Rates of urinary catheter-associated urinary tract infection in Saudi MOH hospitals: a 2-year multi-centre study
Background: The published rates of catheter-associated urinary tract infection (CAUTI) in Saudi Arabia were derived from single-centre studies or nationally non-representative studies.
Objectives: The aim of this study was to estimate CAUTI rates and urinary catheter utilisation (UCU) ratios in 99 Saudi Ministry of Health (MOH) hospitals from all regions.
Methods: A prospective surveillance study was conducted in 15 different types of intensive care units (ICUs) between January 2018 and December 2019. The data were entered into the Health Electronic Surveillance Network (HESN) programme. The methods of the US National Healthcare Safety Network (NHSN) and the Gulf Cooperation Council (GCC) centre for infection control were used.
Results: During 2 years of surveillance covering 919,615 patient-days and 573,720 urinary catheter days, a total of 965 CAUTI events were identified. The overall MOH CAUTI rate was 1.68 (95%confidence interval (CI) 1.58–1.79) per 1,000 urinary catheter days, and the overall UCU was 0.624 (95%CI 0.623–0.625). CAUTI rates were highest in paediatric medical (5.73) and adult medical (2.02) ICUs. UCU were highest in neurosurgical (0.795) and medical surgical (0.743) ICUs. CAUTI standardised infection ratios across different ICUs in Saudi MOH hospitals were 16% lower than NHSN hospitals, 47% lower than GCC hospitals and 69% lower than International Nosocomial Infection Control Consortium (INICC) hospitals. Urinary catheter standardised utilisation ratios across different ICUs in Saudi MOH hospitals were 15% higher than NHSN hospitals, 9% higher than INICC hospitals and 13% lower than GCC hospitals.
Conclusions: The current study is a unique national CAUTI benchmark that can potentially help in the fight against healthcare-associated infection.
Feneley RCL, Hopley IB, Wells PNT. Urinary catheters: history, current status, adverse events and research agenda. J Med Eng Technol 2015; 39(8): 459–70. doi: 10.3109/03091902.2015.1085600
Klevens RM, Edwards JR, Richards CL, Jr., Horan TC, Gaynes RP, Pollock DA, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep 2007; 122(2): 160–6. doi: 10.1177/003335490712200205
World Health Organisation. Report on the burden of endemic health care-associated infection worldwide. A systematic review of the literature. 2011. Available from: http://whqlibdoc.who.int/publications/2011/9789241501507_eng.pdf [cited 01 January 2021).
Alshamrani MM, El-Saed A, Alsaedi A, El Gammal A, Al Nasser W, Nazeer S, et al. Burden of healthcare-associated infections at six tertiary-care hospitals in Saudi Arabia: a point prevalence survey. Infect Contr Hosp Epidemiol 2019; 40(3): 355–7. doi: 10.1017/ice.2018.338
Rosenthal VD, Bat-Erdene I, Gupta D, Belkebir S, Rajhans P, Zand F, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2012–2017: device-associated module. Am J Infect Control 2020; 48(4): 423–32.
Moreno CA, Rosenthal VD, Olarte N, Gomez WV, Sussmann O, Agudelo JG, et al. Device-associated infection rate and mortality in intensive care units of 9 Colombian hospitals: findings of the International Nosocomial Infection Control Consortium. Infect Contr Hosp Epidemiol 2006; 27(4): 349–56. doi: 10.1017/ice.2018.338
Advani SD, Lee RA, Long M, Schmitz M, Camins BC. The impact of 2015 NHSN Catheter-associated Urinary Tract Infection (CAUTI) definition change on Central Line-associated Bloodstream Infection (CLABSI) rates and CLABSI prevention efforts at an Academic Medical Center. Infect Control Hosp Epidemiol 2018; 39(7): 878–80. doi: 10.1017/ice.2018.338
Fakih MG, Groves C, Bufalino A, Sturm LK, Hendrich AL. Definitional change in NHSN CAUTI was associated with an increase in CLABSI events: Evaluation of a large health system. Infect Contr Hosp Epidemiol 2017; 38(6): 685–9. doi: 10.1017/ice.2017.41
Cassini A, Plachouras D, Eckmanns T, Abu Sin M, Blank HP, Ducomble T, et al. Burden of six healthcare-associated infections on European Population Health: Estimating incidence-based disability-adjusted life years through a population prevalence-based modelling study. PLoS Med 2016; 13(10): e1002150. doi: 10.1017/ice.2017.41
Smith DRM, Pouwels KB, Hopkins S, Naylor NR, Smieszek T, Robotham JV. Epidemiology and health-economic burden of urinary-catheter-associated infection in English NHS hospitals: a probabilistic modelling study. J Hosp Infect 2019; 103(1): 44–54. doi: 10.1016/j.jhin.2019.04.010
Umscheid CA, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Contr Hosp Epidemiol 2011; 32(2): 101–14. doi: 10.1016/j.jhin.2019.04.010
Ferguson A. Implementing a CAUTI prevention program in an acute care hospital setting. Urol Nurs 2018; 38(6): 273–302. doi: 10.7257/1053-816X.2018.38.6.273
