ABSTRACT
ABSTRACT BACKGROUND: Urinary tract infections (UTI) are highly preventable and have significant clinical and financial impact on the patient and the health care system. OBJECTIVE: To investigate UTIs in critically ill adult patients and the relationship of antimicrobial consumption and multidrug-resistant isolate. DESIGN AND SETTING: A cohort study performed in a Brazilian tertiary-care university hospital in the city of Uberlandia (MG), located at the Federal University of Uberlandia, southeast region of the country. METHODS: We analyzed a cohort of 363 patients with first episode of UTIs from the adult intensive care unit (ICU), from January 2012 to December 2018. The daily doses of antimicrobial administered were calculated. RESULTS: The incidence rate of UTI was 7.2/1000 patient days, with 3.5/1000 patient-days of bacteriuria, and 2.1/1000 patient-days of candiduria. Of 373 microorganisms identified, 69 (18.4%) were Gram-positive cocci, 190 (50.9%) Gram-negative bacilli, and 114 yeasts (30.7%). Escherichia coli and Candida spp. were the most common. Patients with candiduria had higher comorbidity score (Charlson Comorbidity Index ≥ 3), longer length of stay (P = 0.0066), higher mortality (P = < 0.0001) severe sepsis, septic shock, and were immunocompromised when compared with patients with bacteriuria. We observed correlation between antibiotics consumption and multidrug-resistant (MDR) microorganisms. CONCLUSION: The UTIs incidence was high and was mainly caused by Gram-negative bacteria that were resistant to common antibiotics. We observed increase in the consumption of broad-spectrum antibiotics in ICU correlating with MDR microorganisms. In general, ICU-acquired candiduria may be associated with critical illness and poor prognosis.
ABSTRACT
Urinary tract infections (UTIs) are the most common health-care-associated infections (HCAIs) and one of the top-ranking microbial infections. In the community, about 80% of UTIs are caused by uropathogenic Escherichia coli (UPEC), but there is a high variability of etiological agents involved in hospital-acquired UTIs. With this context in mind, the current study aimed to evaluate the prevalence of the main etiological agents responsible for UTIs and their susceptibility profile at the Hospital das Clínicas de Ribeirão Preto, a high complexity reference hospital in the Southeast region of Brazil. This retrospective and descriptive study analyzed all positive inpatient cultures [100,000 colony-forming unit (CFU)/mL] from November 2016 to April 2017. The most prevalent microorganism was Kleb-siella pneumoniae (23 isolates), equivalent to 37.7% of positive urocultures. The second most prevalent agent was UPEC, with 19 isolates (31.1%). The risk factors evaluated in these inpatients showed that 17.5% underwent a uro-logical procedure on admission, 31.6% were using a urinary catheter; 26.2% were using immunosuppressive drugs during the period in which the clinical diagnosis was made. Our results demonstrate the prevalence of UTI causes in the hospital context and the main risk factors for them and will be pretty helpful in guiding empirical treatment in severe UTIs inside the hospital as well as reflect on the actual need and time duration of invasive procedures in the hospital environmen (AU)
As infecções do trato urinário (IU) são a terceira causa principal de infecções associadas ao ambiente hospitalar, logo após as infecções pulmonares e da corrente sanguínea. Na comunidade, cerca de 80% das IU são causadas por E. coli, mas há uma alta variabilidade de agentes etiológicos envolvidos nas IU hospitalares. Este estudo visa avaliar a prevalência dos principais agentes etiológicos e perfil de suscetibilidade envolvidos em IU em um am-biente hospitalar de referência de alta complexidade no sul do Brasil. Este é um estudo retrospectivo e descritivo que analisou todas as culturas positivas (100.000 ufc/ml) de pacientes nas enfermarias de um hospital terciário no período entre novembro de 2016 a abril de 2017. O microorganismo mais prevalente foi Klebsiella pneumoniae (23 isolados), o que equivale a 37,7% das uroculturas. O segundo agente mais prevalente foi Escherichia coli, com 19 isolados (31,1%). Os fatores de risco avaliados nestes pacientes mostraram que 17,5% foram submetidos a um procedimento urológico na admissão, 31,6% estavam usando um cateter urinário; 26,2% estavam usando drogas imunossupressoras no período em que o diagnóstico clínico foi feito. Nossos resultados demonstram uma mudança importante na prevalência das causas de IU no contexto hospitalar e os principais fatores de risco para elas e serão bastante úteis para orientar o tratamento empírico em IU grave dentro do hospital, bem como refletir sobre a real necessidade e a duração dos procedimentos invasivos no ambiente hospitalar (AU)
