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Mazi WA, Bondad M, Althumali M, Alzahrani T. Reducing catheter-associated urinary tract infection in high dependency unit: an eighteen-month quality improvement intervention study period. Infect Prev Pract 2024; 6:100362. [PMID: 38596199 PMCID: PMC11001618 DOI: 10.1016/j.infpip.2024.100362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/05/2024] [Indexed: 04/11/2024] Open
Abstract
Background The urinary catheter usually leads to a catheter-associated urinary tract infection (CAUTI) contributing to further morbidity and mortality. There is very limited data on the CAUTI incidence rate in high-dependency units (HDUs) in the Kingdom of Saudi Arabia. The institutional CAUTI incidence rate in HDU was six times higher compared to the United States National Healthcare Safety Network (US-NHSN) in 2021. Objective To reduce 50% CAUTI incidence rate by the end of 2022. Method A prospective study was conducted in tertiary HDU from January 2022 to June 2023. A gap analysis was assessed between the hospital practices and the Society Healthcare Epidemiology of America/Infectious Diseases Society of America (SHEA/IDSA) basic recommendations. The Kotter and Rathgebers' changing behavior model was applied at the beginning of the project. Formal education and prevention of CAUTI were applied using the National Strategy Model. Surveillance and statistical data analysis were carried out using US-NHSN guidelines. Results The overall CAUTI incidence rate declined from 7.07- to 3.57/1000 urinary catheter days despite of significant increase in the utilization ratio from 0.79 to 0.94 (P value 0.0001). The compliance rate of the bundle CAUTI prevention was improved and sustained above 90%. A CAUTI incidence rate reduction was observed following the combination of the changing behavior and SHEA/IDSA of CAUTI prevention models over 18 months. Conclusion We assumed the combination of the changing behavior and the prevention models for a long period is useful in reducing the CAUTI incidence rate and possibly applied to reduce other healthcare-associated infections.
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Affiliation(s)
| | - Mylene Bondad
- Infection Prevention and Control Department, King Abdulaziz Specialist Hospital, Taif, Kingdom of Saudi Arabia
| | - Maryam Althumali
- Infection Prevention and Control, Directorate of Health Affairs, Taif, Kingdom of Saudi Arabia
| | - Turki Alzahrani
- Infection Prevention and Control Department, King Abdulaziz Specialist Hospital, Taif, Kingdom of Saudi Arabia
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Karlsson PA, Pärssinen J, Danielsson EA, Fatsis-Kavalopoulos N, Frithiof R, Hultström M, Lipcsey M, Järhult JD, Wang H. Antibiotic use during coronavirus disease 2019 intensive care unit shape multidrug resistance bacteriuria: A Swedish longitudinal prospective study. Front Med (Lausanne) 2023; 10:1087446. [PMID: 36824610 PMCID: PMC9941185 DOI: 10.3389/fmed.2023.1087446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/23/2023] [Indexed: 02/09/2023] Open
Abstract
Objectives High frequency of antimicrobial prescription and the nature of prolonged illness in COVID-19 increases risk for complicated bacteriuria and antibiotic resistance. We investigated risk factors for bacteriuria in the ICU and the correlation between antibiotic treatment and persistent bacteria. Methods We conducted a prospective longitudinal study with urine from indwelling catheters of 101 ICU patients from Uppsala University Hospital, Sweden. Samples were screened and isolates confirmed with MALDI-TOF and whole genome sequencing. Isolates were analyzed for AMR using broth microdilution. Clinical data were assessed for correlation with bacteriuria. Results Length of stay linearly correlated with bacteriuria (R2 = 0.99, p ≤ 0.0001). 90% of patients received antibiotics, primarily the beta-lactams (76%) cefotaxime, piperacillin-tazobactam, and meropenem. We found high prevalence of Enterococcus (42%) being associated with increased cefotaxime prescription. Antibiotic-susceptible E. coli were found to cause bacteriuria despite concurrent antibiotic treatment when found in co-culture with Enterococcus. Conclusion Longer stays in ICUs increase the risk for bacteriuria in a predictable manner. Likely, high use of cefotaxime drives Enterococcus prevalence, which in turn permit co-colonizing Gram-negative bacteria. Our results suggest biofilms in urinary catheters as a reservoir of pathogenic bacteria with the potential to develop and disseminate AMR.
