A multifaceted intervention to reduce rates of catheter-associated urinary tract infections in a resource-limited setting

Abstract

Health care-associated infections such as catheter-associated urinary tract infections (CAUTIs) are prevalent in resource-limited settings. This study was carried out to determine whether a multifaceted intervention targeting health care personnel would reduce CAUTI rates in a public hospital located in a resource-limited setting. A one group, pretest-posttest study was carried out from March to July 2012 in a public district hospital in Nairobi, Kenya. Patients admitted to adult medical wards, and who received urinary catheters, were evaluated for symptomatic CAUTIs using a modified definition by the Centers for Disease Control and Prevention. After collecting baseline CAUTI rates for 8 weeks, a multifaceted intervention consisting of lectures, reminder signs, and infection prevention rounds (week 9) was implemented. The postintervention rate of CAUTIs was measured over 7 subsequent weeks. Bivariable analysis was performed to determine whether the intervention was associated with reduced CAUTIs. A total of 125 patients received urinary catheters, with 82 preintervention and 43 postintervention. Mean duration of catheterization did not change between phases (6.9 vs 5.6 days, respectively, P= .322), but catheter utilization ratio decreased from 0.14 to 0.09 (P < .001). There were 13 preintervention CAUTIs (for 30.4 infections per 1,000 catheter-days) and no postintervention CAUTIs (P=.002). In this resource-limited setting, the baseline rate of CAUTIs was high. A low-cost, multifaceted intervention resulted in decreased urinary catheter use and CAUTI rates.