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.

Catheter-Associated Urinary Tract Infections (CAUTIs) frequently occur in the intensive care unit (ICU) and are correlated with a significant burden. 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. The dependent variable was CAUTI per 1,000 UC days, assessed at baseline and throughout the intervention, in the second month, third month, 4 to 15 months, 16 to 27 months, and 28 to 39 months. Comparisons were made using a 2-sample t test, and the exposure-outcome relationship was explored using a generalized linear mixed model with a Poisson distribution. 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 second month (risk ratio [RR] = 0.37; 95% confidence interval [CI] = 0.34-0.39; P <.001), 3.79 in the third month (RR = 0.25; 95% CI = 0.23-0.28; P <.001), 2.98 in the 4 to 15 months (RR = 0.21; 95% CI = 0.18-0.22; P <.001), 1.86 in the 16 to 27 months (RR = 0.12; 95% CI = 0.11-0.14; P <.001), and 1.71 in the 28 to 39 months (RR = 0.11; 95% CI = 0.09-0.13; P <.001). 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 low- and middle-income countries. • The objective of this study is to implement a strategy to reduce CAUTI rates. • An intervention was conducted in 299 ICUs across 32 countries. • 150,258 patients were monitored over 978,364 days, including 652,053 UC-days. • CAUTI rates decreased from 14.89 to 1.71/ 1,000 UC days in the 28^th-39^th months. • The intervention was implemented without incurring costs or additional staff. [ABSTRACT FROM AUTHOR]