Subject(s)
Humans , Urinary Tract Infections , Escherichia coli , Urinary Catheters , Immunosuppressive Agents , Klebsiella pneumoniaeABSTRACT
Objective:To probe into the influence of adhesive tape and string fixation on postoperative catheter-associated urinary tract infection(CAUTI) and comfort degree of patients undergoing percutaneous nephrolithotomy.Methods:A total of 106 cases of male urinary tract calculi patients undergoing percutaneous nephrolithotomy in Urology Department of First Affiliated Hospital of Zhengzhou University from January 2018 to April 2019 were selected. They were divided into the experimental group (55 cases) and the control group (51 cases) by random digits tbale method. The control group received platform fixation method, the experimental group implemented adhesive tape and string fixation method for catheter fixation. The incidence of CAUTI were compared between two groups, the catheter exposed length changes and catheter-related discomfort changes was also compared.Results:The incidence of CAUTI were 3.9%(2/51) in the experimental group, significantly lower than 16.7%(8/48) in the control group, the difference was statistically significant ( χ2=4.42, P<0.05). After 3 days, 5 days and 7 days of indwelling catheter, the catheter exposed length were (17.76 ± 1.41), (17.12 ± 1.28), (16.49 ± 1.63) cm, significantly longer than those in the control group (16.04 ± 1.96), (15.81 ± 1.78), (15.29 ± 1.96) cm ( t=5.00, 4.17, 3.32, all P<0.05); the catheter-related discomfort symptom scores at above mentioned time were 0.82 ± 0.09, 0.53 ± 0.07, 0.49 ± 0.08, significantly lower than those in the control group (1.17 ± 0.23, 0.92 ± 0.09, 0.77 ± 0.11), the differences were statistically significant ( t=2.10, 2.88, 2.46, all P<0.05). Conclusions:Adhesive tape and string fixation method for catheter fixation can reduce the incidence of CAUTI of patients with urinary tract calculi, improve the catheter fixed state as well as reduce the patient′s catheter-related discomfort.
ABSTRACT
Objective:To investigate the clinical effect of cluster nursing on the prevention of perioperative urinary catheter associated urinary tract infection (CAUTI) in patients with spinal fracture.Methods:A retrospective case-control method was used to select 160 patients with spinal fracture admitted to the department of spinal cord injury in emergency care from January 2018 to March 2020 in the Department of Orthopaedics General Hospital of Chinese People′s Liberation Army as study subjects, 80 patients admitted to the department of spinal cord injury from January to December 2018 were set as the control group, and 80 patients admitted from January 2019 to March 2020 as the observation group. The control group was given standardized clinical nursing measures during the perioperative period, while the observation group was given cluster nursing measures. The duration of indwelling of catheters, the incidence of catheter reinsertion and the incidence of CAUTI were compared between the two groups.Results:The catheter indwelling time in the observation group was (3.37±0.64) days, lower than that in the control group (6.35±1.52) days. The incidence of catheter insertion and CAUTI was 5.00%(4/80), 3.80%(3/80) in the observation group, lower than 11.30%(9/80), 11.60%(13/80) in the control group. The differences were statistically significant ( χ2 values were -2.927, -2.654, all P<0.05). Conclusions:Cluster nursing intervention for patients with spinal fracture in the perioperative period can effectively shorten the catheter indwelling time, reduce the incidence of catheter re-insertion and the incidence of patients with CAUTI, significantly improve the quality of clinical care in the department, and have positive significance for the treatment and rehabilitation of patients.
