Volume 19 Supplement 2

Eighth International Symposium on Intensive Care and Emergency Medicine for Latin America

Open Access

Success of a urinary catheter insertion team in reducing urinary infections in the ICU

  • Deianira Regagnin1,
  • Debora Schettini da Silva Alves1 and
  • Luciana Reis Guastelli1
Critical Care201519(Suppl 2):P44

https://doi.org/10.1186/cc14690

Published: 28 September 2015

Introduction

About 8-21 % of hospital infections in ICUs are urinary [1, 2], 80 % of them being associated with the use of urinary catheters [3]. Several studies show that the early removal of urinary catheters reduces the rate of urinary tract infection. However, critically ill patients who require this device do not have the option to remove. For this group, the best preventive measure seems to be educative activity for the nursing staff responsible for the insertion and manipulation of this device.

Objective

To create a team of professionals trained in the insertion of urinary catheters and to organize actions aimed at reducing the rate of urinary tract infection associated with urinary catheters in the ICU.

Methods

Prospective study conducted for 12 months in the ICU. Started in July 2013, the intervention program involved the creation of a qualified team for the insertion of urinary catheter and the creation of audits to stimulate the removal of inappropriate urinary catheters and assess the process of inserting these devices. The obtained results were compared with the 12 months preceding the beginning of the interventions.

Results

Comparison between August 2012-July 2013 and August 2013-July 2014 (Table 1, Figures 1 and 2) shows that there was a fall of 57.2 % (2.4-1.0, p = 0.040) in the rate of urinary tract infection associated with a urinary catheter and a reduction of 13.4 % (from 0.24 to 0.21, p = 0.001) in the utilization rate of urinary catheters. In the 12 months after intervention (August 2013-July 2014) the percentage of compliance of technical insertion of urinary catheter was 97 % and the inappropriate removal rate of urinary catheters was 85 % (Table 2).
Table 1

Incidence density ratio urinary tract infection and utilization ratio urinary catheter before and after interventions according to the location.

Place

Ratio

Time

Mean

DP

Median

Min

Max

Mean reduction (%)

pvalue

ICU

IDR UTI

Before

1.69

1.47

1.57

0.00

4.76

40.9

0.286

  

After

1.00

1.62

0.00

0.00

4.66

  
 

UR

Before

0.57

0.05

0.57

0.47

0.62

11.3

0.016

  

After

0.50

0.07

0.54

0.37

0.57

  

SDU

IDR UTI

Before

4.01

4.52

3.38

0.00

12.71

66.9

0.084

  

After

1.33

2.45

0.00

0.00

6.37

  
 

UR

Before

0.11

0.02

0.11

0.09

0.13

25.0

<0.001

  

After

0.08

0.01

0.08

0.06

0.09

  

ICU + SDU

IDR UTI

Before

2.39

1.89

2.08

0.00

6.59

57.2

0.040

  

After

1.02

1.07

1.20

0.00

3.23

  
 

UR

Before

0.24

0.02

0.25

0.21

0.26

13.4

0.001

  

After

0.21

0.02

0.22

0.16

0.23

  

Student t test

SDU step down unit, IDR UTI incidence density ratio of urinary tract infection,

UR utilization ratio of urinary catheter

Figure 1

Incidence density ratio of urinary tract infections before and after interventions.

Figure 2

Utilization rate of urinary catheters before and after interventions.

Table 2

Results of audited items between August 2013 and July 2014.

 

ICU

SDU

ICU + SDU

Number of patients observed

9571

25,716

35,287

Number of patients with IDC

4752

2370

7122

  % Urinary catheter appropriate

92

86

90

  % Urinary catheter inappropriate

10

16

12

  % Discontinued inappropriate IDC

97

70

85

Number of insertions of IDC audited

803

280

1083

  % Proper techniques for insertion of IDCs

99

95

97

IDC indwelling urinary catheters; SDU step down unit

Conclusion

The results show that low-cost educational interventions can reduce urinary infections and provide more security for patients in ICUs.

Authors’ Affiliations

(1)
Department of Critically Ill Patients, Hospital Israelita Albert Einstein

References

  1. Eriksen HM, Iversen BG, Aavitsland P: Prevalence of nosocomial infections in hospitals in Norway, in 2002 and 2003. J Hosp Infect. 2005, 40-5. 60Google Scholar
  2. Lizioli A, Privitera G, Alliata E, Antonietta Banfi IN, Boselli L, Panceri ML, et al: Prevalence of nosocomial infections in Italy: result from the Lombardy survey in 2000. J Hosp Infect. 2003, 54: 141-8. 10.1016/S0195-6701(03)00078-1.View ArticlePubMedGoogle Scholar
  3. Klevens RM, Edward JR, Richards CL, et al: Estimating health care associated infections and Deaths in US hospitals. Public Health Rep. 2007, 122: 160e-Google Scholar

Copyright

© Regagnin et al.; 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 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.

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