Catheter Associated Urinary Tract Infection

Catheter-associated urinary tract infection: infection control practices in a Brazilian intensive care unit

Marina Gabriella Pereira de Andrada Magalhães,1,2, Tomaz Christiano de Albuquerque Gomes2, Moacir Batista Jucá2, Lívia Alves de Medeiros2, Ludmila Medeiros Outtes Alves2, Paulo André Freire Magalhães1, Veridiana Frutuoso Coelho2, Maria do Carmo1

1Instituto de Medicina Integral Prof. Fernando Figueira - IMIP, Department of Maternal-Child Health

2Hospital São Marcos, Department of Hospital Infection Control, Avenida Portugal, 52 - Boa Vista, Recife - PE, 52010-010

INTRODUCTION: Catheter-associated urinary tract infections (CAUTI) are one of the most common infections acquired by patients in intensive care unit (ICU). The medical literature has consistently linked inappropriate use and longer duration of urinary catheter (UC) with the development of CAUTI, other risk factors include inappropriate care of the UCs. OBJECTIVES: Describe the infection control practices used to reduce CAUTI on a Brazilian ICU. METHODS: Study carried out in an adult ICU with 20 beds in a general hospital in the city of Recife, Brazil, from January 2011 to December 2014. During the intervention period, were implemented the CAUTI bundle, including check list of aseptic insertion, sterile catheter maintenance, closed drainage system, positioning of the drainage tube below the level of the bladder, anchoring of the UC and education of staff to reduce the inappropriate catheterization. Nurses played a central role in both the daily inspection of the bundle (by shift, with double-checking of the infection control service) as prompting removal of unnecessary UCs. At the end of each month, the infections cases were analyzed with the multidisciplinary staff, including the rate and median time of use of UCs, as well as the infections were presented as feedback to keep the ICU staff's efforts. RESULTS: In initial observation was revealed a high rate of unnecessary UC use, but over the following 3 years, this combination of interventions led to an 46% reduction in UC use and a 95% reduction in acquired CAUTI, as shown on Table 1.

Table 1. ID of CAUTI after bundles implementation.

Variable	2011	2012	2013	2014
Adherence to the CAUTI Bundle (%)	-	42,51	89,96	94,23
Median time of UC use (days)	-	-	6	4
Incidence density of CAUTI (per 1000 catheter-days)	22,83	8,13	2,08	1,17
Utilization rate of UC (%)	62,42	42,78	32,98	33,75

CONCLUSIONS: To decrease the rate of catheter-associated infections in a ICU, removal of the bladder catheter must be performed as soon as possible. The combination of staff education, CAUTI bundle and reducing the use and duration of UCs were effective on decreased the ID of CAUTI. Infection control programs in health care facilities must implement and monitor strategies to limit CAUTI, including surveillance of catheter use, appropriateness of indications and appropriate maintenance.

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