ABSTRACT
Background: present study is done to study the antibiotic-sensitivity and resistance pattern of bacteria causing catheter associated urinary tract infection. Objectives of this study were to study the bacterial etiology of CAUTI, to study the prevalence of various bacteria causing catheter associated urinary tract infection, the antibiogram (sensitivity and resistance) pattern of isolated bacteria and the percentage of asymptomatic bacteriuria in the study population.Methods: In this prospective observational study, under aseptic precautions, urine sample was taken after 48 hours of catheterization and sent for culture and sensitivity pattern is studied.Results: In this study 500 urine samples were cultured and its antibiotic sensitivity pattern was observed. Out of the 53 culture positive samples most the subjects had asymptomatic bacteriuria. The study gave the incidence of catheter associated urinary tract infection (CAUTI) to be 10.6% and about 9% were polymicrobial. In this study about 7 causative bacteria were isolated. Escherichia coli were the most common organism that was isolated. On studying the antibiotic susceptibility pattern of each isolate, it has been observed that all of them are multidrug resistant and the sensitivity pattern is migrating towards higher antibiotics.Conclusions: Empirical use of antibiotics must be avoided and antibiotics must be used only after sensitivity testing. This will help in selection of the appropriate antibiotic for therapeutic use and prevent indiscriminate and irrational use of antibiotics. This will also improve the cost efficiency and decrease the duration of hospital stay.
ABSTRACT
BACKGROUND: Ureteral stents have been extensively applied In the stenosis In the conjunction of the renal pelvis and ureter, the reconstruction of in situ urine flow, ureter or nephroscope lithotripsy, renal transplant, and tumors. However, the long-term retention of ureteral stents can induce catheter-associated urinary tract Infection complications. OBJECTIVE: To Investigate the morphological characteristics of bacterial blofilm on ureteral stent, and to analyze the features of pathogenic distribution and antimicrobial drug resistance to bacterial biofilm. METHODS: Specimens of ureteral stent were collected from 127 patients at Yongchuan Hospital, Chongqing Medical University between January and December 2016. The morphological characteristics of bacterial blofilm on the stent were observed under scanning electron microscope. Each specimen was divided Into three parts (renal pelvis, ureter and bladder) for screening biofilm-forming bacteria strains separately by Congo red medium. The urine was bacterially cultured. Drug susceptibility test was done with the collected biofilm-forming bacteria strains. The study was approved by the Ethics Committee of Yongchuan Hospital, Chongqing Medical University (approval No. 201422). RESULTS AND CONCLUSION: (1) Bacterial blofilm was observed on the surface of ureteral stents at 7,15 and 30 days of retention, with various numbers of inflammatory attachments or crystals. Bacteria on the bacterial biofilm were embraced by large amounts of fiber membranes. Patchy bacterial colonies were observed on the surface of the ureteral stent at 7 and 15 days of retention, which mainly focused on bacillus. Heap-shaped bacterial colonies were found on the surface of ureteral stents that were retained for 30 days, which mainly were bacillus and coccus. (2) A total of 106 bacterial blofilms were detected in the ureteral stent samples obtained from 127 patients. The positive rate was 83.5%, in which the bladder section had the highest positive rate, followed by the renal pelvis section and ureter section. There were 25 copies of positive urine culture, and the positive rate was 19.7%. The strains obtained from the bacterial biofilm on each section of the ureteral stents were significantly higher than that from the urine bacteria culture (P < 0.05). (3) A total of 227 strains were detected from 106 positive samples. Among these samples, the number of Gram-negative strains was significantly higher than that of Gram-positive strains (P < 0.05). Among culture bacteria of the bacterial biofilm on the ureteral stent and urine culture bacteria, colibacillus, pseudomonas aeruginosa, enterococcus faecalis and enterococcus faecium were the most common. (4) The biofilm-forming bacteria on the ureteral stent had a high drug resistance. (5) In summary, bacterial blofilm may be the important reason for catheter-associated urinary tract infection.
ABSTRACT
Healthcare-associated infections (HAI) are preventable in up to 30% of patients with evidence-based infection prevention and control (IPC) activities. IPC activities require effective surveillance to generate data for the HAI rates, defining priority areas, identifying processes amenable for improvement and institute interventions to improve patient's safety. However, uniform, accurate and standardised surveillance methodology using objective definitions can only generate meaningful data for effective execution of IPC activities. The highly exhaustive, complex and ever-evolving infection surveillance methodology pose a challenge for effective data capture, analysis and interpretation by ground level personnel. The present review addresses the gaps in knowledge and day-to-day challenges in surveillance faced by infection control team for effective implementation of IPC activities.
