Abstract：
BACKGROUND: Catheter-Associated Urinary Tract Infections (CAUTIs) frequently occur in the intensive care unit (ICU) and are correlated with a significant burden.
METHODS: We implemented a strategy involving a 9-element bundle, education, surveillance of CAUTI rates and clinical outcomes, monitoring compliance with bundle components, feedback of CAUTI rates and performance feedback. This was executed in 299 ICUs across 32 low- and middle-income countries. The dependent variable was CAUTI per 1,000 UC days, assessed at baseline and throughout the intervention, in the second month, third month, 4 to 15 months, 16 to 27 months, and 28 to 39 months. Comparisons were made using a 2-sample t test, and the exposure-outcome relationship was explored using a generalized linear mixed model with a Poisson distribution.
RESULTS: Over the course of 978,364 patient days, 150,258 patients utilized 652,053 UC-days. The rates of CAUTI per 1,000 UC days were measured. The rates decreased from 14.89 during the baseline period to 5.51 in the second month (risk ratio [RR] = 0.37; 95% confidence interval [CI] = 0.34-0.39; P < .001), 3.79 in the third month (RR = 0.25; 95% CI = 0.23-0.28; P < .001), 2.98 in the 4 to 15 months (RR = 0.21; 95% CI = 0.18-0.22; P < .001), 1.86 in the 16 to 27 months (RR = 0.12; 95% CI = 0.11-0.14; P < .001), and 1.71 in the 28 to 39 months (RR = 0.11; 95% CI = 0.09-0.13; P < .001).
CONCLUSIONS: Our intervention, without substantial costs or additional staffing, achieved an 89% reduction in CAUTI incidence in ICUs across 32 countries, demonstrating feasibility in ICUs of low- and middle-income countries.
METHODS: We implemented a strategy involving a 9-element bundle, education, surveillance of CAUTI rates and clinical outcomes, monitoring compliance with bundle components, feedback of CAUTI rates and performance feedback. This was executed in 299 ICUs across 32 low- and middle-income countries. The dependent variable was CAUTI per 1,000 UC days, assessed at baseline and throughout the intervention, in the second month, third month, 4 to 15 months, 16 to 27 months, and 28 to 39 months. Comparisons were made using a 2-sample t test, and the exposure-outcome relationship was explored using a generalized linear mixed model with a Poisson distribution.
RESULTS: Over the course of 978,364 patient days, 150,258 patients utilized 652,053 UC-days. The rates of CAUTI per 1,000 UC days were measured. The rates decreased from 14.89 during the baseline period to 5.51 in the second month (risk ratio [RR] = 0.37; 95% confidence interval [CI] = 0.34-0.39; P < .001), 3.79 in the third month (RR = 0.25; 95% CI = 0.23-0.28; P < .001), 2.98 in the 4 to 15 months (RR = 0.21; 95% CI = 0.18-0.22; P < .001), 1.86 in the 16 to 27 months (RR = 0.12; 95% CI = 0.11-0.14; P < .001), and 1.71 in the 28 to 39 months (RR = 0.11; 95% CI = 0.09-0.13; P < .001).
CONCLUSIONS: Our intervention, without substantial costs or additional staffing, achieved an 89% reduction in CAUTI incidence in ICUs across 32 countries, demonstrating feasibility in ICUs of low- and middle-income countries.
摘要：
背景：导管相关性尿路感染（CAUTIs）经常发生在ICU中，并且与重大负担相关。
方法：我们实施了一个包含9元素束的策略，教育,监测CAUTI率和临床结果，监控捆绑组件的合规性，CAUTI率反馈和性能反馈。这项工作在32个低收入和中等收入国家（LMICs）的299个ICU中执行。因变量为每1000-UC天的CAUTI，在基线和整个干预期间进行评估，在第二个月，第三个月,4-15个月,16-27个月,28-39个月。使用双样本t检验进行比较，并使用具有泊松分布的广义线性混合模型探索暴露与结果的关系。
结果：在978,364个患者天的过程中，150,258名患者使用了652,053UC天。测量每1,000UC天的CAUTI比率。这些比率从基线期间的14.89下降到第2个月的5.51（RR=0.37；95％CI=0.34-0.39；P<0.001），第3个月为3.79（RR=0.25；95％CI=0.23-0.28；P<0.001），在4-15个月内为2.98（RR=0.21；95％CI=0.18-0.22；P<0.001），在16-27个月内为1.86（RR=0.12；95％CI=0.11-0.14；P<0.001），和1.71在28-39个月(RR=0.11;95%CI=0.09-0.13;P<0.001)。
结论：我们的干预措施，没有大量的成本或额外的人员配备，在32个国家的ICU中，CAUTI发病率降低了89%，在LMIC的ICU中证明可行性。
方法：我们实施了一个包含9元素束的策略，教育,监测CAUTI率和临床结果，监控捆绑组件的合规性，CAUTI率反馈和性能反馈。这项工作在32个低收入和中等收入国家（LMICs）的299个ICU中执行。因变量为每1000-UC天的CAUTI，在基线和整个干预期间进行评估，在第二个月，第三个月,4-15个月,16-27个月,28-39个月。使用双样本t检验进行比较，并使用具有泊松分布的广义线性混合模型探索暴露与结果的关系。
结果：在978,364个患者天的过程中，150,258名患者使用了652,053UC天。测量每1,000UC天的CAUTI比率。这些比率从基线期间的14.89下降到第2个月的5.51（RR=0.37；95％CI=0.34-0.39；P<0.001），第3个月为3.79（RR=0.25；95％CI=0.23-0.28；P<0.001），在4-15个月内为2.98（RR=0.21；95％CI=0.18-0.22；P<0.001），在16-27个月内为1.86（RR=0.12；95％CI=0.11-0.14；P<0.001），和1.71在28-39个月(RR=0.11;95%CI=0.09-0.13;P<0.001)。
结论：我们的干预措施，没有大量的成本或额外的人员配备，在32个国家的ICU中，CAUTI发病率降低了89%，在LMIC的ICU中证明可行性。
