الفهرس 
TitleOnly 14 pages are availabe for public view
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Abstract
Healthcare-associated infections (HAIs) are related to increasing cost of health care as well as mortality and morbidity. These types of infections are preventable.
Indwelling catheters count for about 80% of urinary tract infections. The most common and costly healthcare related infection that prolongs the length of stay and co morbidity is catheter –associated urinary tract infections (CAUTI). Regardless of how hard many organizations put energy to reduce CAUTIs; Foley catheter use and Catheter –associated Urinary Tract Infections continue to grow.
CAUTI prevention is largely based on nursing awareness regarding best practices in catheter care and timely removal of catheter .Many CAUTI prevention strategies have been bundle into a composite of multimodal sets of interventions known as bladder bundles. These bundles consist of educational interventions to improve appropriate use and clinical skill in catheter placement, behavioral interventions such as restriction and removal protocols.
The aim of the present work was to determine the incidence of catheter-associated urinary tract infections and evaluate the infection control measures and medical staff compliance with these measures in Intensive Care Unit of Qabbary Hospital, Alexandria, in addition to identifying possible risk factors for these infections, and clarifying the distribution of the causative pathogens.
Our study was an observational one where we recorded the occurrence of cases of Catheter-associated urinary tract infections and compliance to infection control measures during insertion of Urinary catheterization procedures in ICU.
Our study was conducted in 3 phases for a period of 9 months. During Phase I Data of 50 patients was recorded to determine the amplitude of the Catheter Associated Urinary Tract Infection (CAUTI) and were observed for compliance of ICU staff for infection control measures during Urinary Catheter insertion(UC) procedures in our Qabbary Hospital, Alexandria. During phase2 data recorded in phase 1 was analyzed. After data analysis, a 3 hours training session twice weekly were given to ICU staff for 3 months. After the 3 months training given to ICU staff, their practice during UC procedures was re-evaluated again. Another 46 patients were observed using the same observation checklist in phase III.
Before training period included a total of 50 patients (19) males (38%) and 31 females (62) while after training the patients included were 46 (20 males (43.5%) and 26 females (56.5%)
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Urinary tract infection was the dominant infection representing (50)(51.5%) and both VAP and BSI were equally represented 11(11.3%) each, and 25(25.9%) were admitted to icu due to other indications (AKI, Anemia, DHF).still after training UTI s represented the highest group of patients admitted to ICU(43.4%)followed by patient admitted for other indications ,BSI(5.6%) and VAP(4.7%).
During catheterization steps it was found that washing hands, use of sterile technique, disposable gloves and cleaning perneal area, wear of sterile gloves and using betadine to clean urethra were as follow:25,15,46,88,89% these were improved to 92, 95,89,100,100 respectively.
Regarding steps of catheterization (catheter bundle), it was noticed that all steps were not performed except steps no (a , b). After training these all steps were performed by 95-100%. It has to be mentioned that in the ICU there was no collection catheter kit available and all tools/supplies were available separately. After training a collection catheter kit was used containing all used tools and implemented. This results in saving time, prevent contamination if any of the needed tools was missing)
Also, maintenance of the used catheter and patient care were improvement in several steps as: Maintain external cleanliness around the catheter from zero to 100%, Keep the catheter drainage bag below the level of bladder at all times from 39 to 91% and Keep the tubing coiled by the patient ’S side allowing urine to properly drain from 46 to 88%.
Days of catheterization ranged from 2-17 days with a mean of 9.22days in the Phase I patients ( pre training period) and fortunately the days of catheterization were reduced to a range 2-5 days with mean 2.9 days
As for the result of urine cultures of patients with UTI in phase I : 34(68%) out of 50 urine culture were (culture positive) and 16 (32%) were culture negative .On the other hand only 17(36.9%) out of the 46 patients included after training were (culture positive) and 29(63.1%) were culture negative .
out of the 34 culture positive; Gram negative bacteria were isolated more frequently as follows: E.coli 9(34.6%) ,both paracollon bacilli and Klebsiella 6(23.1% each),Enterobacter 3(11.5%)and Pseudomonas 2(7.7%) while Gram positive bacteria (Staph .aures) was isolated less often from 8 cultures (23.5%). After training the total number of culture positive decreased to17. Still Gram negative bacteria were isolated more frequently 12(70.6%) times as follows : E.coli 4(33.3%), Paracollon bacilli, klebsilla, pseudomonas, Enterobacter 2(16.6%) each. Gram positive bacteria were isolated 5(29.4%) times as follows: S.aures 4(23.5%) and CNS 1(5.9%)
Infection of ICU patient with UTI was classified into HAI and CAI. Before training there were 34 UTI patients with positive urine culture of them 25(73.5% ) were HAI and 9( 26.5 ) CAI .Out of the 25 HAI ,20(80%)were MDR and only 5(20%)were NMDR, while out 9CAI ,6(66.7%)were MDR and only 3(33.3%) were NMDR .
On the other hand, after training there were only 17 culture positive of them 7(41.2%) were HAI and 10(58.8%) CAI. Of HAI 4(57.1%) were MDR and 3(42.9%) were NMDR and out CAI 50% were MDR and NMDR (5 cases for each) .This means that 26 (76.5 )out of the 34 positive urine culture were MDR and only 8( 23.5% ) were
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NMDR compared to 9(52.9% ) and 8(47.1%) respectively out of 17 culture positive after training .This means that HAI decreased from 80% - 50% and total MDR isolated decreased from 76.47% in pre training period to52.9% after training. Finally, the goal of this study was to improve patient’s safety and quality of care by reducing Catheter Associated Urinary Tract Infections (CAUTIs) in our hospital. This was achieved through Implementation new implementing interventions the insertion and maintenance bundle. Also evidence supports the routine replacement of long-term urinary catheters in order to achieve improved patient outcomes was noticed.