1. Introduction

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Ensuring quality of care and creating a safe environment for patients and medical staff in health-care facilities is a strategic public health objective. Health-care associated infections (HAI) have a negative impact on the quality of care and the safety of patients and staff [1–4]. It is known that the death rate in the group of hospitalized patients with developed HAI is 8-10 times higher than in the group of hospitalized patients without infection [3–5]. In the European Union, 4.1 million cases of HAI are reported each year, of which 37,000 are fatal. According to the World Health Organization (WHO) in South-East Asia, the most frequent outbreaks occur (10% of patients develop HAI). Among all of the HAI, the most common are urinary tract infections (UTI), proportion of which are about 40% of all nosocomial infections and which cause significant economic, medical and social harm [5,6] The vast majority of UTI are catheter-associated urinary tract infections (CAUTI) associated with bladder catheterization - a common procedure administered to patients. Up to 25% of all hospitalized patients require indwelling bladder catheters during of their hospitalization [6,7]. Approximately 15-25% of all hospitalized patients undergo short-term urethral catheterization. The prevalence of long-term urethral catheterization remains unknown. There is disparate evidence that in the United States the prevalence of long-term urethral catheterization in patients with long-stay in the ward is about 5% with the presence of about 50,000 catheterized patients at any one time. CAUTI are an important problem of the patient’s safety and should be the focus of attention, as are any invasive interventions that pose a risk to the patient [8–11].

At the same time, according to various estimates, from 17 to 69% CAUTI can be prevented by the infection prevention and control programs, which means that around 380 000 infections and 9000 deaths related with CAUTI can be prevented yearly. In order to develop effective, efficient and cost-effective strategies for the prevention of these infections is necessary to know the presence and severity of risks, the extent of the epidemic well-being of health care facilities that may be not the same in different hospitals [12–20]. Assessment of the epidemiologic situation allows rational allocation of resources, use the most effective measures to prevent cases of CAUTI.

2. Materials And Methods

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We conducted an integral assessment of the conditions for the occurrence and spread of CAUTI in hospitals of various types. To this end, factors that contributed to or hampered the emergence and spread of CAUTI were identified [8–20], since different groups of factors with different intensity of exposure may be possible in different hospitals and specific conditions. The contribution of each specific indicator to the integral assessment of the risk of occurrence of CAUTI was justified and calculated. The influence of such indicators as percentage of patients with bacteriuria, the lenght of catheterization of the bladder in days, the diameter of the urinary catheter, the risk of occurrence of CAUTI depending on the type of hospital wards, the length of stay of the patient in hospital, the type of drainage system, the number of patients with a silicone catheter, the number of patients with a latex catheter, the number of patients with other types of urinary catheter, the total number of patients with urinary catheters, sex, age of the patient were studied.

3. Results

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The utility model refers to medicine, namely, the epidemiology of infections related to the provision of HAI, and can be used to assess the epidemic situation with CAUTI in health care facilities.

An epidemiological situation is an indicator of the well-being of a territory (object) at a certain time, characterized by the level and dynamics of people's morbidity due to infectious diseases, the presence or absence of appropriate factors of transmission of infection and other circumstances that affect risk of drift and the spread of infectious diseases.

These criteria make it possible to judge the welfare or unhappiness of the epidemiological situation and the severity of the problem. Conditionally it is possible to allocate safe, unstable, unsuccessful and extreme epidemiological situations. The probability of occurrence of an emergency in relation to CAUTI is unlikely and is not considered in this work.

We say about a welfare epidemiological situation when cases of infectious diseases are not registered or their sporadic cases are reported, there are no favorable conditions for the spread of these diseases. We say about an unstable epidemiological situation when the level of people's morbidity due to infectious diseases does not exceed the average long-term indicators, but there are favorable conditions for the spread of these diseases. We say about an adverse epidemiological situation when the level of peoples' morbidity due to infectious diseases in excess of normal expectancy, outbreaks of infectious diseases are recorded.

A comprehensive assessment of the degree of epidemiological well-being or disadvantage of a certain population or territory usually is based on a comparison of certain specific statistical indicators, such as quantity of cases, incidence, prevalence. However, in practice the epidemic situation with respect to CAUTI is determined by other determinants (for example, sex, age, duration of catheterization, etc.) With indicators that vary in different directions, a reliable conclusion about epidemiological well-being or adverse-being is based, in addition to logical analysis, on the use of a single integrated indicator.

To calculate a single integrated indicator, we selected the main determinants that contribute to the emergence and spread of CAUTI. They included the percentage of positive patients with bacteriuria, the duration catheterization of the patient's urinary bladder, characteristics of the urinary catheter and drainage system used, type of hospital and duration of catheterization, the total number of patients with urinary catheters and the number of patients with different types of catheters (silicone, latex, etc.), sex and age of patients. First, the duration of the bladder catheterization is determined, then, depending on the data obtained, the desired formula is chosen (if the length of catheterization of the bladder is between 1 and 3 days, we choose the first formula; if the length of catheterization of the bladder is more than 3 and less than 23 days, we choose the second formula; if the length of catheterization of the bladder is more 23 days, we choose the third formula) and the obtained values of the indices are introduced into the formula:

Some parameters of the formula take fixed values depending on expert estimates. These values include DC (Table 1), LH (Table 2), D (Table 3), H (Table 4), S (Table 5), A (Table 6).

If the integral indicator of well-being is less than 0.001, then the epidemiological situation in CAUTI is assessed as welfare and safe, if the integral indicator of well-being is from 0.001 to 0.5, then the epidemiological situation is assessed as unstable, and if the integral indicator of well-being reaches more than 0.5, the epidemiological the situation is assessed as unfavorable.

The single integral indicator includes all the factors that determine and contribute to the occurrence of CAUTI and provides the expansion of the arsenal of methods for epidemiological diagnosis of the epidemiological situation of CAUTI in the health care setting.

The developed method allows assessing the epidemic situation with CAUTI in health care facilities. The method is tested in various hospital wards in the Kharkiv region, Ukraine.

4. Conclusion

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Thus, the proposed assessment of the epidemiological situation with regard to CAUTI can provide a comprehensive risk assessment for the generalized indicator, taking into account the main determinants of the CAUTI epidemic process, forecast the epidemiological situation based on the obtained generalized data taking into account the integral risk index; to develop, based on the data obtained, measures to eliminate or reduce the negative impact of unfavorable factors; to prioritize measures to improve the safety of inpatient visits to patients and medical staff.