Effect of instruction and implementation of a preventive urinary tract infection bundle on the incidence of catheter associated urinary tract infection in intensive care unit patients

The effectiveness of quality management interventions in reducing hospital-associated infections in adult patients: A systematic literature review

BACKGROUND

This systematic literature review evaluates the effectiveness of Quality Management Tools (QMTs) in reducing Hospital-Associated Infections (HAIs) among adult inpatients in hospital settings.

METHODS

The systematic literature review, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline, systematically analyzed relevant studies from 2013 to 2023 across three electronic databases: PubMed, CINAHL, and EMBASE, using Covidence. The risk of bias assessment was performed using different validated tools depending on the study design.

RESULTS

The study encompassed 34 studies conducted in diverse healthcare settings worldwide. QMT interventions consisted of a total of 18 bundle interventions, five stewardship programs, four catheter usage interventions, three checklists, two audit and feedback interventions, and two oral care policies. Twenty-five studies showed significant decreases, whereas nine studies showed insignificant decreases in HAI rates after the deployment of QMTs. Although these interventions show promise, caution in interpretation is advised as only 6 of the included 34 studies had low risk of bias. The meta-analysis of seven studies on bundle interventions for ventilator-associated pneumonia (VAP), showed a 40% reduction in VAP incidence (OR: 0.40, 95% CI: 0.24-0.65; I² = 80.8%, P = 0.00).

CONCLUSION

Introduction QMTs has the potential to reduce HAI among adult inpatients. Further research is warranted to optimize the implementation of QMTs to enhance patient care and public health outcomes.

Interventions for improving critical care in low- and middle-income countries: a systematic review

PURPOSE

To systematically review the typology, impact, quality of evidence, barriers, and facilitators to implementation of Quality Improvement (QI) interventions for adult critical care in low- and middle-income countries (LMICs).

METHODS

MEDLINE, EMBASE, Cochrane Library and ClinicalTrials.gov were searched on 1st September 2022. The studies were included if they described the implementation of QI interventions for adult critical care in LMICs, available as full text, in English and published after 2000. The risks of bias were assessed using the ROB 2.0/ROBINS-I tools. Intervention strategies were categorised according to a Knowledge Translation framework. Interventions' effectiveness were synthesised by vote counting and assessed with a binomial test. Barriers and facilitators to implementation were narratively synthesised using the Consolidated Framework for Implementation Research.

RESULTS

78 studies were included. Risk of bias was high. The most common intervention strategies were Education, Audit & Feedback (A&F) and Protocols/Guidelines/Bundles/Checklists (PGBC). Two multifaceted strategies improved both process and outcome measures: Education and A&F (p = 0.008); and PGBC with Education and A&F (p = 0.001, p < 0.001). Facilitators to implementation were stakeholder engagement, organisational readiness for implementation, and adaptability of interventions. Barriers were lack of resources and incompatibility with clinical workflows.

CONCLUSIONS

The evidence for QI in critical care in LMICs is sparse and at high risk of bias but suggests that multifaceted interventions are most effective. Co-designing interventions with and engaging stakeholders, communicating relative advantages, employing local champions and adapting to feedback can improve implementation. Hybrid study designs, process evaluations and adherence to reporting guidelines would improve the evidence base.

Healthcare workers' compliance with the catheter associated urinary tract infection prevention guidelines: an observational study in Yemen

BACKGROUND

Catheter-associated urinary tract infection is a global problem but it can be prevented with the appropriate implementation of evidence-based guidelines. This study was conducted to assess the level of compliance of healthcare workers with the catheter-associated urinary tract infection prevention guidelines during the insertion of a urinary catheter.

METHODS

An observational study using a descriptive cross-sectional design was conducted at Sana'a City hospitals, Yemen. All the nurses and physicians from the governmental, teaching, and private hospitals were eligible to participate in the study. The data collection was performed through convenience sampling from March 2020 to December 2020, using a structured observational checklist prepared specifically for this study.

RESULTS

The majority of the urinary catheter insertions were performed by nurses. There were no written policy or procedures for an urinary catheter insertion and no in-service education or training departments in the majority of the hospitals. The overall mean score of compliance was 7.31 of 10. About 71% of the healthcare workers had a high or acceptable level of compliance and 29% had an unsafe level of compliance. Compliance was low for maintaining aseptic technique throughout the insertion procedure, using a single use packet of lubricant jelly, performing hand hygiene immediately before insertion, and securing the urinary catheter once inserted. Factors affecting the healthcare workers compliance were gender, the working ward/unit of the healthcare workers, the availability of a written policy/procedure and a department or unit for in-service education.

CONCLUSION

Yemeni healthcare workers' overall compliance was acceptable but it was unsafe in several critical measures. There is an urgent need for developing, implementing, and monitoring national guidelines and institutional policy and procedures for catheter-associated urinary tract infection prevention. Periodical in-service education and training programs and adequate access to the necessary materials and supplies are paramount.

Determination of Antimicrobial and Antibiofilm Activity of Combined LVX and AMP Impregnated in p(HEMA) Hydrogel

Catheter-associated urinary tract infections (CAUTIs) are nosocomial infections, causing more than one million cases per year. CAUTIs cause serious health issues; in addition, the cost of replacement of the device constrains the employment of urological devices. Therefore, there is an urgent need to develop novel biomaterials for use in catheters. In this study, poly hydroxyethyl-methacrylate p(HEMA) and drugs-loaded p(HEMA) with ampicillin trihydrate (AMP), levofloxacin (LVX), and drug combinations were prepared using free radical polymerization. The characterization of the dried films included the determination of glass transition temperature (Tg), ultimate tensile strength, elongation percentage, and Young’s modulus. Formulation toxicity, antimicrobial activity, and biofilm-formation ability were tested. Decreases in Tg value, U.T.S., and Young’s modulus, and an increase in elongation percentage were observed in AMP-loaded p(HEMA). Different ratios of drug combinations increased the Tg values. The films exhibited a cell viability higher than 80% on HEK 293 cells. Antimicrobial activity increased when p(HEMA) was loaded with LVX or a combination of LVX and AMP. Biofilm-forming ability reduced after the addition of antimicrobial agents to the films. p(HEMA) impregnated with AMP, LVX, and drug combinations showed significantly increased antimicrobial activity and decreased biofilm-forming ability compared with p(HEMA), in addition to the effects on (HEMA) mechanical properties.