1. 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

2. 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
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3. 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),
The STRUTI Project Surveillance To Reduce Urinary Tract Infections

4. 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

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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

6. 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

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

8. 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

9. 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)
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10. 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
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11. 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
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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
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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
Jansen J, et al. Reduction of unnecessary use of indwelling urinary catheters. BMJ Quality & Safety 2013;22:
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 Available from
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:
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
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Contact details
Brett Mitchell
Bola Fasugba
Wendy Beckingham
Noleen Bennett
Anne Gardner