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Affiliation(s)
- Philip A. Karlsson
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden,Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | - Julia Pärssinen
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Erik A. Danielsson
- Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | | | - Robert Frithiof
- Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | - Michael Hultström
- Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden,Department of Medical Cell Biology, Integrative Physiology, Uppsala University, Uppsala, Sweden
| | - Miklos Lipcsey
- Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden,Hedenstierna Laboratory, CIRRUS, Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | - Josef D. Järhult
- Department of Medical Sciences, Zoonosis Science Center, Uppsala University, Uppsala, Sweden,*Correspondence: Josef D. Järhult,
| | - Helen Wang
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden,Helen Wang,
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Li Y, Liu Y, Huang Y, Zhang J, Ma Q, Liu X, Chen Q, Yu H, Dong L, Lu G. Development and validation of a user-friendly risk nomogram for the prediction of catheter-associated urinary tract infection in neuro-intensive care patients. Intensive Crit Care Nurs 2023; 74:103329. [PMID: 36192313 DOI: 10.1016/j.iccn.2022.103329] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study aimed to develop a user-friendly nomogram model to evaluate the risk of catheter-associated urinary tract infections in neuro-critically ill patients. METHODS A retrospective cohort analysis was conducted on 537 patients with indwelling catheters admitted to the neuro-intensive care unit. Patients' general information, laboratory examination findings, and clinical characteristics were collected. Multivariate regression analysis was applied to develop the nomogram for the prediction of catheter-associated urinary tract infections in this group of patients. The discriminative capacity, calibration ability, and clinical effectiveness of the nomogram were evaluated. RESULTS The occurrence of catheter-associated urinary tract infections was 3.91 % and Escherichia coli was the major causative pathogen. Multivariate regression analysis showed that age ≥ 60 years (odds ratio: 35.2, 95 % confidence interval: 2.3-550.8), epilepsy (39.3, 5.1-301.4), a length of neuro-intensive care stay > 30 days (272.2, 8.3-8963.5), and low albumin levels (<35 g/L) (12.1, 2.1-69.9) were independent risk factors associated with catheter-associated urinary tract infection in neuro-intensive care patients. The nomogram demonstrated good calibration and discrimination in both the training and the validation sets. The model exhibited good clinical use since the decision curve analysis covered a large threshold probability. CONCLUSIONS We developed a user-friendly nomogram to predict catheter-associated urinary tract ibfection in neuro-intensive care patients. The nomogram incorporated clinical variables collected on admission (age, admission diagnosis, and albumin levels) and the length of stay and enabled the effective prediction of the likelihood of catheter-associated urinary tract infections.
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Affiliation(s)
- Yuping Li
- Neuro Intensive Care Unit, Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou 225001, China; Clinical Medical College of Yangzhou University, Yangzhou 225009, China
| | - Yuting Liu
- School of Nursing, Yangzhou University, Yangzhou 225009, China
| | - Yujia Huang
- Neuro Intensive Care Unit, Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou 225001, China; Clinical Medical College of Yangzhou University, Yangzhou 225009, China
| | - Jingyue Zhang
- School of Nursing, Yangzhou University, Yangzhou 225009, China
| | - Qiang Ma
- Neuro Intensive Care Unit, Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou 225001, China
| | - Xiaoguang Liu
- Neuro Intensive Care Unit, Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou 225001, China
| | - Qi Chen
- School of Public Health, Medical College of Yangzhou University, Yangzhou University, Yangzhou 225009, China
| | - Hailong Yu
- Neuro Intensive Care Unit, Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou 225001, China
| | - Lun Dong
- Neuro Intensive Care Unit, Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou 225001, China
| | - Guangyu Lu
- School of Public Health, Medical College of Yangzhou University, Yangzhou University, Yangzhou 225009, China.
