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Impact of Care Bundle Implementation on Incidence of Catheter-associated Urinary Tract Infection: A Comparative Study in the Intensive Care Units of a Tertiary Care Teaching Hospital in South India

INTRODUCTION: Implementation of evidence-based infection control practices is the need of the hour for every institute to reduce the device-associated infections, which directly reflects the quality of care. As catheter-associated urinary tract infection (CAUTI) is the most common nosocomial infecti...

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Autores principales: Soundaram, Geni VG, Sundaramurthy, Raja, Jeyashree, Kathiresan, Ganesan, Vithiya, Arunagiri, Ramesh, Charles, Jhansi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Jaypee Brothers Medical Publishers 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7482344/
https://www.ncbi.nlm.nih.gov/pubmed/32963437
http://dx.doi.org/10.5005/jp-journals-10071-23473
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author Soundaram, Geni VG
Sundaramurthy, Raja
Jeyashree, Kathiresan
Ganesan, Vithiya
Arunagiri, Ramesh
Charles, Jhansi
author_facet Soundaram, Geni VG
Sundaramurthy, Raja
Jeyashree, Kathiresan
Ganesan, Vithiya
Arunagiri, Ramesh
Charles, Jhansi
author_sort Soundaram, Geni VG
collection PubMed
description INTRODUCTION: Implementation of evidence-based infection control practices is the need of the hour for every institute to reduce the device-associated infections, which directly reflects the quality of care. As catheter-associated urinary tract infection (CAUTI) is the most common nosocomial infection, the study was planned to evaluate the impact of the catheter care bundle in reducing CAUTI incidence. MATERIAL AND METHODS: The prospective interventional study before and after the trial study was carried out in adult intensive care units over a period of 9 months (April–June 2017—pre-implementation phase; July–September 2017—training of healthcare worker and implementation of catheter care bundle; October–December 2017—post-implementation phase). Catheter-associated urinary tract infection rates pre- and post-implementation were expressed as incidence rates with Poisson confidence interval. RESULTS: Statistically significant reduction was found in the incidence of CAUTI (60%—from 10.7 to 4.5 per 1,000 catheter days). The key factors that contributed were significant reduction in device utilization ratio (from 0.71 to 0.56) and average catheter days per patient (from 4.8 to 3.7). This holistic approach has resulted in less incidence of CAUTI even among patients with risk factors and prolonged catheter days. Neuro ICU showed drastic improvement compared to other ICUs due to the poor baseline status of their care practices. CONCLUSION: Adherence to all elements of care bundle brought a significant decrease in CAUTI. Implementing care bundle and auditing the adherence to each element should be included as a part of routine hospital infection control committee (HICC) practices. CLINICAL SIGNIFICANCE: Hospital-acquired infection directly reflects on the quality care of the hospital. Bundle care is an “all or none” phenomenon. Adherence to each element will have some influence in reducing CAUTI in terms of reducing the device utilization ratio and average catheter days per patient. Auditing the care bundle adherence is having a positive influence on the outcome. HOW TO CITE THIS ARTICLE: Soundaram GVG, Sundaramurthy R, Jeyashree K, Ganesan V, Arunagiri R, Charles J. Impact of Care Bundle Implementation on Incidence of Catheter-associated Urinary Tract Infection: A Comparative Study in the Intensive Care Units of a Tertiary Care Teaching Hospital in South India. Indian J Crit Care Med 2020;24(7):544–550.
