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SummaryHand washing is widely accepted as the cornerstone of infection control in the intensive care unit (ICU). Nosocomial infections are frequently viewed as indicating poor compliance with hand washing guidelines. To determine the hand hygiene (HH) compliance rate among healthcare workers (HCWs) and its effect on the nosocomial infection rates in the ICU of our hospital, we conducted an interventional study. The study spanned a period of 7 months (February 2011–August 2011) and consisted of education about HH indications and techniques, workplace reminder posters, focused group sessions, and feedback on the HH compliance and infection rates. The WHO HH observation protocol was used both before and after a hospital-wide HH campaign directed at all staff members, particularly those in the ICU. Compliance was measured by direct observation of the HCWs, using observation record forms in a patient-directed manner, with no more than two patients observed simultaneously. The overall HH compliance rate was calculated by dividing the number of HH actions by the total number of HH opportunities. The nosocomial infection rates for the pre- and post-interventional periods were also compared to establish the effect of the intervention on rate of infections acquired within the unit. The overall rate of HH compliance by all the HCWs increased from 42.9% pre-intervention to 61.4% post-intervention, P < 0.001. Individually, the compliance was highest among the nurses, 49.9 vs. 82.5%, respectively (P < 0.001) and lowest among the doctors, 38.6 vs. 43.2%, respectively (P = 0.24). The effect of the increase in the HH compliance rate on the nosocomial infection rate was remarkable. There were significant reductions in the following: the rate of overall health care-associated infections/1000 patient-days, which fell from 37.2 pre-intervention to 15.1 post-intervention (P < 0.001); the rate of bloodstream infections, which fell from 18.6 to 3.4/1000 central-line-days (P < 0.001); and the rate of lower respiratory tract infections, which fell from 17.6 to 5.2/1000 ventilator-days (P < 0.001). Similarly, there were significant reductions in the isolation rates of 4 major hospital pathogens (P < 0.001 and P = 0.03). These findings suggest that although cross-infection in the ICU is a complex process, its frequency can be affected by meticulous adherence to hand hygiene recommendations. Highlights► Hand hygiene (HH) compliance by nurses was better than doctors. ► Educational intervention improved overall HH compliance. ► Intervention resulted in statistically significant reduction in nosocomial infections. KeywordsHand hygiene Compliance Nosocomial infections Multidrug-resistant organisms Cited by (0)Copyright © 2012 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved. ABSTRACTObjective:to identify the gap in the prevention of catheter-associated urinary tract infection. Method:an observational study conducted by an audit of process indicators in relation to the recommendations for preventing catheter-associated urinary tract infection during its maintenance and handling. The collection was carried out between July and September of 2017 in an adult intensive care unit located in the State of Minas Gerais, Brazil. The observations were made with the help of a developed instrument for the present study and the data were analyzed by means of descriptive statistics. Results:451 evaluations were performed related to maintenance of the urinary catheter with a focus on its fixation, the collector bag maintenance, and volume and urinary flow of the drainage system. Regarding clinical practice gaps, inadequate fixation of the urinary catheter and drainage pocket were found, with more than three-quarters of its capacity filled (97.7% and 3.5%, respectively). Regarding the handling of 556 urinary catheters, there was non-conformity in the hygiene of the urethral meatus in 22.9% of the situations, and non-adherence to hands hygiene before and after handling the urinary catheter was 94.2% and 66.5%, respectively (p=0.002). Conclusion:isolated measures had good adherence rates, but prevention of catheter-associated urinary tract infection should be based on adherence to several measures simultaneously. The prevention gap is in the awareness of health professionals that the recognized prevention measures of catheter - associated urinary tract infection should be adopted collectively in order to guarantee patient and clinical practice safety. DESCRIPTORS: RESUMENObjetivo:identificar el gap para prevención de infección del tracto urinario asociado al uso del catéter vesical. Métodos:estudio observacional conducido por auditoría de indicadores de proceso en relación a las recomendaciones para prevención de la infección del tracto urinario asociada al uso de catéter vesical durante su mantenimiento y manipulación. La recolección se realizó entre julio y septiembre de 2017, en una unidad de cuidados