Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 24 , ISSUE 7 ( July, 2020 ) > List of Articles

Original Article

Impact of Care Bundle Implementation on Incidence of Catheter-associated Urinary Tract Infection: A Comparative Study in the Intensive Care Units of a Tertiary Care Teaching Hospital in South India

Kathiresan Jeyashree, Ramesh Arunagiri

Citation Information : Jeyashree K, Arunagiri R. Impact of Care Bundle Implementation on Incidence of Catheter-associated Urinary Tract Infection: A Comparative Study in the Intensive Care Units of a Tertiary Care Teaching Hospital in South India. Indian J Crit Care Med 2020; 24 (7):544-550.

DOI: 10.5005/jp-journals-10071-23473

License: CC BY-NC 4.0

Published Online: 22-11-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Introduction: Implementation of evidence-based infection control practices is the need of the hour for every institute to reduce the device-associated infections, which directly reflects the quality of care. As catheter-associated urinary tract infection (CAUTI) is the most common nosocomial infection, the study was planned to evaluate the impact of the catheter care bundle in reducing CAUTI incidence. Material and methods: The prospective interventional study before and after the trial study was carried out in adult intensive care units over a period of 9 months (April–June 2017—pre-implementation phase; July–September 2017—training of healthcare worker and implementation of catheter care bundle; October–December 2017—post-implementation phase). Catheter-associated urinary tract infection rates pre- and post-implementation were expressed as incidence rates with Poisson confidence interval. Results: Statistically significant reduction was found in the incidence of CAUTI (60%—from 10.7 to 4.5 per 1,000 catheter days). The key factors that contributed were significant reduction in device utilization ratio (from 0.71 to 0.56) and average catheter days per patient (from 4.8 to 3.7). This holistic approach has resulted in less incidence of CAUTI even among patients with risk factors and prolonged catheter days. Neuro ICU showed drastic improvement compared to other ICUs due to the poor baseline status of their care practices. Conclusion: Adherence to all elements of care bundle brought a significant decrease in CAUTI. Implementing care bundle and auditing the adherence to each element should be included as a part of routine hospital infection control committee (HICC) practices. Clinical significance: Hospital-acquired infection directly reflects on the quality care of the hospital. Bundle care is an “all or none” phenomenon. Adherence to each element will have some influence in reducing CAUTI in terms of reducing the device utilization ratio and average catheter days per patient. Auditing the care bundle adherence is having a positive influence on the outcome.

  1. Rosenthal VD, Maki DG, Salomao R, Moreno CA, Mehta Y, Higuera F, et al. Device-associated nosocomial infections in 55 intensive care units of 8 developing countries. Ann Intern Med 2006;145(8):582–591. DOI: 10.7326/0003-4819-145-8-200610170-00007.
  2. Parida S, Mishra SK. Urinary tract infections in the critical care unit: A brief review. Indian J Crit Care Med 2013;17(6):370–374. DOI: 10.4103/0972-5229.123451.
  3. Clec'h C, Schwebel C, Français A, Toledano D, Fosse J-P, Garrouste-Orgeas M, et al. Does catheter-associated urinary tract infection increase mortality in critically ill patients? Infect Control Hosp Epidemiol 2007;28(12):1367–1373. DOI: 10.1086/523279.
  4. Tambyah PA, Knasinski V, Maki DG. The direct costs of nosocomial catheter-associated urinary tract infection in the era of managed care. Infect Control Hosp Epidemiol 2002;23(1):27–31. DOI: 10.1086/501964.
  5. Nicolle LE. Catheter associated urinary tract infections. Antimicrob Resist Infect Control 2014;3(1):23. DOI: 10.1186/2047-2994- 3-23.
  6. Saint S. Clinical and economic consequences of nosocomial catheter-related bacteriuria. Am J Infect Control 2000;28(1):68–75. DOI: 10.1016/s0196-6553(00)90015-4.
  7. Bagshaw SM, Laupland KB. Epidemiology of intensive care unit-acquired urinary tract infections. Curr Opin Infect Dis 2006;19(1): 67–71. DOI: 10.1097/01.qco.0000200292.37909.e0.
  8. 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;35(5):464–479. DOI: 10.1086/675718.
  9. 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 2009. Infect Control Hosp Epidemiol 2010;31(4):319–326. DOI: 10.1086/651091.
  10. Safety P, National Healthcare Safety Network (NHSN) Overview. [cited 2017 Jul 31]; Available from:
  11. Mathur P. Prevention of healthcare-associated infections in low- and middle-income countries: the “bundle approach. Indian J Med Microbiol 2018;36(2):155. DOI: 10.4103/ijmm.IJMM_18_152.
  12. Prakash SS, Rajshekar D, Cherian A, Sastry AS. Care bundle approach to reduce device-associated infections in a tertiary care teaching hospital, South India. J Lab Physicians 2017;9(4):273–278. DOI: 10.4103/JLP.JLP_162_16.
  13. Cooke FJ, Holmes AH. The missing care bundle: antibiotic prescribing in hospitals. Int J Antimicrob Agents 2007;30(1):25–29. DOI: 10.1016/j.ijantimicag.2007.03.003.
  14. Lai C-C, Lee C-M, Chiang H-T, Hung C-T, Chen Y-C, Su L-H, et al. Implementation of a national bundle care program to reduce catheter-associated urinary tract infection in high-risk units of hospitals in Taiwan. J Microbiol Immunol Infect 2017;50(4):464–470. DOI: 10.1016/j.jmii.2017.01.006.
  15. Blanck AM, Donahue M, Brentlinger L, Stinger KD, Polito C. A quasi-experimental study to test a prevention bundle for catheter-associated urinary tract infections. J Hosp Adm 2014;3(4):101. DOI: 10.5430/jha.v3n4p101.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.