ABSTRACT
Artificial conduits, including ureteral stents and catheters, are used widely as drainage tools in the urinary system. However, various bacteria in the urine and long duration of insertion can arouse the biofilm formation on the pipeline surface, which calls for effective antibacterial strategy. In this article, the mechanism of Catheter Associated Urinary Tract Infections (CAUTI) is explained from the perspective of etiology. Then, the biofilm formation conditions and the features of urine are analyzed, the antibacterial agents and approaches suitable for ureteral stents and catheters are introduced and their pros and cons are discussed respectively.
Subject(s)
Humans , Anti-Bacterial Agents , Catheters , Drainage , Stents , Urinary Catheterization , Urinary Tract InfectionsABSTRACT
Objective To develop a scale of catheter-associated urinary tract infection (CAUTI) knowledge-attitude-practice (KAP) and to test its psychometric properties, and to provide effective assessment tools for clinical evaluation of knowledge, attitude and practice of CAUTI prevention. Methods Based on KAP theory and CAUTI preventive current guideline,the scale was developed by using literature review,Delphi expert inquiry.A questionnaire survey was conducted among 300 medical workers in a third grade A hospital in Qingdao.Exploratory factor analysis and confirmatory factor analysis were both conducted to screen the items further.The psychometric properties of scale was tested. Results The finalized scale included 4 subscales and 45 items,amount to 63.21% of the variance contribution rate. The total Cronbach's alpha was 0.914,and the split half reliability was 0.812.The content validity of the scale was 0.895,while it ranged from 0.846-1.000 for each subscale.The correlation of item-to total was 0.711-0.862,and the correlation coefficient of item-to-item ranged from 0.425-0.564. Conclusions The scale of CAUTI KAP has good reliability and validity. It can be used to evaluate CAUTI related knowledge,attitude and practice level of medical workers.
ABSTRACT
Objective To investigate the characteristics of healthcare-associated infection(HAI) in elderly hospitalized patients,and analyze the risk factors for HAL Methods Incidences of HAI in elderly(elderly group) and non-elderly hospitalized patients (control) in a tertiary first-class hospital were investigated,the underlying diseases,infection sites,department distribution and so on between two groups of patients were compared.Results The incidence of HAI in elderly group was higher than that in control group(3.38 ％ vs 1.45 ％,P＜0.05);the proportions of hypertension and diabetes mellitus in elderly group was higher than control group,while cerebrovascular disease was lower than control group.The proportion of lower respiratory tract infection,urinary system infection and antimicrobial-associated diarrheal in the elderly were higher than control group(41.62％ vs 28.00％,15.44％ vs 12.02％,6.03％ vs 3.15％,respectively).The incidence of catheter-associated urinary tract infection in the elderly group was higher than that in control group(6.85‰ vs 3.95‰,RR95％CI =1.209-2.485,P＜0.05).The proportion of HAI in the elderly group in internal medicine departments was higher than that in control group (52.71％ vs 40.03％),while in intensive care unit was lower than control group (33.52％ vs 41.19％).Conclusion The characteristics of HAI in elderly patients are closely related to their demographic characteristics,early prevention of HAI in key sites should be carried out according to its characteristics.
ABSTRACT
Objective To detection the urine of bacteria hyphae and intracellular bacterial communities in patients with indwelling urinary catheter and discuss intracellular bacterial comnmunities in the pathogenesis of catheter-related urinary tract infection.Methods From May 2014 to February 2016,95 cases with D-J stent indwelling were enrolled in this study,including 38 male patients and 57 female patients.The mean age was (43 ±21)years old,ranging from 25 to 83 years old.We recorded those patient g clinical symptoms,middle urine culture results.If the middle urine culture was positive,further pathology test and scanning electron microscopy for bacteria hyphae and intracellular bacterial communities would be considered.Results The middle urine culture showed positive in 21 cases (22％,21/95);The classification of bacteria included E.coli in 11 cases,dung enterococcus in 2 cases,klebsiella pneumonia in 4 cases,pseudomonas aeruginosa in 3 cases,epidermis staphylococcus aureus in 1 case.Among those 21 patients,9 cases had the symptoms of fever and shiver.Urine pathology testing found hyphae in 6 cases (6％,6/95).all others were E.coli infection.For scanning electron microscope,6 cases were found rodshaped bacteria and hyphae.3 cases were found intracellular bacterial communities.Conclusions The presence of intracellular bacterial communities made urothelial itself the source of endogenous bacteria of urinary tract infection.Catheter-related urinary tract infections in patients with recurrence maybe basically homology bacteria.