intensivos adultos, en el Estado de Minas Gerais, Brasil. Las observaciones fueron realizadas con ayuda de un instrumento desarrollado para el presente estudio y los datos fueron analizados por medio de estadística descriptiva. Resultados:se realizaron 451 evaluaciones relacionadas con el mantenimiento del catéter vesical con foco en su fijación, mantenimiento de la bolsa colectora, y volumen y flujo urinario del sistema de drenaje. Como lagunas de la práctica clínica, se verificó la fijación inadecuada del catéter vesical y bolsa colectora de drenaje con más de tres cuartos de su capacidad llenada (97,7% y 3,5%, respectivamente). En cuanto a la manipulación, de 556 cateteres vesicales, hubo inconformidad en la higiene del meato uretral en el 22,9% de las situaciones, y la no adhesión a la higienización de las manos antes y después del manejo del catéter vesical fue del 94,2% y 66,5%, respectivamente (p=0,002). Conclusión:medidas aisladas presentaron buenas tasas de adhesión, pero la prevención de la infección del tracto urinario asociada al uso del catéter vesical debe basarse en la adhesión a varias medidas de forma simultánea. El gap para prevención está en la concientización de los profesionales de salud de que las medidas reconocidas para prevenir la infección del tracto urinario asociada al uso del catéter vesical deben ser adoptadas de forma colectiva, para garantizar la seguridad del paciente y de la práctica clínica. DESCRIPTORES: RESUMOObjetivo:identificar o gap para prevenção de infecção do trato urinário associada ao uso do cateter vesical. Método:estudo observacional conduzido por auditoria de indicadores de processo em relação às recomendações para prevenção da infecção do trato urinário associada ao uso de cateter vesical durante sua manutenção e manipulação. A coleta foi realizada entre julho e setembro de 2017, em uma unidade terapia intensiva adulto, localizada no Estado de Minas Gerais, Brasil. As observações foram realizadas com auxílio de um instrumento desenvolvido para o presente estudo e os dados foram analisados por meio de estatística descritiva. Resultados:foram realizadas 451 avaliações relacionadas à manutenção do cateter vesical com foco em sua fixação, manutenção da bolsa coletora e volume e fluxo urinário do sistema de drenagem. Como lacunas da prática clínica, foram verificadas fixação inadequada do cateter vesical e bolsa coletora de drenagem com mais de três quartos de sua capacidade preenchida (97,7% e 3,5%, respectivamente). No tocante à manipulação, de 556 cateteres vesicais, houve inconformidade na higiene do meato uretral em 22,9% das situações, e a não adesão à higienização das mãos antes e após o manuseio do cateter vesical foi de 94,2% e 66,5%, respectivamente (p=0,002). Conclusão:medidas isoladas apresentaram boas taxas de adesão, mas a prevenção da infecção do trato urinário associada ao uso do cateter vesical deve se basear na adesão a várias medidas de forma simultânea. O gap para prevenção está na conscientização dos profissionais de saúde de que as medidas reconhecidas para prevenção da infecção do trato urinário associada ao uso do cateter vesical devem ser adotadas de forma coletiva, visando garantir a segurança do paciente e da prática clínica. DESCRITORES: INTRODUCTIONHealthcare-associated infections (HAIs) are seen as an aggravation of broad epidemiological significance within the context of hospital care, and as the fourth cause of complication in developed countries, mainly due to the use of invasive
devices.11. Dereli N, Necl D, Esra O, Semih D, Saziye S, Filiz K. Three-year evaluation of nosocomial infection rates of the ICU. Rev Bras Anestesiol [Internet]. 2013 Feb [cited 2018 Feb 10];63(1):73-84. Available from: Available from: https://dx.doi.org/10.1590/S0034-70942013000100006 It is estimated that up to 69% of CAUTIs are avoidable, provided that prevention and control strategies are implemented. As prevention measures, in addition to their proper use and aseptic technique for urinary catheter insertion, quality
improvement programs should be implemented with an active approach through process audits to evaluate team adherence to aspects related to appropriate practices for maintenance and handling of the urinary catheter. For the maintenance, these practices include care in fixation of the urinary catheter; the bag collector having less than three-quarters of its capacity filled, being below bladder level and not having contact with the ground; unobstructed urinary flow and use of a closed drainage
system. In handling, five moments for hand hygiene (before and after contact with the patient, before the aseptic procedure, after exposure to body fluids and after contact with areas close to the patient) can be mentioned, and standard precautions.33. Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA. Healthcare Infection Control Practices Advisory Committee. Guideline for Prevention of Catheter-Associated Urinary Tract Infections [Internet]. US: Centers for
