200. A Cluster-Randomized Controlled Trial of CAtheter Reminder and Evaluation (CARE) Program to Reduce Catheter-Day and Catheter-associated Infections: Results from Aggregate Data Analysis
Session: Poster Abstract Session: Catheter-associated UTIs
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
  • final poster care.pdf (89.9 kB)
  • Background: Prolonged use of urinary catheter is considered a major risk factors for catheter-related urinary tract infections (CA-UTIs). Many guidelines recommend removal of urinary catheter when appropriate indications are not present. Our study aimed to evaluate  the impact of the CARE program on urinary catheter days in general medical wards.

    Methods: A cluster RCT with wards as the unit of randomization was conducted during Feb 1, 2013 - April 30, 2013 at Siriraj hospital, Bangkok, Thailand. Six general medical wards were randomly allocated to either the intervention (CARE program) group or the control group. The CARE program involved two steps. First: a ward nurse evaluated each patient on daily basis. If a given patient had an acute urinary catheter in place, an order sheet then was marked with a CARE stamp indicating the first date of catheter use. Second: a responsible physician filled an indication of catheter use during a service round. If an appropriate indication was not written, a given urinary catheter  then was automatically removed. Individual data was obtained by chart- reviewing while all aggregate data were obtained via Siriraj Infection Control Surveillance System. 

    Results: Data of urinary catheter days and patient days in each group three months before and after starting the study are shown in figure 1. Median rate of urinary catheter use (catheter days/1,000 patient days) was comparable between the intervention group [380.0, range 232.8-443.6] and the control group [321.4, range 244.3-431.7], by unadjusted analysis (p=0.40). We also performed additional analysis by using only data from  three intervention wards before and after starting the study. Segmented poisson regression analysis revealed a significantly lower rate of urinary catheter use after the intervention implemented [RR=0.74 (0.65-0.84);p<0.001].

    Conclusion: The pre/post analysis revealed the positive impact of the CARE program while no effect was detected by analysis with the parallel control groups. Since we used cluster randomization, baseline characteristics between 2 study groups may be different. Hierarchical model adjusting for clustering effect should be further performed to determine  the real effect of this program.  


    Figure 1. Data of urinary catheter days and patients days among the CARE group and the control group

    Pinyo Rattanaumpawan, MD, MSCE, Nicha Therathorn, MD and Visanu Thamlikitkul, MD, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand


    P. Rattanaumpawan, None

    N. Therathorn, None

    V. Thamlikitkul, None

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