Randomized control trial of application of the CDC.control guidelines category I and education for reduction of nosocomial uti in CMU. hospital

Abstract

Nosocomial infection is a problem in health care facilities. It causes increased morbidity, mortality, expense and duration of hospitalization. Urinary tract infection has been the highest rate among other nosocomial infections. We conducted a randomized control trial to investigate whether a Nosocomial Control Programme using CDC guidelines category I and education could reduce urinary tract infection rates and increase favourable control behaviours among nursing personnels in Chiangmai University Hospital general medical wards compared to control. Ward was the unit of randomization. The intervention wards received the control guidelines combined with education. The control wards received only the guidelines. After three months, the two groups received the alternative interventions for another three months. A positive urine culture at the time of catheter removal was considered an infection. Behaviours were monitored using blinded observations and checklists. Seventy-eight nursing personnels and four hundred and sixty-two patients were studied. The personnel control behaviors were significantly improved (p<0.05) for the following items: Handwashing Immediately Before Catheterization, Handwashing Immediately After Catheterization, Catheter Stabilization After Insertion, Clamping The Outflow Spigot and Separation Use of Container for Emptying the Urine Bag. However, some of these improvements could not be sustained. There were no significant reduction in infection rates between the two groups (survival analysis and Mantel haenzel chi-square) Further studies should address the following issues: asymptomatic and symptomatic infections; strategies for maintenance of the favorable control behaviors; study in different ward settings; and a more precise detection of onset of infections.