“IMPACT OF IPC BUNDLES AND ANTIMICROBIAL STEWARDSHIP ON DEVICE-ASSOCIATED INFECTIONS IN ADULT ICUS: A PRE–POST QUASI-EXPERIMENTAL STUDY”

Abstract

:  Device-associated healthcare-associated infections (HAIs) such as CAUTI, CLABSI, and VAP remain major causes of morbidity and mortality in intensive care units, especially in low- and middle-income countries where device utilization and antimicrobial resistance are high. Limited adherence to Infection Prevention and Control (IPC) practices and suboptimal antimicrobial use further increase infection burden. Care bundles and Antimicrobial Stewardship (AMS) interventions have shown significant effectiveness when consistently applied. This study evaluates the combined impact of structured IPC bundles and AMS strategies on reducing device-associated HAIs in adult ICUs of a tertiary-care teaching hospital.

Material and Methods: A pre–post quasi-experimental study was conducted over 18 months in adult ICUs. A total of 400 patients (200 pre-intervention and 200 post-intervention) were included. Standardized CAUTI, CLABSI, and VAP bundles were implemented along with AMS measures such as culture-before-antibiotics, de-escalation, and optimization of antibiotic duration. HAI rates were calculated per 1,000 device-days using CDC/NHSN definitions. Compliance with IPC bundles and AMS indicators was monitored using daily audits and structured checklists.

Results: Following the intervention, device-associated HAI rates significantly decreased. CAUTI reduced from 3.66 to 1.83 per 1,000 catheter-days (50% reduction), VAP declined from 6.34 to 1.60 per 1,000 ventilator-days (75% reduction), and CLABSI decreased from 4.18 to 0.00 per 1,000 central-line days. Bundle compliance improved from 58% to 85%. AMS indicators also showed improvement, with culture-before-antibiotics increasing from 62% to 81%, de-escalation from 24% to 46%, and broad-spectrum overuse (>5 days) reducing from 41% to 26%.

Conclusion: Integration of IPC bundles with AMS interventions led to a significant reduction in CAUTI, CLABSI, and VAP in adult ICUs. The study demonstrates that low-cost, standardized, and evidence-based strategies—supported by active surveillance and antimicrobial stewardship—can substantially enhance patient safety and reduce antimicrobial resistance in resource-limited healthcare settings. These findings support wider adoption of combined IPC and AMS programs for sustainable infection reduction.