Disease Control and Prevention, 2017[cited 2018 Feb 10]. Available from: Available from: https://www.cdc.gov/infectioncontrol/guidelines/cauti/ 4. Lo E, Nicolle LE, Coffin SE, Gould C, Maragakis LL, Meddings J, et al. Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals: 2014 Update. Infect Control Hosp
Epidemiol. 2014;5(35):464-79. doi: 10.1086/675718 5. Saint S, Greene MT, Krein SL, Rogers MA, Ratz D, Fowler KE, et al. A program to prevent catheter-associated urinary tract infection in acute care. N Engl J Med. 2016;374(22):2111-9. doi: 10.1056/NEJMoa1504906 https://www.who.int/gpsc/5may/tools/9789... Reducing IRAS through evidence-based
recommendations has become an increasing priority, both for patient safety and for reducing health costs.77. Gray D,Nussle R,Cruz A,Kane G,Toomey M,Bay C, et al. Effects of a catheter-associated urinary tract infection prevention campaign on infection rate, catheter utilization, and health care workers perspective at a community safety net hospital. Am J Infect Control. 2016;44(1):115-6. doi:
10.1016/j.ajic.2015.08.011 In concern for healthcare quality, the Institute for Healthcare Improvement proposed a set of actions (a bundle), which potentiate significantly better results when implemented simultaneously compared to when measures are adopted individually, even if their effectiveness is scientifically
proven.33. Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA. Healthcare Infection Control Practices Advisory Committee. Guideline for Prevention of Catheter-Associated Urinary Tract Infections [Internet]. US: Centers for Disease Control and Prevention, 2017[cited 2018 Feb 10]. Available from: Available from: https://www.cdc.gov/infectioncontrol/guidelines/cauti/
However, any improvement strategy should be evaluated for its expected impact in clinical practice. The availability of outcome indicators through reports and analysis of surveillance data often does not allow for understanding the reality of HAI occurrence to enable planning and measures aimed at effective prevention. Thus, the existence of a protocol
and/or the isolated use of outcome indicators is not a guarantee of qualified clinical practice.44. Lo E, Nicolle LE, Coffin SE, Gould C, Maragakis LL, Meddings J, et al. Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals: 2014 Update. Infect Control Hosp Epidemiol. 2014;5(35):464-79. doi: 10.1086/675718 This study aimed to identify the gap in the prevention of catheter-associated urinary tract infection. METHODAn observational study performed at the intensive care unit (ICU) for adult patients containing ten beds in a highly complex hospital in the State of Minas Gerais, with 80% of the services performed by the Unified Health System (SUS - Sistema Único de Saúde). Data collection was performed by convenience sampling from July to September 2017, uninterrupted by two nursing students in Scientific Initiation, duly trained through studies and discussion of evidence-based practices for CAUTI prevention. Direct observation of professionals’ adherence to the CAUTI prevention measures during the maintenance and handling of the urinary catheter occurred in a way that the professionals did not associate the presence of the observer with the motives for the observation in seeking to soften the Hawthorne effect. For this, a strategy of presenting observers being present in the unit was adopted for other justifications, which had no direct relation with their real intention. The academics positioned themselves in the vicinity of the patient beds who had urinary catheters and thus observed the professionals’ adherence to the CAUTI prevention measures. A pilot study was conducted in May 2017 in a unit similar to the research site, following the same design in order to evaluate the instrument, its replicability and standardization in the collection. The observations were carried out using a specifically prepared structured script for the present study containing recommendations for CAUTI prevention during maintenance and handling of the urinary catheter, and
were performed during the daytime (at 7:00 to 19:00) and at night (from 19:00 to 7:00). The instrument was developed based on evidence-based practices for CAUTI prevention recommended by the Guidelines for Prevention of Catheter-Associated Urinary Tract Infections;33. Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA. Healthcare Infection Control Practices Advisory Committee. Guideline for Prevention of Catheter-Associated Urinary Tract Infections
