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Volume 50, Number 4, August 2017

Implementation of a national bundle care program to reduce catheter-associated urinary tract infection in high-risk units of hospitals in Taiwan 

Chih-Cheng Lai, Chun-Ming Lee, Hsiu-Tzy Chiang, Ching-Tzu Hung, Ying-Chun Chen, Li-Hsiang Su, Zhi-Yuan Shi, Jein-Wei Liu, Chang-Pan Liu, Min-Chi Lu, Yin-Ching Chuang, Wen-Chien Ko, Shu-Hui Tseng, Yen-Hsu Chen, Po-Ren Hsueh for the Infection Control Society of Taiwan


Corresponding author:

Po-Ren Hsueh, Corresponding author. Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, No. 7 Chung-Shan South Road, Taipei 100, Taiwan. 


Background and purpose: 

This study was intended to investigate the impact of implementation of catheter-associated urinary tract infection (CA-UTI) bundle care on the incidence of CA-UTI in high-risk units.




Thirteen high-risk units, including medical (n = 5), surgical (n = 3), cardiac intensive care units (n = 2), respiratory care centers (n = 2), and respiratory care ward (n = 1) were included in this quality-improvement project. This study was divided into pre-intervention phase (from January 1 to July 31) and post-intervention phase (from August 1 to October 31) in 2013. 



The incidence of CA-UTI decreased by 22.7%, from 3.86 to 2.98 per 1000 catheter-days (95% confidence interval, 0.65–0.82; p < 0.0001) before and after the introduction of the CA-UTI bundle. Among 66 episodes of culture-proven CA-UTIs, Candida spp. were the most common pathogens (n = 17, 25.8%), followed by Escherichia coli (n = 10, 15.2%). For the seven elements of the insertion bundle, the compliance was the lowest for cleaning of the perineum, followed by hand hygiene. The overall compliance rates of the insertion bundle were 93.4%, 99.5%, and 96.3% in medical centers, regional hospitals, and district hospital, respectively. For the six elements of the maintenance bundle, the compliance was the lowest for daily review of the need of a Foley catheter. The overall compliance rates of the maintenance bundle were 95.7%, 99.9%, and 99.9% in medical centers, regional hospitals, and district hospital, respectively. 



The implementation of CA-UTI bundle care successfully reduced CA-UTI in Taiwanese high-risk units. A process surveillance checklist can be helpful for understanding which parts of the bundle care require improvements. 


Key words:

Bundle care, Catheter-associated urinary tract infection, Surveillance