ABSTRACT
Objective To evaluate the effect of targeted monitoring and comprehensive intervention measures on reducing the occurrence of catheter-associated urinary tract infection(CAUTI)in patients in non-intensive care unit(Non-ICU).Methods In quarter 4 of 2015,patients with indwelling urinary catheter in clinical departments were conducted a baseline survey(before intervention),risk factors for CAUTI in patients were analyzed,targeted monitoring programmes and comprehensive intervention measures were initiated in 2016(after intervention),incidence of CAUTI before and after intervention was compared.Results After taking intervention measures,hand hygiene compliance rate increased from 78.51%in quarter 4 of 2015 to 92.99%in quarter 3 of 2016 and 90.73%in quarter 4 of 2016(x2=7.342,3.998,respectively,both P<0.05),the correct disposal rate of patients' urinary catheterization system increased from 72.83%in quarter 4 of 2015 to 95.44%in quarter 4 of 2016(x2=30.267,P<0.05).A total of 12 067 patients with indwelling urinary catheter were monitored,incidence of CAUTI dropped from 1.03%(24/23 313)in quarter 4 of 2015(before intervention)to 0.53%(14/26 595)in quarter 4 of 2016(after intervention),difference was statistically significant(x2=4.126,P=0.042).Conclusion Improving the quality of urinary catheterization system in patients with indwelling catheter through targeted monitoring can effectively reduce the incidence of CAUTI in patients in Non-ICU.
ABSTRACT
Objective To evaluate the effects of a self-designed multi-function anti-reflux drainage connector on preventing catheter-associated urinary infection in patients with long-term indwelling catheters.Methods A total of 100 elderly males with indwelling catheters from 10 nursing homes in our city were selected and randomly divided into the control group (n=50) and the experimental group (n=50) from January 2013 to December 2015.The patients in the control group were indwelled with Foley catheters and connected with an ordinary disposable drainage bags;the patients in the experimental group were indwelled the same catheters and connected to disposable drainage bags with an multi-function anti-reflux drainage connector.Patients' urine in catheters and drainage bags from two groups were collected for urine culture on 7th,14th,21st,28th days.The cases of catheter plugging on the 7th,14th,21st,28th days and the cases of catheter encrustation on 28th day in two groups were recorded.Results The cases of bacteriuria on the 7th,14th,21st,28th days in the experimental group were significantly less than those in the control group (P＜0.05),and were also significantly less than those in the drainage bags in the same group (P＜0.05).The cases of catheter plugging on the 7th,14th,21st,28th days were not significantly different between two groups(P＞0.05).The cases of catheter encrustation on the 28th day in the experimental group were significantly less than those in the control group (P＜0.05).Conclusion Multi-function anti-reflux drainage connector can safely and effectively prevent catheter-associated urinary infection,reducing bacteria ascending with reflux of urine as well as catheter encrustation.
ABSTRACT
Objective To understand the occurrence of catheter-associated urinary tract infection(CAUTI)in pa-tients with catheterization,and provide evidence for reducing the incidence of CAUTI.Methods Based on monito-ring requirement for CAUTI in competency building project of healthcare-associated infection(HAI)prevention and control established by Hospital Infection Management Committee of Chinese Hospital Association,CAUTI among patients who hospitalized and received urinary catheterization ≥2 days in a hospital from January to December 2014 were analyzed prospectively,incidences of CAUTI in different patients were compared.Results A total of 6 046 patients with urinary catheterization were monitored,166 of whom developed CAUTI,incidence of CAUTI was 2.75%,the total urinary catheter days were 31 833 days,incidence of CAUTI was 5.21 per 1 000 urinary catheter days.There was no significant difference in the incidence of CAUTI among patients of different genders (χ2 =1 .23, P =0.54);incidence of CAUTI in patients > 60 years old was higher than those ≤60 years (4.72% vs 2.07%,χ2=30.38,P <0.01);incidence of CAUTI in patients with different duration of catheterization was significantly dif-ferent(χ2 = 251 .14,P <0.01 );with the prolongation of duration of catheterization,incidence of CAUTI also in-creased(trendχ2 =211 .82,P <0.001 ).Patients in department of neurology had the longest average catheterization time(14.84 days)and highest incidence of CAUTI(15.00%,10.11 ‰);patients in the other departments of surgery had the shortest average catheterization time(3.56 days)and lowest incidence of CAUTI(0.97%,2.74‰);inci-dences of CAUTI in patients with urinary catheterization in different departments were significantly different(χ2 =302.24,P <0.001).166 CAUTI patients were isolated 66 isolates of pathogenic strains,86.36% were gram-nega-tive bacilli,33.33% of which were Escherichia coli .Conclusion CAUTI is related to the age of patients and dura-tion of indwelling urinary catheter.Daily assessment on the necessity of indwelling catheter and timely removal of catheter is helpful for reducing the occurrence of CAUTI.