[Internet]. US: Centers for Disease Control and Prevention, 2017[cited 2018 Feb 10]. Available from: Available from: https://www.cdc.gov/infectioncontrol/guidelines/cauti/ The instrument included six process indicators related to maintenance and another six to process handling (Box 1). Box 1 The handling types were divided into three groups: bathing in bed, emptying the collector bag and handling the urinary catheter, which is characterized as any other care in which the professionals’ hands touched the catheter. Descriptive data analysis was performed as well as the Pearson chi-square test or Fisher’s exact test in the Statistical Package for Social Sciences (SPSS®), version 23.0. The research complied with all recommendations of resolution 466/2012 of the National Health Council. RESULTSA total of 57 daily observations were performed, 31 in the day shift and 26 at night, totaling 376 hours and 451 evaluations of the urinary catheterization maintenance. The audit results of the process indicators for maintenance of the urinary catheter in the ICU are presented in Table 1. Table 1 - It was only possible to observe fixation of the urinary catheter in 262 maintenance evaluations, with a non-compliance rate of 97.7%. Fixation was not performed in most of the observations (76.0%), and when present (21.7%) it was done incorrectly (on the bed and the external part of the patient’s thigh). There was no difference in the behavior of the professionals considering day and night shifts in the maintenance care of the urinary catheter, except in the care of the collector bag with less than three-fourths of its filled capacity, since this non-conformity was most observed during the night shift (81.3%, p=0.008). The results of the professionals’ adherence to the CAUTI prevention measures during handling the urinary catheter refer to 556 procedures. Bathing in the bed represented 39.3% of the handling; direct handling of the urinary catheter, 32.5%; and emptying the collector bag accounted for 28.2% of the handling (Table 2). The professionals who performed the greatest amount of handling were nursing technicians (98.4%), followed by the doctors (0.9%) and nurses (0.7%). Table 2 - The overall adherence rate to the use of procedure gloves was 92.1% and hand hygiene before and after urinary catheter handling was 5.8% and 33.5%, respectively (p=0.002). Before handling the urinary catheter, simple hand hygiene was performed in 100% of the sample, and after in 96.2%; antiseptic friction was done in 2.7%; and simple hygiene followed by antiseptic friction in 1.1% of the handlings. Figure 1 shows adherence to hand hygiene before and after each type of urinary catheter handling in the ICU for 376 hours of observation. Figure 1 - DISCUSSIONEven though CAUTI it is considered an avoidable adverse event, it still represents a challenge for the quality of healthcare.77. Gray D,Nussle R,Cruz A,Kane G,Toomey M,Bay C, et al. Effects of a catheter-associated urinary tract infection prevention campaign on infection rate, catheter utilization, and health care workers perspective at a community safety net hospital. Am J Infect Control.
2016;44(1):115-6. doi: 10.1016/j.ajic.2015.08.011 In the evaluation of the maintenance conditions and handling of the urinary catheter in this investigation, adherence was
observed in isolated prevention measures, compromising the quality of provided care. This fact leads us to believe that there is still difficulty for health professionals in understanding multiple measures simultaneously, evidencing an important gap to be filled by means of training, discussing cases and conducting audits in the units, especially in those with greater use of invasive devices and more critical patients.44. Lo E, Nicolle LE, Coffin SE, Gould C,
Maragakis LL, Meddings J, et al. Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals: 2014 Update. Infect Control Hosp Epidemiol. 2014;5(35):464-79. doi: 10.1086/675718 Non-conformities to the process indicators in the maintenance and handling of the urinary catheter were identified and present risk conditions for patient safety. Although the majority of items reached close to 100% adequacy indices, general compliance was impaired due to the low adherence of the team to adequate catheter fixation, hand hygiene before and after handling, and hygiene of the urethral meatus during which there are potential actions that favor CAUTI occurrence. On the other hand, it is important to note that the closed urinary drainage system is a structure item related to the type of material offered by the hospital to perform
the procedure. However, it is not able to prevent CAUTI in isolation if: (1) it is not fixed correctly; (2) its fill level is above recommended; and (3) the handling is not appropriate - to mention some aspects that are intended for prevention.33. Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA. Healthcare Infection Control Practices Advisory Committee. Guideline for Prevention of Catheter-Associated Urinary Tract Infections [Internet]. US: Centers for Disease
Control and Prevention, 2017[cited 2018 Feb 10]. Available from: Available from: https://www.cdc.gov/infectioncontrol/guidelines/cauti/ Incorporating and recognizing the importance of other measures to prevent CAUTI in an individual and collective way through training is essential, since only making adequate materials available is insufficient if they are not used correctly. Urinary catheter fixation was the indicator component with the lowest adequacy index. The great risk associated with inadequate fixation is directly related to the possibility of urinary catheter traction, which can cause lesions in the urethra and bladder neck during