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Advani S, Vaughn VM. Quality Improvement Interventions and Implementation Strategies for Urine Culture Stewardship in the Acute Care Setting: Advances and Challenges. Curr Infect Dis Rep 2021; 23:16. [PMID: 34602864 PMCID: PMC8486281 DOI: 10.1007/s11908-021-00760-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW The goal of this article is to highlight how and why urinalyses and urine cultures are misused, review quality improvement interventions to optimize urine culture utilization, and highlight how to implement successful, sustainable interventions to improve urine culture practices in the acute care setting. RECENT FINDINGS Quality improvement initiatives aimed at reducing inappropriate treatment of asymptomatic bacteriuria often focus on optimizing urine test utilization (i.e., urine culture stewardship). Urine culture stewardship interventions in acute care hospitals span the spectrum of quality improvement initiatives, ranging from strong systems-based interventions like suppression of urine culture results to weaker interventions that focus on clinician education alone. While most urine culture stewardship interventions have met with some success, overall results are mixed, and implementation strategies to improve sustainability are not well understood. SUMMARY Successful diagnostic stewardship interventions are based on an assessment of underlying key drivers and focus on multifaceted and complementary approaches. Individual intervention components have varying impacts on effectiveness, provider autonomy, and sustainability. The best urine culture stewardship strategies ultimately include both technical and socio-adaptive components with long-term, iterative feedback required for sustainability.
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Affiliation(s)
- Sonali Advani
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Duke Infection Control Outreach Network, Durham, NC, USA
| | - Valerie M. Vaughn
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
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5
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Chuang L, Tambyah PA. Catheter-associated urinary tract infection. J Infect Chemother 2021; 27:1400-1406. [PMID: 34362659 DOI: 10.1016/j.jiac.2021.07.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
This guideline contains updated recommendations on the management and prevention of CAUTIs by the Urological Association of Asia and the Asian Association of Urinary Tract Infection and Sexually Transmitted Infection.
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Affiliation(s)
- Leyland Chuang
- Raffles Internal Medicine Centre, Raffles Hospital, Singapore
| | - Paul Anantharajah Tambyah
- University Medicine Cluster, National University Health System, Singapore; Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Fakih MG, Advani SD. Striving to Reach the Optimal Measure for Catheter-Associated Urinary Tract Infection (CAUTI): Moving to Catheter Harm. Clin Infect Dis 2020; 72:e424. [DOI: 10.1093/cid/ciaa1005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mohamad G Fakih
- Quality, Clinical & Network Services, Ascension, St. Louis, Missouri, USA
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Sonali D Advani
- Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Division of Infectious Diseases, Durham, North Carolina, USA
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The evolution of catheter-associated urinary tract infection (CAUTI): Is it time for more inclusive metrics? Infect Control Hosp Epidemiol 2019; 40:681-685. [PMID: 30915925 DOI: 10.1017/ice.2019.43] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Catheter-associated urinary tract infection (CAUTI) has long been considered a preventable healthcare-associated infection. Many federal agencies, the Centers for Medicare and Medicaid Services (CMS), and public and private healthcare organizations have implemented strategies aimed at preventing CAUTIs. To monitor progress in CAUTI prevention, the National Healthcare Safety Network (NHSN) CAUTI metric has been adopted nationally as the primary outcome measure and has been refined over the past decades. However, this surveillance metric may underestimate infectious and noninfectious catheter harm. We suggest evolving to more inclusive performance metrics to better reflect quality improvement efforts underway in hospitals. The standardized device utilization ratio (SUR) provides a good surrogate for preventable catheter harm. On the other hand, a population-based metric that combines both standardized infection ratio (SIR) and SUR would address both infectious and noninfectious harm, while adjusting for population risk. Finally, electronically captured catheter-associated bacteriuria may contribute essential information on local testing stewardship.