ABSTRACT
Objective To identify the occurrence and microorganism profile of device-associated healthcare-associa-ted infections (DA-HAIs)in the intensive care unit (ICU)of a university hospital in China.Methods From Janua-ry 1 to November 30,2015,patients admitted to the ICU of a university hospital in China for more than 48 hours were performed prospective descriptive study. DA-HAIs were defined according to the criteria of the Centers for Disease Control and Prevention (CDC)of U.S.,descriptive statistical analysis was performed.Results Of 254 pa-tients admitted to ICU,the overall incidence of DA-HAIs was 15.35% ,with 10.23 cases of DA-HAIs per 1 000 ICU-days;the incidence of ventilator-associated pneumonia (VAP ),catheter-associated urinary tract infection (CAUTI),and central line-associated bloodstream infection (CLABSI)were 7.05 per 1 000 ventilator-days,4.91 per 1 000 urinary catheter-days,and 3.22 per 1 000 central line-days,respectively. The main infection site was lower respiratory tract,accounting for 48. 27% ,followed by bloodstream system (27. 59% ),urinary tract (22.99% ),and gastrointestinal tract(1.15% ). The major isolated microorganism was Acinetobacterbaumannii (21 .52% ).Conclusion The surveillance system can identify the epidemiological status of DA-HAIs and make effec-tive control measures to ensure the healthcare safety.
ABSTRACT
Objective To assess the application effect of the catheter management software on the management of Indwelling urinary catheter in the Emergency intensive care unit (EICU). Methods A prospective control study of targeted surveillance of catheter-associated urinary tract infection was conducted from January 2014 to December 2015 in EICU. The patients were divided into two groups. The patients in control group (131 patients) were treated from January 1, 2014 to December 31, 2014 and received routine catheter management, and the patients in test group (135 patients) were treated from January 1, 2015 to December 31, 2015, and received catheter management by software. The catheter management software was developed and applied, and the process specification which collaborated with the software was established. The quality of the catheter management including the omission rate of the catheter management, the rate of urinary catheter-associated urinary tract infections (CAUTI) and the rate of catheter used etc were evaluated after the software's application. Results Through software applications, the omission rate of the catheter management, the omission rate of urine drainage bag replacementand the omission rate of urinary catheter replacement in test group were significantly lower than those in control group:0 vs. 36.64%(48/131), 0 vs. 15.27%(20/131) and 0 vs. 9.92%(13/131), P<0.01 or<0.05. The performance rate of catheter daily management in test group was significantly higher than that in control group: 99.26%(134/135) vs. 64.12%(84/131), P<0.01. The rate of CAUTI in test group was significantly lower than that in control group: 1.90‰ vs. 9.16‰, χ2=4.843, P=0.028. The rate of catheter used in test group was significantly lower than that in control group: 60.74%(82/135) vs. 73.28%(96/131), P<0.01. Conclusions The development and the establishment of the management software can improve the rate of implement, and declinethe rate of CAUTI.
