Implementation of a national bundle care program to reduce catheter-associated urinary tract infection in high-risk units of hospitals in Taiwan
Journal
Journal of Microbiology, Immunology and Infection
Journal Volume
50
Journal Issue
4
Pages
464-470
Date Issued
2017
Author(s)
Lai C.-C.
Lee C.-M.
Chiang H.-T.
Hung C.-T.
Chen Y.-C.
Su L.-H.
Shi Z.-Y.
Liu J.-W.
Liu C.-P.
Lu M.-C.
Chuang Y.-C.
Ko W.-C.
Tseng S.-H.
Chen Y.-H.
for the, Infection Control Society of Taiwan
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. ? 2017
SDGs
Other Subjects
Acinetobacter baumannii; Acinetobacter calcoaceticus; Article; bundle care program; Candida albicans; Candida glabrata; catheter infection; checklist; Citrobacter; cleaning; coronary care unit; disinfection; Enterococcus faecalis; Enterococcus faecium; Escherichia coli; Foley balloon catheter; hand washing; health care personnel; health care quality; health program; hospital; human; Klebsiella oxytoca; medical intensive care unit; medical society; multidrug resistance; nonhuman; practice guideline; Proteus mirabilis; protocol compliance; Pseudomonas aeruginosa; Pseudomonas putida; public health; public hospital; respiratory care; risk reduction; Staphylococcus aureus; Staphylococcus epidermidis; Stenotrophomonas maltophilia; surgical intensive care unit; Taiwan; Taiwanese; total quality management; treatment duration; Trichosporon; urinary catheter; urinary tract infection; urine culture; care bundle; catheter infection; health care policy; incidence; procedures; urinary tract infection; Catheter-Related Infections; Health Policy; Hospitals; Humans; Incidence; Patient Care Bundles; Taiwan; Urinary Tract Infections
Type
journal article