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spelling pubmed-74823442020-09-21 Impact of Care Bundle Implementation on Incidence of Catheter-associated Urinary Tract Infection: A Comparative Study in the Intensive Care Units of a Tertiary Care Teaching Hospital in South India Soundaram, Geni VG Sundaramurthy, Raja Jeyashree, Kathiresan Ganesan, Vithiya Arunagiri, Ramesh Charles, Jhansi Indian J Crit Care Med Original Article INTRODUCTION: Implementation of evidence-based infection control practices is the need of the hour for every institute to reduce the device-associated infections, which directly reflects the quality of care. As catheter-associated urinary tract infection (CAUTI) is the most common nosocomial infection, the study was planned to evaluate the impact of the catheter care bundle in reducing CAUTI incidence. MATERIAL AND METHODS: The prospective interventional study before and after the trial study was carried out in adult intensive care units over a period of 9 months (April–June 2017—pre-implementation phase; July–September 2017—training of healthcare worker and implementation of catheter care bundle; October–December 2017—post-implementation phase). Catheter-associated urinary tract infection rates pre- and post-implementation were expressed as incidence rates with Poisson confidence interval. RESULTS: Statistically significant reduction was found in the incidence of CAUTI (60%—from 10.7 to 4.5 per 1,000 catheter days). The key factors that contributed were significant reduction in device utilization ratio (from 0.71 to 0.56) and average catheter days per patient (from 4.8 to 3.7). This holistic approach has resulted in less incidence of CAUTI even among patients with risk factors and prolonged catheter days. Neuro ICU showed drastic improvement compared to other ICUs due to the poor baseline status of their care practices. CONCLUSION: Adherence to all elements of care bundle brought a significant decrease in CAUTI. Implementing care bundle and auditing the adherence to each element should be included as a part of routine hospital infection control committee (HICC) practices. CLINICAL SIGNIFICANCE: Hospital-acquired infection directly reflects on the quality care of the hospital. Bundle care is an “all or none” phenomenon. Adherence to each element will have some influence in reducing CAUTI in terms of reducing the device utilization ratio and average catheter days per patient. Auditing the care bundle adherence is having a positive influence on the outcome. HOW TO CITE THIS ARTICLE: Soundaram GVG, Sundaramurthy R, Jeyashree K, Ganesan V, Arunagiri R, Charles J. Impact of Care Bundle Implementation on Incidence of Catheter-associated Urinary Tract Infection: A Comparative Study in the Intensive Care Units of a Tertiary Care Teaching Hospital in South India. Indian J Crit Care Med 2020;24(7):544–550. Jaypee Brothers Medical Publishers 2020-07 /pmc/articles/PMC7482344/ /pubmed/32963437 http://dx.doi.org/10.5005/jp-journals-10071-23473 Text en Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd. © The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Original Article
Soundaram, Geni VG
Sundaramurthy, Raja
Jeyashree, Kathiresan
Ganesan, Vithiya
Arunagiri, Ramesh
Charles, Jhansi
Impact of Care Bundle Implementation on Incidence of Catheter-associated Urinary Tract Infection: A Comparative Study in the Intensive Care Units of a Tertiary Care Teaching Hospital in South India
title Impact of Care Bundle Implementation on Incidence of Catheter-associated Urinary Tract Infection: A Comparative Study in the Intensive Care Units of a Tertiary Care Teaching Hospital in South India
title_full Impact of Care Bundle Implementation on Incidence of Catheter-associated Urinary Tract Infection: A Comparative Study in the Intensive Care Units of a Tertiary Care Teaching Hospital in South India
title_fullStr Impact of Care Bundle Implementation on Incidence of Catheter-associated Urinary Tract Infection: A Comparative Study in the Intensive Care Units of a Tertiary Care Teaching Hospital in South India
title_full_unstemmed Impact of Care Bundle Implementation on Incidence of Catheter-associated Urinary Tract Infection: A Comparative Study in the Intensive Care Units of a Tertiary Care Teaching Hospital in South India
title_short Impact of Care Bundle Implementation on Incidence of Catheter-associated Urinary Tract Infection: A Comparative Study in the Intensive Care Units of a Tertiary Care Teaching Hospital in South India
title_sort impact of care bundle implementation on incidence of catheter-associated urinary tract infection: a comparative study in the intensive care units of a tertiary care teaching hospital in south india
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7482344/
https://www.ncbi.nlm.nih.gov/pubmed/32963437
http://dx.doi.org/10.5005/jp-journals-10071-23473
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