Sustainability of a program for continuous reduction of catheter-associated urinary tract infection

Abstract

Background: Urinary tract infections account for 8%-21% of health care-associated infections; of these, 80% are associated with the use of a urinary catheter.

Methods: A quasi-experimental study was conducted in 2 medical-surgical intensive care units (ICUs) with 48 beds and 3 step-down units (SDUs) with 95 beds in a private tertiary care hospital in Sao Paulo, Brazil. The study had 3 phases over a 9-year period to determine the sustainability of a program for continuous reduction of catheter-associated urinary tract infection (CAUTI).

Results: Over the 3 phases of the study, rates of CAUTI in the ICUs fell from 7.0 to 3.5 to 0.9 infections per 1,000 catheter days. In the SDUs, CAUTI rates decreased from 14.9 to 6.6 to 1.0 per 1,000 catheter days. Comparisons of CAUTI rates in the 3 study phases, both in the ICUs and SDUs, showed significant reductions both between the 3 periods and in all possible combinations of analysis phases (all P < .001).

Conclusions: These results suggest that it is possible to reduce CAUTI rates to near zero and sustain these rates, but it requires a multidisciplinary team with different strategies that require continuous monitoring.

Keywords: Catheter-associated urinary tract infection; health care–associated infection prevention; urinary catheter.