/j.ajic.2013.07.007

• Health care-associated infections
• Quality improvement interventions
• Developing settings
• Infection surveillance and prevention

Background: Health care-associated infections such as catheter-associated urinary tract infections (CAUTIs) are prevalent in resource-limited settings. This study was carried out to determine whether a multifaceted intervention targeting health care personnel would reduce CAUTI rates in a public hospital located in a resource-limited setting.
Methods: A one group, pretest-posttest study was carried out from March to July 2012 in a public district hospital in Nairobi, Kenya. Patients admitted to adult medical wards, and who received urinary catheters, were evaluated for symptomatic CAUTIs using a modified definition by the Centers for Disease Control and Prevention. After collecting baseline CAUTI rates for 8 weeks, a multifaceted intervention consisting of lectures, reminder signs, and infection prevention rounds (week 9) was implemented. The postintervention rate of CAUTIs was measured over 7 subsequent weeks. Bivariable analysis was performed to determine whether the intervention was associated with reduced CAUTIs.
Results: A total of 125 patients received urinary catheters, with 82 preintervention and 43 postintervention. Mean duration of catheterization did not change between phases (6.9 vs 5.6 days, respectively, P - .322), but catheter utilization ratio decreased from 0.14 to 0.09 (P < .001). There were 13 preintervention CAUTIs (for 30.4 infections per 1,000 catheter-days) and no postintervention CAUTIs (P = .002).
Conclusion: In this resource-limited setting, the baseline rate of CAUTIs was high. A low-cost, multifaceted intervention resulted in decreased urinary catheter use and CAUTI rates.

• 出版日期2014-1