EFFECT OF INFECTION CONTROL PROGRAM ON CATHETER ASSOCIATED URINARY TRACT INFECTION IN INTENSIVE CARE UNITS AT ZAGAZIG UNIVERSITY HOSPITAL
Abstract
ABSTRACT
Background: Catheter-associated urinary tract infection produces substantial morbidity in hospitalized
patients including discomfort, fever, malaise and unnecessary antibiotic use, which may become an
important source of antibiotic resistant organisms. Further, the catheterized urinary tract acts as a reservoir
for the dissemination of these drug resistant organisms to other patients.
Aim of the study: was to improve the safety of intensive care unit (ICU) patients with urinary catheter via
decreasing the incidence of catheter-associated urinary tract infection (CAUTI) at Zagazig University
Hospital through assessment of knowledge and practice of ICU staff about catheter associated infection and
assessment of the incidence of CAUTI among ICU patients in Zagazig University Hospital and
implementation of Infection Control Program in the selected ICUs.
Subjects and methods: An interventional study (one-group pre-test post-test design) was conducted during
the period from 2016 to 2018 at Zagazig university Hospital in two ICUs; surgical and emergency intensive
care units. The study was carried out through two phases; the first included the followings: active electronic
surveillance for (CAUTI); assessment of health care providers' knowledge about CAUTI before and after
intervention through constructed questionnaire and assessment of health care providers' practice before and
after intervention by using performance observation checklist. The second phase, included implementation of
infection control program based on the conceptual model of Comprehensive Unit-based Safety Program
(CUSP).
Results: There was a high statistical significant increase in knowledge of resident physicians and nurses
about guidelines for prevention of catheter associated urinary tract infection in the studied intensive care
units after intervention (P ˂0.01). There was high statistical significant improvement in urinary
catheterization practice in the studied intensive care units after intervention (P ˂0.01). Regarding incidence
of CAUTI, before intervention, CAUTI incidence was 10.6 per 1000 urinary catheter days. After
intervention, CAUTI incidence significantly dropped to 5.4 per 1000 urinary catheter days. Risk of CAUTI
before intervention was approximately twice that after intervention. The intervention reduced risk of CAUTI
by 49.1%. Regarding isolated pathogens associated with reported CAUTI, the most frequent isolated
pathogens were Klebsiella spp. (31.4%), followed by Candida albicans (21.4%), Pseudomonas spp. (14.3%)
and E. coli (12.9%)
Conclusion: At Zagazig university hospitals’ ICUs, implementation of infection control program on CAUTI
was noticed to be associated with improvement in healthcare providers’ knowledge and practice and
decrease in CAUTI incidence. Sustainability is required to maintain such improvement. So. It is
recommended to keep continuous training of ICU staff and upgrade ICU protocols according to recent
guidelines.
Keywords: Infection Control, Catheter Associated Urinary Tract Infection, Intensive Care Unit
Background: Catheter-associated urinary tract infection produces substantial morbidity in hospitalized
patients including discomfort, fever, malaise and unnecessary antibiotic use, which may become an
important source of antibiotic resistant organisms. Further, the catheterized urinary tract acts as a reservoir
for the dissemination of these drug resistant organisms to other patients.
Aim of the study: was to improve the safety of intensive care unit (ICU) patients with urinary catheter via
decreasing the incidence of catheter-associated urinary tract infection (CAUTI) at Zagazig University
Hospital through assessment of knowledge and practice of ICU staff about catheter associated infection and
assessment of the incidence of CAUTI among ICU patients in Zagazig University Hospital and
implementation of Infection Control Program in the selected ICUs.
Subjects and methods: An interventional study (one-group pre-test post-test design) was conducted during
the period from 2016 to 2018 at Zagazig university Hospital in two ICUs; surgical and emergency intensive
care units. The study was carried out through two phases; the first included the followings: active electronic
surveillance for (CAUTI); assessment of health care providers' knowledge about CAUTI before and after
intervention through constructed questionnaire and assessment of health care providers' practice before and
after intervention by using performance observation checklist. The second phase, included implementation of
infection control program based on the conceptual model of Comprehensive Unit-based Safety Program
(CUSP).
Results: There was a high statistical significant increase in knowledge of resident physicians and nurses
about guidelines for prevention of catheter associated urinary tract infection in the studied intensive care
units after intervention (P ˂0.01). There was high statistical significant improvement in urinary
catheterization practice in the studied intensive care units after intervention (P ˂0.01). Regarding incidence
of CAUTI, before intervention, CAUTI incidence was 10.6 per 1000 urinary catheter days. After
intervention, CAUTI incidence significantly dropped to 5.4 per 1000 urinary catheter days. Risk of CAUTI
before intervention was approximately twice that after intervention. The intervention reduced risk of CAUTI
by 49.1%. Regarding isolated pathogens associated with reported CAUTI, the most frequent isolated
pathogens were Klebsiella spp. (31.4%), followed by Candida albicans (21.4%), Pseudomonas spp. (14.3%)
and E. coli (12.9%)
Conclusion: At Zagazig university hospitals’ ICUs, implementation of infection control program on CAUTI
was noticed to be associated with improvement in healthcare providers’ knowledge and practice and
decrease in CAUTI incidence. Sustainability is required to maintain such improvement. So. It is
recommended to keep continuous training of ICU staff and upgrade ICU protocols according to recent
guidelines.
Keywords: Infection Control, Catheter Associated Urinary Tract Infection, Intensive Care Unit
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