bed mobilization, as well as the migration of potentially infectious agents, considerably increasing the CAUTI risk.99. Agência Nacional de Vigilância Sanitária (Anvisa). Medidas de Prevenção de Infecção Relacionada à Assistência à Saúde [Internet]. Brasília, DF: Anvisa; 2017[cited 2018 Feb 10]. Available from: Available from:
http://portal.anvisa.gov.br/documents/33852/3507912/Caderno+4+-+Medidas+de+Prevenção+de+Infecção+Relacionada+à+Assistência+à+Saúde/a3f23dfb-2c54-4e64-881c-fccf9220c373 14. Menegueti MG, Martins MA, Canini SR, Basie-Filho A, Laus AM. Urinary infection in intensive care unit: indicators of procedure for prevention. Rev Rene [Internet]. 2012 [cited 2018 Feb 10];13(3):632-8. Available from: Available from: http://www.redalyc.org/pdf/3240/324027982016.pdf https://doi.org/10.12968/bjcn.2014.19.9.... Hand hygiene practice stands out as the main measure for preventing and controlling HAIs because of its effectiveness, practicality and low
cost.1616. Oliveira AC, Gama CS, Paula AO. Multimodal strategy to improve the adherence to hand hygiene and self-assessment of the institution for the promotion and practice of hand hygiene. J Public Health. 2018;40(1):163-8. doi: 10.1093/pubmed/fdx035 The
five moments were defined with the aim to bring understanding of hand hygiene importance to health professionals in the more frequent care practices in clinical practice.66. World Health Organization (WHO). Clean Care is Safe Care. WHO guidelines on hand hygiene in health care [Internet]. Geneva: WHO, 2009 [cited 2018 Feb 10]. Available from: Available from: https://www.who.int/gpsc/5may/tools/9789241597906/en/
The adhesion rate to hand hygiene was significantly higher after handlings, demonstrating the care of professionals at that moment in relation to
occupational health; but on the other hand, it proved to be below that required for safe care when compared to similar studies,1717. Dailly S. Auditing urinary catheter care. Nurs Stand. 2012;26(20):35-40. doi: 10.7748/ns.26.20.35.s48 Gloves alone are not sufficient to prevent HAI transmission and do not fully protect healthcare workers against microbial agents; it also does not exempt them from properly sanitizing their hands, countering the false premise which still needs to be heavily worked on and demystified that wearing gloves makes the hand hygiene
procedure unnecessary. Microorganisms can contaminate the hands of health professionals during their removal or through unperceived microperforations. The reverse path may also occur: previously contaminated hands disseminate microorganisms to the environment and the patient being touched and/or handled. Gloves should therefore be used during all patient care activities where there may be exposure to blood and/or other bodily fluids in order to reduce the risk of spreading microorganisms into
the environment and transmission from the health professional to the patient and vice versa, as well as from one patient to another.1919. Ghorbani A, Sadeghi L, Shahrokhi A, Mohammadpour A, Addo M, Khodadadi E. Hand hygiene compliance before and after wearing gloves among intensive care unit nurses in Iran. Am J Infect Control. 2016;44(11):e279-81. doi:
10.1016/j.ajic.2016.05.004 Regarding the type of hand hygiene used by professionals, a trend towards simple hygiene was observed. In urinary catheter handling, antiseptic friction (use of alcoholic preparations) and simple hygiene (use of water and soap) are
recommended, with the latter being mandatory when the hands are visibly dirty or contaminated with body fluids, and after the use of the procedure gloves - in this study, due to the presence of talc. Simple hygiene followed by antiseptic friction was observed in this investigation on two occasions of isolated urinary catheter handling. The consecutive use of these techniques is not recommended, as it is considered inappropriate behavior. In addition to the waste of resources, they do not
contribute to reducing cross-transmission of micro-organisms and can also cause dermatitis.66. World Health Organization (WHO). Clean Care is Safe Care. WHO guidelines on hand hygiene in health care [Internet]. Geneva: WHO, 2009 [cited 2018 Feb 10]. Available from: Available from: https://www.who.int/gpsc/5may/tools/9789241597906/en/ Another relevant aspect in this study was the non-compliance with hygiene of the urethral meatus (22.9%). Studies evaluating bladder catheter care in critically ill patients also pointed to professionals’ negligence in relation to such practice.2121. Miranda AL, Oliveira AL, Nacer DT, Aguiar CA. Results after implementation of a protocol on the incidence of urinary tract infection in an intensive care unit. Rev Lat Am Enfermagem. 2016;24:e2804.
