• Victor D Rosenthal, Bala Ramachandran, Lourdes Dueñas, Carlos Alvarez-Moreno, J A Navoa-Ng, Alberto Armas-Ruiz, Gulden Ersoz, Lorena Matta-Cortés, Mandakini Pawar, Ata Nevzat-Yalcin, Marena Rodríguez-Ferrer, Bran de CasaresAna ConcepciónAC, Claudia Linares, Victoria D Villanueva, Roberto Campuzano, Ali Kaya, Luis Fernando Rendon-Campo, Amit Gupta, Ozge Turhan, Nayide Barahona-Guzmán, Lilian de Jesús-Machuca, María Corazon V Tolentino, Jorge Mena-Brito, Necdet Kuyucu, Yamileth Astudillo, Narinder Saini, Nurgul Gunay, Guillermo Sarmiento-Villa, Eylul Gumus, Alfredo Lagares-Guzmán, and Oguz Dursun.
• International Nosocomial Infection Control Consortium, Avenue Corrientes4580,Buenos Aires, Argentina. victor_rosenthal@inicc.org
• Infect Control Hosp Epidemiol. 2012 Jul 1; 33 (7): 696-703.

DesignA before-after prospective surveillance study to assess the impact of a multidimensional infection control approach for the reduction of catheter-associated urinary tract infection (CAUTI) rates.SettingPediatric intensive care units (PICUs) of hospital members of the International Nosocomial Infection Control Consortium (INICC) from 10 cities of the following 6 developing countries: Colombia, El Salvador, India, Mexico, Philippines, and Turkey.PatientsPICU inpatients.MethodsWe performed a prospective active surveillance to determine rates of CAUTI among 3,877 patients hospitalized in 10 PICUs for a total of 27,345 bed-days. The study was divided into a baseline period (phase 1) and an intervention period (phase 2). In phase 1, surveillance was performed without the implementation of the multidimensional approach. In phase 2, we implemented a multidimensional infection control approach that included outcome surveillance, process surveillance, feedback on CAUTI rates, feedback on performance, education, and a bundle of preventive measures. The rates of CAUTI obtained in phase 1 were compared with the rates obtained in phase 2, after interventions were implemented.ResultsDuring the study period, we recorded 8,513 urinary catheter (UC) days, including 1,513 UC-days in phase 1 and 7,000 UC-days in phase 2. In phase 1, the CAUTI rate was 5.9 cases per 1,000 UC-days, and in phase 2, after implementing the multidimensional infection control approach for CAUTI prevention, the rate of CAUTI decreased to 2.6 cases per 1,000 UC-days (relative risk, 0.43 [95% confidence interval, 0.21-1.0]), indicating a rate reduction of 57%.ConclusionsOur findings demonstrated that implementing a multidimensional infection control approach is associated with a significant reduction in the CAUTI rate of PICUs in developing countries.

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