Examining the Impact of a 9-Component Bundle and the INICC Multidimensional Approach on Catheter-Associated Urinary Tract Infection Rates in 32 Countries across Asia, Eastern Europe, Latin America, and the Middle East.

Background Catheter-Associated Urinary Tract Infections (CAUTIs) frequently occur in the 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 (LMICs). The dependent variable was CAUTI per 1,000-UC-days, assessed at baseline and throughout the intervention, in the 2nd month, 3rd month, 4-15 months, 16-27 months, and 28-39 months. Comparisons were made using a two-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 2nd month (RR=0.37; 95% CI= 0.34-0.39; P<0.001), 3.79 in the 3rd month (RR=0.25; 95% CI= 0.23-0.28; P<0.001), 2.98 in the 4-15 months (RR=0.21; 95% CI=0.18-0.22; P<0.001), 1.86 in the 16-27 months (RR=0.12; 95% CI=0.11-0.14; P<0.001), and 1.71 in the 28-39 months (RR=0.11; 95% CI=0.09-0.13; P<0.001). 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 LMICs.