Results of the STRUTI project A point prevalence study of healthcare associated urinary tract infections in Australian acute and aged care facilities: Results of the STRUTI project Mitchell B¹,², Fasugba O¹, Beckingham W³, Bennett N⁴, Gardner A¹ 1Australian Catholic University, 2Avondale College of Higher Education, 3Infection Control Canberra Hospital, 4Victorian Hospital-Acquired Infection Surveillance (VICNISS) The STRUTI Project Surveillance To Reduce Urinary Tract Infections

The STRUTI Project Surveillance To Reduce Urinary Tract Infections Introduction Urinary tract infections are the most frequently reported healthcare-associated infections (HAIs) Most healthcare associated urinary tract infections (HAUTIs) are associated with indwelling urinary catheters (CAUTIs) Elvy & Colville, 2009 Most important risk factor for infection is duration of catheterisation Jansen et al, 2013 CAUTIs can prolong length of hospital stay Saint, 2000 HAUTIs including CAUTIs are potentially preventable through implementation of effective infection prevention and control strategies NHMRC, 2010 The STRUTI Project Surveillance To Reduce Urinary Tract Infections

The STRUTI Project Surveillance To Reduce Urinary Tract Infections Types and prevalence of healthcare associated infections Smyth et al (2008). J Hosp Infect; 69 (3), 230- 248 The STRUTI Project Surveillance To Reduce Urinary Tract Infections

The STRUTI Project Surveillance To Reduce Urinary Tract Infections Introduction STRUTI is Phase II of a 3 Phase project and builds on the findings of Phase I Phase I was conducted in 3 publicly funded and 3 private hospitals in 2 Australian jurisdictions Gardner et al, 2014 Preliminary findings used to develop a national protocol which has been published Mitchell et al, 2014 Phase II provided evidence for proof of concept by testing our protocol using an online process The STRUTI Project Surveillance To Reduce Urinary Tract Infections

The STRUTI Project Surveillance To Reduce Urinary Tract Infections Aims The aims of the overall study were: To provide proof of concept of a national protocol for HAUTI prevalence To develop a website and pilot and online process for conducting point prevalence survey of HAUTIs including CAUTIs To establish usability of a national protocol for HAUTI surveillance in residential aged care facilities To determine the point prevalence of HAUTIs including CAUTIs in aged care facilities The STRUTI Project Surveillance To Reduce Urinary Tract Infections

The STRUTI Project Surveillance To Reduce Urinary Tract Infections Methods 82 acute care hospitals and 17 aged care facilities within 4 Australian jurisdictions participated STRUTI website was developed which enabled data collectors to enter and submit data Training manual explaining all necessary data collection procedures developed and piloted during Phase I Data collection occurred between 1st July and 7th August 2015 Data collectors were ICPs, nurses and nursing aides The STRUTI Project Surveillance To Reduce Urinary Tract Infections

The STRUTI Project Surveillance To Reduce Urinary Tract Infections STRUTI website homepage The STRUTI Project Surveillance To Reduce Urinary Tract Infections

The STRUTI Project Surveillance To Reduce Urinary Tract Infections Methods All patients hospitalised overnight/residents of aged care facilities at the study sites were included Patients in the emergency departments, mental health units and outpatients were excluded In acute care, HAUTI were defined using the Health Protection Agency (HPA)/European Centre for Disease Prevention and Control criteria HPA, 2011 In aged care, the McGeer surveillance definitions were used Stone et al, 2012 Following online data collection, data collectors completed an evaluation survey The STRUTI Project Surveillance To Reduce Urinary Tract Infections

The STRUTI Project Surveillance To Reduce Urinary Tract Infections Results Results Acute care n (%) N=1320 Aged care n (%) N=663 Age in years (median, IQR) 74 (58-84) 86 (79-90) Gender Female 727 (55.1) 446 (67.3) HAUTI prevalence 19 (1.4) 10 (1.5) CAUTI prevalence 3 (0.2) 2 (0.3) Catheter use 123 (9.3) 22 (3.3) The STRUTI Project Surveillance To Reduce Urinary Tract Infections

The STRUTI Project Surveillance To Reduce Urinary Tract Infections Discussion Prevalence of HAUTI in acute care similar to Phase I results Acute and aged care HAUTI rates comparable to other studies Prevalence of catheter use was three times higher in acute care compared to aged care Catheter use for acute and aged care low in comparison to Europe and United States The STRUTI Project Surveillance To Reduce Urinary Tract Infections

The STRUTI Project Surveillance To Reduce Urinary Tract Infections Implications and conclusion Given the burden and high risk of systemic sepsis from UTI, we should aim for zero HAUTI prevalence Study provides evidence to support undertaking online HAUTI point prevalence Finings will be used to inform the establishment of a national online database Centralised web based system and data collection processes developed will allow for collection of timely national healthcare associated urinary tract infection in Australia The STRUTI Project Surveillance To Reduce Urinary Tract Infections

The STRUTI Project Surveillance To Reduce Urinary Tract Infections Thanks and Acknowledgements This study was funded by an Australian Catholic University Faculty of Health Sciences Research Grant and an Ian Potter Foundation Health and Disability Grant Thanks to staff of all participating sites for their time and assistance with data collection We thank the information technology team at VICNISS for the development and ongoing support for the website Thanks also to Dr Jane Koerner and Ms Alex Hoskins for their research assistance The STRUTI Project Surveillance To Reduce Urinary Tract Infections

The STRUTI Project Surveillance To Reduce Urinary Tract Infections References Elvy J, Colville A. Catheter associated urinary tract infection: what is it, what causes it and how can we prevent it? J Infect Prev 2009;10:36-41 Gardner A, Mitchell B, Beckingham W & Fasugba O. A point prevalence study of healthcare associated urinary tract infections in six Australian hospitals. BMJ Open 2014; 4:1-9 Health Protection Agency. Fourth National Point Prevalence Survey on Healthcare Associated Infections and First National Point Prevalence Survey on Antimicrobial Use and Quality Indicators in England2011. Available from http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1296687778967 Jansen J, et al. Reduction of unnecessary use of indwelling urinary catheters. BMJ Quality & Safety 2013;22:984-988. Mitchell B, Gardner A, Beckingham W & Fasugba O. Healthcare associated urinary tract infections: a protocol for a national point prevalence study. Healthcare Infection 2014;19:26-31 National Health and Medical Research Council. Australian Guidelines for the Prevention and Control of Infection in Healthcare 2010. Available from http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cd33_complete.pdf. Saint S. Clinical and economic consequences of nosocomial catheter-related bacteriuria. American journal of infection control. 2000;28:68-75. Smyth ETM, McIlvenny G, Enstone JE, Emmerson AM, Humphreys H, Fitzpatrick F, et al. Four Country Healthcare Associated Infection Prevalence Survey 2006: overview of the results. Journal of Hospital Infection. 2008;69:230-48. Stone N, Ashraf M, Calder J, Crnich C, Crossley K, Drinka P, et al. Surveillance Definitions of Infections in Long-Term Care Facilities: Revisiting the McGeer Criteria. Infect Control Hosp Epidemiol 2012;33:965-77 The STRUTI Project Surveillance To Reduce Urinary Tract Infections

The STRUTI Project Surveillance To Reduce Urinary Tract Infections Contact details Brett Mitchell Brett.Mitchell@avondale.edu.au Bola Fasugba Oyebola.Fasugba@acu.edu.au Wendy Beckingham Wendy.Beckingham@act.gov.au Noleen Bennett Noleen.Bennett@mh.org.au Anne Gardner Anne.Gardner@acu.edu.au