Comparison of Catheter Care Practices and Catheter Infection Rates of Turkish and Dutch Intensive Care Units in Two University Hospitals: A Prospective Study

Introduction: The aim of this study was to compare catheter care practices before and after an educational intervention and also catheter infection rates after intervention in the intensive care units (ICUs) of two university hospitals, in Turkey and Holland. Materials and Methods: The study was prospectively conducted in the ICUs of two university hospitals (1 Turkish, 1 Dutch). We compared catheter-related infection (CRI) rates and catheter care practices (hand hygiene practice, hub disinfection, skin antisepsis) before and after educational interventions. The study consisted of three periods: pre-interventional period, interventional period (feedback, educational program) and re-observations of the nurses, at one and six month(s) after the intervention. Results: Skin antisepsis and dressing practices differed between the two hospitals, while both settings employed bedside alcoholic rubs. The overall compliance with hand disinfection prior to the intervention was significantly different between the two ICUs (65% versus 18% in the Dutch and Turkish ICUs, respectively). In both settings, the interventions led to an immediate increase in hand hygiene compliance. However, six months after the intervention, compliance dropped in the Turkish ICUs, whereas it further increased in the Dutch setting. Comparably, hub disinfection rates were lower in the Turkish ICUs before and after the intervention. Most likely as a result of the lower compliance with catheter-care practices, CRI rates were two-fold higher among Turkish ICU patients. Conclusion: Catheter-related bloodstream infection (CR-BSI) can be significantly reduced by applying multifaceted interventions that help to ensure adherence with simple, evidence-based infection control measures. Educational programs and feedback are part of these interventions but, as shown in the present study, will not achieve persistent behavioral changes unless they are repeatedly applied