Van Mourik MSM, Perencevich EN, Gastmeier P, Bonten MJM. Designing surveillance of healthcare-associated infections in the era of automation and reporting mandates. Clin Infect Dis 2018; 66(6): 970–6. doi: 10.1093/cid/cix835
Menegueti MG, Ciol MA, Bellissimo-Rodrigues F, Auxiliadora-Martins M, Gaspar GG, Canini S, et al. Long-term prevention of catheter-associated urinary tract infections among critically ill patients through the implementation of an educational program and a daily checklist for maintenance of indwelling urinary catheters: a quasi-experimental study. Medicine (Baltimore) 2019; 98(8): e14417. doi: 10.1093/cid/cix835
Marigliano A, Barbadoro P, Pennacchietti L, D’Errico MM, Prospero E. Active training and surveillance: 2 good friends to reduce urinary catheterization rate. Am J Infect Contr 2012; 40(8): 692–5. doi: 10.1016/j.ajic.2012.01.021
Palumbo AJ, Loveless PA, Moll ME, Ostroff S. Evaluation of healthcare-associated infection surveillance in Pennsylvania hospitals. Infect Contr Hosp Epidemiol 2012; 33(2): 105–11. doi: 10.1086/663709
Gaid E, Assiri A, McNabb S, Banjar W. Device-associated nosocomial infection in general hospitals, Kingdom of Saudi Arabia, 2013–2016. J Epidemiol Glob Health 2018; 7(Suppl 1): S35–40. doi: 10.1016/j.jegh.2017.10.008
Al Nasser W, El-Saed A, Al-Jardani A, Althaqafi A, Alansari H, Alsalman J, et al. Rates of catheter-associated urinary tract infection in tertiary care hospitals in 3 Arabian Gulf countries: a 6-year surveillance study. Am J Infect Contr 2016; 44(12): 1589–94. doi: 10.1016/j.ajic.2016.06.030. PMID: 27692786.
Al-Tawfiq JA, Amalraj A, Memish ZA. Reduction and surveillance of device-associated infections in adult intensive care units at a Saudi Arabian hospital, 2004–2011. Int J Infect Dis 2013; 17(12): e1207–11. doi: 10.1016/j.ijid.2013.06.015
Khan ID, Basu A, Kiran S, Trivedi S, Pandit P, Chattoraj A. Device-associated healthcare-associated infections (DA-HAI) and the caveat of multiresistance in a multidisciplinary intensive care unit. Med J Armed Forces India 2017; 73(3): 222–31. doi: 10.1016/j.mjafi.2016.10.008
Saudi Ministry of Health (MOH). Statistical yearbook 1439H (2018 G). 2019. Available from: https://www.moh.gov.sa/en/Ministry/Statistics/book/Documents/book-Statistics.pdf [cited 01 January 2021).
National Healthcare Safety Network (NHSN). NHSN patient safety component manual. Januray 2018. Available from: http://www.cdc.gov/nhsn/PDFs/pscManual/pcsManual_current.pdf [cited 1 January 2021).
GCC Centre for Infection Control and Ministry of National Guard Health Affairs. Healthcare-associated infections surveillance manual. 3rd ed. 2018. Available from: http://ngha.med.sa/English/MedicalCities/AlRiyadh/MedicalServices/Documents/3rd_edition_Surveillance_Manual.pdf [cited 1 January 2021].
Saudi Ministry of Health (MOH). Health electronic surveillance network. 2020. Available from: https://hesn.moh.gov.sa/webportal/ [cited 1 January 2021).
Dudeck MA, Edwards JR, Allen-Bridson K, Gross C, Malpiedi PJ, Peterson KD, et al. National Healthcare Safety Network report, data summary for 2013, Device-associated Module. Am J Infect Control 2015; 43(3): 206–21. doi: 10.1016/j.ijid.2013.06.015
Dudeck MA, Weiner LM, Allen-Bridson K, Malpiedi PJ, Peterson KD, Pollock DA, et al. National Healthcare Safety Network (NHSN) report, data summary for 2012, device-associated module. Am J Infect Contr 2013; 41(12): 1148–66. doi: 10.1016/j.ijid.2013.06.015
Rosenthal VD, Maki DG, Mehta Y, Leblebicioglu H, Memish ZA, Al-Mousa HH, et al. International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007–2012. Device-associated module. Am J Infect Contr 2014; 42(9): 942–56.
El-Saed A, Balkhy HH, Weber DJ. Benchmarking local healthcare-associated infections: available benchmarks and interpretation challenges. J Infect Public Health 2013; 6(5): 323–30. doi: 10.1016/j.ijid.2013.06.015
Humayun T, Alshanbari N, Alanazi A, Aldecoa YS, Alanazi KH, Saleh GB, et al. Rates of ventilator associated pneumonia in Saudi Ministry of Health Hospitals; a two-year multi-center study. Am J Infect Dis Microbiol. 2021; 9(1): 25–31. doi: 10.12691/ajidm-9-1-6
Humayun T, Qureshi A, Roweily SF, Carig J, Humayun F. Efficacy of hydrogen peroxide fumigation in improving disinfection of hospital rooms and reducing the number of microorganisms. J Ayub Med Coll Abbottabad 2019; 31(4 Suppl 1): 646–50.
Copyright (c) 2022 Yvonne S. Aldecoa, Adel Alanazi, Ghada Bin Saleh, Nasser Alshanbari, Tabish Humayun, Faisal Alsheddi, Aiman El-Saed, Mohammed Alqahtani, Khalid H. Alanazi
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright of their work, with first publication rights granted to IJIC. Read the full Copyright- and Licensing Statement.