Effect of instruction and implementation of a preventive urinary tract infection bundle on the incidence of catheter associated urinary tract infection in intensive care unit patients
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Instructor, Department of Nursing, Fatemeh Nursing and Midwifery school, Shiraz University of Medical Sciences, Shiraz, Iran
Master student of critical care nursing, Fatemeh Nursing and Midwifery school, Shiraz University of Medical Sciences. Shiraz, Iran
MD, Professor, Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences. Shiraz, Iran
Assistant professor, Community based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Assistant professor, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
International Nosocomial Infection Control Consersium (INICC)
Online publication date: 2018-08-08
Publication date: 2019-04-22
Electron J Gen Med 2019;16(2):em131
Background and Objective:
Catheter Associated Urinary Tract infection (CAUTI) is one of the most prevalent hospital acquired infections which causes increased medical costs, hospital stay and mortality. Patients in critical care units are in a higher risk. The main purpose of the present study is the Identification of the effect of instruction and implementation of a preventive urinary tract infection bundle on the incidence of CAUTI.

Materials and Methods:
This was a before-after quasi-experimental study. 330 patients were included (185 patients in before and 145 in after the intervention). In both phases, the incidence of CAUTI, compliance with principles of CAUTI prevention, urinary catheter utilization and indications of catheter insertion were evaluated. CAUTI was identified based on the Center for Disease Control and Prevention/ National Healthcare Safety Network (CDC/NHSN) criteria with the online INICC software. Interventions included the instruction of the bundle to all health care workers in selected intensive care units and implementing interventions to improve facilities required for the implementation of the bundle.

No significant decrease was seen in the incidence of the CAUTI after the intervention (3.2 v/s 1.36 in 1000 catheter-day, p<0.388). The most prevalent indication for urinary catheter utilization in both phases, were critical monitoring of urine output (80.16% and 72.26%, respectively). Before the intervention, 1.6 % of catheterized cases were labeled inappropriate by the physicians. This increased significantly to 5.5% after intervention (P<0.001). Before the intervention, 37.5% of the catheters which were labeled inappropriate were removed which increased to 42/4% after the intervention insignificantly (P<0/709). From the 88 hours of compliance monitoring. The number of observed noncompliance cases before the intervention, which was 1941, decreased significantly after the intervention (P<.001).

This study revealed that although instruction and implementation of the preventive bundle reduced CAUTI, this reduction was not significant. Future studies should be conducted with larger sample sizes and in longer periods. The most prevalent criterion for urinary catheter utilization was the need for critical monitoring of urine output. Instruction of the bundle reduced noncompliance with principles of urinary tract infection control.

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