doi: 10.1590/1518-8345.0866.2804 The source of microorganisms which cause CAUTI may be endogenous, typically through the urethral or exogenous meatus, through contaminated hands of health professionals due to a breakdown of aseptic techniques in handling the catheter and its drainage system.33. Gould CV, Umscheid CA, Agarwal RK,
Kuntz G, Pegues DA. Healthcare Infection Control Practices Advisory Committee. Guideline for Prevention of Catheter-Associated Urinary Tract Infections [Internet]. US: Centers for Disease Control and Prevention, 2017[cited 2018 Feb 10]. Available from: Available from: https://www.cdc.gov/infectioncontrol/guidelines/cauti/ Thus, it is important for the team to fully adhere to the
recommended prevention measures in order to interrupt the transmission chain and prevent CAUTI occurrence and to reduce colonization (use of the closed drainage system, urethral meatus hygiene and hand hygiene) and the ascent of microorganisms through the bladder catheter (adequate fixation, adequate maintenance of the collector bag, volume and urinary flow), as well as attention to the really necessary usage time of the urinary catheter.33. Gould CV, Umscheid CA,
Agarwal RK, Kuntz G, Pegues DA. Healthcare Infection Control Practices Advisory Committee. Guideline for Prevention of Catheter-Associated Urinary Tract Infections [Internet]. US: Centers for Disease Control and Prevention, 2017[cited 2018 Feb 10]. Available from: Available from: https://www.cdc.gov/infectioncontrol/guidelines/cauti/ The rates presented as results of the performance indicators are not sufficient to assess risk conditions for CAUTI. They should be contrasted with process indicators through clinical practice audits, as conducted in this study. Indirect surveillance often presents adequate indicators, but they are almost always incompatible with on-site observations/audits, which reaffirms that results of isolated measures may be misleading for planning consolidated actions and do not have the desired effect in reducing CAUTI rates. To overcome the gap between evidence-based recommendations for CAUTI prevention and clinical practice, the first step is to identify and correct non-conformities.2222.
Taleschian-Tabrizi N, Farhadi F, Madani N, Mokhtarkhani M, Kolahdouzan K, Hajebrahimi S. Compliance with guideline statements for urethral catheterization in an iranian teaching hospital. Int J Health Policy Manag. 2015;4(12):805-11. doi: 10.15171/ijhpm.2015.128 25. Vacca M,
Angelos D. Elimination of catheter-associated urinary tract infections in an adult neurological intensive care unit. Crit. Care Nurse [Internet]. 2013 [cited 2018 Feb 10];33(6):78-80. Available from: Available from: https://dx.doi.org/10.4037/ccn2013998 26. Galiczewski JM, Shurpina KM. An intervention to improve the catheter associated urinary tract infection rate
in a medical intensive care unit: Direct observation of catheter insertion procedure. Intensive Crit Care Nurs. 2017;40(1):26-34. doi: 10.1016/j.iccn.2016.12.003 https://dx.doi.org/10.1590/S0104-0707201... Regarding limitations of the present study, it can be pointed out that the study only being carried out in one institution restricts extrapolation or comparison of the results, possibly interfering in its external validity. CONCLUSIONAlthough most of the process indicators for urinary catheter maintenance and handling achieved satisfactory indices of adequacy, overall compliance was impaired. Although the unit has a prevention and control protocol, through this audit it was possible to identify non-adherence by the professionals to the preventive measures based on scientific evidence established in the guidelines. The gap in prevention is in the awareness by health professionals that the measures recognized for preventing catheter-associated urinary tract infection should be adopted collectively. The identification of gaps in clinical practice should be seen as the main strategy for planning punctual interventions, as well as to form an organizational culture that values care quality and patient safety. REFERENCES
What is the most common cause of hospital acquired UTI?The most important risk factor for developing a catheter-associated UTI (CAUTI) is prolonged use of the urinary catheter.
What's a UTI caused by?Urinary tract infections are caused by microorganisms — usually bacteria — that enter the urethra and bladder, causing inflammation and infection. Though a UTI most commonly happens in the urethra and bladder, bacteria can also travel up the ureters and infect your kidneys.
What is the most important intervention to prevent hospital acquired catheter associated UTI?CAUTI can be prevented by things such as hand washing, not using urine drain tubes and if they must be used, inserting them properly and keeping them clean. Catheters should be put in only when necessary, and removed as soon as possible. Core Prevention Strategies: Insert catheters only for appropriate indications.
How can nosocomial urinary tract infections be prevented?The most important strategies for prevention of catheter-related urinary infection are to avoid insertion of a catheter and, if a catheter must be used, to limit the duration to as short a time as possible. It is remarkable that so few facilities measure this risk exposure.
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