Chih-Cheng Lai1, Chun-Ming Lee2, Hsiu-Tzy Chiang3, Ching-Tzu Hung4, Ying-Chun Chen5, Li-Hsiang Su6, Zhi-Yuan Shi7, Jein-Wei Liu8, Chang-Pan Liu9, Min-Chi Lu10, Yin-Ching Chuang11, Wen-Chien Ko12, Shu-Hui Tseng13, Yen-Hsu Chen14, Po-Ren Hsueh15. 1. Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan. 2. Department of Internal Medicine, St. Joseph's Hospital, Yunlin County, Taiwan; Division of Infectious Disease, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan; Infection Control Center, MacKay Memorial Hospital, Taipei, Taiwan. 3. Infection Control Center, MacKay Memorial Hospital, Taipei, Taiwan. 4. Center of Infection Control, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. 5. Center of Infection Control, Taichung Veterans General Hospital, Taichung, Taiwan. 6. Center of Infection Control, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. 7. Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan. 8. Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. 9. Division of Infectious Disease, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Infection Control Center, MacKay Memorial Hospital, Taipei, Taiwan. 10. Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Microbiology and Immunology, School of Medicine, China Medical University, Taichung, Taiwan. 11. Department of Internal Medicine, Chi Mei Hospital, Liouying, Taiwan. 12. Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan; Center of Infection Control, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan. 13. Center for Disease Control, Ministry of Health and Welfare, Taiwan. 14. Center of Infection Control, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; School of Medicine, Graduate Institute of Medicine, Sepsis Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: infchen@gmail.com. 15. Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: hsporen@ntu.edu.tw.
Abstract
BACKGROUND/ PURPOSE: This study was intended to investigate the impact of implementation of catheter-associated urinary tract infection (CA-UTI) bundle care on the incidence of CA-UTI in high-risk units. METHODS: Thirteen high-risk units, including medical (n = 5), surgical (n = 3), cardiac intensive care units (n = 2), respiratory care centers (n = 2), and respiratory care ward (n = 1) were included in this quality-improvement project. This study was divided into pre-intervention phase (from January 1 to July 31) and post-intervention phase (from August 1 to October 31) in 2013. RESULTS: The incidence of CA-UTI decreased by 22.7%, from 3.86 to 2.98 per 1000 catheter-days (95% confidence interval, 0.65-0.82; p < 0.0001) before and after the introduction of the CA-UTI bundle. Among 66 episodes of culture-proven CA-UTIs, Candida spp. were the most common pathogens (n = 17, 25.8%), followed by Escherichia coli (n = 10, 15.2%). For the seven elements of the insertion bundle, the compliance was the lowest for cleaning of the perineum, followed by hand hygiene. The overall compliance rates of the insertion bundle were 93.4%, 99.5%, and 96.3% in medical centers, regional hospitals, and district hospital, respectively. For the six elements of the maintenance bundle, the compliance was the lowest for daily review of the need of a Foley catheter. The overall compliance rates of the maintenance bundle were 95.7%, 99.9%, and 99.9% in medical centers, regional hospitals, and district hospital, respectively. CONCLUSIONS: The implementation of CA-UTI bundle care successfully reduced CA-UTI in Taiwanese high-risk units. A process surveillance checklist can be helpful for understanding which parts of the bundle care require improvements.
BACKGROUND/ PURPOSE: This study was intended to investigate the impact of implementation of catheter-associated urinary tract infection (CA-UTI) bundle care on the incidence of CA-UTI in high-risk units. METHODS: Thirteen high-risk units, including medical (n = 5), surgical (n = 3), cardiac intensive care units (n = 2), respiratory care centers (n = 2), and respiratory care ward (n = 1) were included in this quality-improvement project. This study was divided into pre-intervention phase (from January 1 to July 31) and post-intervention phase (from August 1 to October 31) in 2013. RESULTS: The incidence of CA-UTI decreased by 22.7%, from 3.86 to 2.98 per 1000 catheter-days (95% confidence interval, 0.65-0.82; p < 0.0001) before and after the introduction of the CA-UTI bundle. Among 66 episodes of culture-proven CA-UTIs, Candida spp. were the most common pathogens (n = 17, 25.8%), followed by Escherichia coli (n = 10, 15.2%). For the seven elements of the insertion bundle, the compliance was the lowest for cleaning of the perineum, followed by hand hygiene. The overall compliance rates of the insertion bundle were 93.4%, 99.5%, and 96.3% in medical centers, regional hospitals, and district hospital, respectively. For the six elements of the maintenance bundle, the compliance was the lowest for daily review of the need of a Foley catheter. The overall compliance rates of the maintenance bundle were 95.7%, 99.9%, and 99.9% in medical centers, regional hospitals, and district hospital, respectively. CONCLUSIONS: The implementation of CA-UTI bundle care successfully reduced CA-UTI in Taiwanese high-risk units. A process surveillance checklist can be helpful for understanding which parts of the bundle care require improvements.
Authors: Geni Vg Soundaram; Raja Sundaramurthy; Kathiresan Jeyashree; Vithiya Ganesan; Ramesh Arunagiri; Jhansi Charles Journal: Indian J Crit Care Med Date: 2020-07
Authors: Eric Laborde; Hayden Hill; Thomas E Dukovac; Stephen P Carriere; Kathleen Lata-Arias; Kristi Hebert; Raunak Patel; Jessie Gills Journal: Ochsner J Date: 2021