ISQUA18-1440Results of Promotion of Catheter-Associated Urinary Tract Infection Care Bundle in Taiwan for Reducing Catheter-Associated Urinary Tract Infection

Abstract

Objectives: According to international surveillance data, urinary tract infections (UTIs) are one of the most common healthcare associated infections (HAIs), accounting for approximately 40% of all infections. Based on surveillance data from the Taiwan Centers for Disease Control (CDC), UTIs account for >35% of all HAIs and always rank as one of the top four most common HAIs. Most of the patients that had nosocomial UTIs were catheter-associated. This study evaluated whether the introduction of catheter-associated urinary tract infection (CAUTI) care bundle reduces the infection rate. Method(s): A 3-year program, from 2015 to 2017, that Taiwan CDC, the Joint Commission of Taiwan, experts, and hospitals cooperated to promote CAUTI care bundle. Elements of bundle shown in Fig. 1, checklists to track organization compliance and indicators to evaluate intervention outcome were established. Experts from local and overseas conducted exchange discussions and guidance with the hospitals. In addition, e-learning courses, demonstration videos, and promotion materials were provided as reference for hospital implementation. One or two external audits each year, as well as clinical practice operation competitions and innovation awards were conducted to improve the understanding of CAUTI bundle in healthcare workers, therefore they can comply with all components of the bundle in daily practice to effectively reduce the occurrence of CAUTI. Fifty-two hospitals participated in this program in 2015 and sustained for at least 2 years, then another 34 hospitals joined in 2017. It is hypothesized that the catheter utilization rate and CAUTI density for the 52 participating hospitals before program implementation (January 2014 to June 2015) would be significantly different from those after the intervention (July 2015 to September 2017), regardless of the size and type of participating units of the hospital. The Poisson Regression Analysis was used for data analysis. Result(s): Two hundred and forty-eighty units participated in this program, comprising acute care units (124 units), intensive care units (109 units), and respiratory care center (15 units). At the beginning of the program, the compliance rate and correct rate for hand hygiene were 93.45% and 88.36%, respectively, and then slightly increased to 96.5% and 90.34% after intervention. Further analysis showed the catheter utilization rate and infection density before project started were 37.04% and 3.10, respectively, and then decreased to 32.55% and 2.53 (P < 0.01). The results showed that the catheter utilization rate declined and the infection density decreased significantly after intervention. Conclusion(s): The motivation to enhance the quality of care and to reduce nosocomial infection rates was the crucial factor that drove a hospital to participate in this initiative. The results confirm that implementation of CAUTI bundle could reduce the catheter utilization rate and infection density, which was achieved by establishing appropriate cognition and incorporating into behavioral changes, and setting up internal audit mechanisms for continuous evaluation and feedback. It suggested that participating hospitals could share successful experiences with medical institutions around the country; hence continue to enhance patient safety and quality of medical care.