ABSTRACT
Objective To realize the current situation of prevention and control of catheter-associated urinary tract infection (CAUTI)since the development of healthcare-associated infection(HAI)management in China in the re-cent 30 years.Methods Random cluster sampling was used to select 165 secondary and tertiary hospitals in 13 provinces and cities in China,questionnaires were filled in,the content included time,scope,method,data feed-back,and incidence of CAUTI monitoring.Results Of 165 hospitals,92.12% (152/165)have implemented targe-ted monitoring,the implementation rate in tertiary hospitals was higher than secondary hospitals (98.08% [102/104]vs 81.97%[50/61],χ2 =13.748,P <0.001).Most hospitals (82.24%[125/152])only implemented monito-ring in intensive care units(ICUs)or partial ICUs.HAI management professionals,HAI control doctors and nurses in 69.08%(105/152)of hospitals jointly took responsibility for CAUTI monitoring.95.39% (145/152)of hospitals diagnosed CAUTI by combination of clinical manifestations and laboratory examination results.98.68%(150/152) of hospitals have gradually implemented intervention measures,such as strictly mastering the indications of urinary indwelling catheters,hand hygiene of health care workers,non-frequent change of urinary indwelling catheters,and necessity for daily assessment of catheterization.75.66% (115/152)of hospitals conducted feedback of monitored results to the whole hospital.Incidences of CAUTI in pre-2010,2010,and 2015 were 3.10‰,4.72‰,and 1.89‰respectively.Conclusion In the recent 30 years,monitoring on CAUTI in China has obtained achievement,CAUTI monitoring is gradually standardized and scientific,but the development at all levels of medical institutions is still imbalance,which needs to be improved further.
ABSTRACT
Purpose: Device-associated infections constitute the majority of health care-associated infections (HAIs) in ICUs. Trauma patients are predisposed to acquire such infections due to various trauma-related factors. The prevalence of HAIs is underreported from developing nations due to a lack of systematic surveillance. This study reports the impact of an intensive surveillance on the rates and outcome of device-associated infections in trauma patients from a developing country and compares the rates with a previous pilot observation. Materials and Methods: The study was conducted at a level-1 trauma centre of India. Surveillance for ventilator-associated pneumonia (VAP), central line-associated blood stream infections (CLA-BSIs) and catheter-associated urinary tract infections (CA-UTIs) was done based on centre for disease control-National Healthcare Safety Network (CDC-NHSN) defi nitions. The impact of an intensive surveillance, education and awareness drive on the rates of infections over the study period, and compliance to preventive bundles and hand hygiene was assessed. Results: A total of 15,462 ventilator days, 12,207 central line days and 17,740 urinary catheter days were recorded in the study population. The overall rates of VAP, CLA-BSI and CA-UTI were respectively 17, 7.2 and 15.5/1000 device days. There was a signifi cant correlation between device days and the propensity to develop infections. Infections were the cause of death in 36.6% of fatal trauma cases. A signifi cantly higher rate of VAP, CLA-BSI and CA-UTIs was noted in fatal cases. The compliance to ventilator bundle, central line bundle, bladder bundle and hand hygiene were 74.5%, 86%, 79.3% and 64.6%, respectively. A high rate of multi-drug-resistance was observed in all pathogens. A gross reduction in the rates of all infections was observed over time during the study due to implementation of a stringent surveillance system, feedbacks and education. The compliance to hand hygiene and preventive bundles also increased over time. Conclusion: The automated surveillance was easy and useful for data entry and analysis. Surveillance had a signifi cant impact on reduction of HAIs and mortality in trauma patients.
ABSTRACT
Objective To improve health care workers’(HCWs)infection prevention and control consciousness through carrying out catheter-associated urinary tract infection(CAUTI)prevention and control project,and imple-ment prevention and control measures in practical work.Methods Diagnostic criteria of CAUTI issued by the U.S. Centers for Disease Prevention and Control/National Healthcare Safety Network were adopted,from October 2013 to September 2014,monitoring was conducted on CAUTI in patients with indwelling urinary catheters for >2 con-secutive days at different types of ICUs in hospitals participated in the project .Results A total of 14 124 CAUTI cases were collected,410 patients developed CAUTI,urinary catheter usage rate was 79.33%(203 114/256 042), incidence of CAUTI was 2.02‰(410/203 114),urine specimen detection rate was 46.52%(6 570 /14 124).The detection rate of urine specimens increased from 37.24% (the fourth quarter of 2013)to 49.76% (the third quarter of 2014).Of prevention measures,the difference in the indication of catheterization was significantly different(P <0.01).Conclusion Through the development of competence building project of healthcare-associated infection pre-vention and control,prevention and control of CAUTI has achieved good intervention effect.