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8
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Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections: The tale of two teaching hospitals. Infect Control Hosp Epidemiol 2018; 39:1494-1496. [PMID: 30303048 DOI: 10.1017/ice.2018.251] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We compared interventions to improve urinary catheter care and urine culturing in adult intensive care units of 2 teaching hospitals. Compared to hospital A, hospital B had lower catheter utilization, more compliance with appropriate indications and maintenance, but higher urine culture use and more positive urine cultures per 1,000 patient days.
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9
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Abstract
PURPOSE OF REVIEW Patients in the ICU are at higher risk for catheter-associated urinary tract infection (CAUTI) due to more frequent use of catheters and lower threshold for obtaining urine cultures. This review provides a summary of CAUTI reduction strategies that are specific to the intensive care setting. RECENT FINDINGS The surveillance definition for CAUTI is imprecise and measures catheter-associated bacteriuria rather than true infection. Alternatives have been proposed, but CAUTI rates measured by this definition are currently required to be reported to the Centers for Medicare and Medicaid Services and high CAUTI rates can result in financial penalties. Although CAUTI may not directly result in significant patient harm, it has several indirect patient safety implications and CAUTI reduction has several benefits. Various bundles have been successful at reducing CAUTI both in individual institutions and on larger scales such as healthcare networks and entire states. SUMMARY CAUTI reduction is possible in the ICU through a combination of reduced catheter usage, improved catheter care and stewardship of urine cultures.
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10
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Abrantes-Figueiredo JI, Ross JW, Banach DB. Device Utilization Ratios in Infection Prevention: Process or Outcome Measure? Curr Infect Dis Rep 2018; 20:8. [DOI: 10.1007/s11908-018-0616-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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11
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Garcia R, Spitzer ED. Promoting appropriate urine culture management to improve health care outcomes and the accuracy of catheter-associated urinary tract infections. Am J Infect Control 2017; 45:1143-1153. [PMID: 28476493 DOI: 10.1016/j.ajic.2017.03.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/03/2017] [Accepted: 03/04/2017] [Indexed: 12/16/2022]
Abstract
Published literature indicates that the unjustified ordering or improper collection of urine for urinalysis or culture from either catheterized patients or those without indwelling devices, or misinterpretation of positive results, often leads to adverse health care events, including increased financial burdens, overreporting of mandated catheter-associated urinary tract infection events, overtreatment of patients with antimicrobial agents, selection of multidrug-resistant organisms, and Clostridium difficile infection. Moreover, national guidelines that provide evidence-based direction on core processes that form the basis for subsequent clinical therapy decisions or surveillance interpretations; that is, the appropriate ordering and collection of urine for laboratory testing and the treatment of patients with symptomatic urinary tract infection, are not widely known or lack adherence. This article provides published evidence on the influence of inappropriate ordering of urine specimens and subsequent treatment of asymptomatic bacteriuria and associated adverse effects; reviews research on bacterial contamination and preservation; and delineates best practices in the collection, handling, and testing of urine specimens for culture or for biochemical analysis in both catheterized and noncatheterized patients. The goal is to provide infection preventionists (IPs) with a cohesive evidence-based framework that will assist them in facilitating the implementation of a urine culture management program that reduces patient harms, enhances the accuracy of catheter-associated urinary tract infection surveillance, improves antibiotic stewardship, and reduces costs.
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12
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Mody L, Greene MT, Meddings J, Krein SL, McNamara SE, Trautner BW, Ratz D, Stone ND, Min L, Schweon SJ, Rolle AJ, Olmsted RN, Burwen DR, Battles J, Edson B, Saint S. A National Implementation Project to Prevent Catheter-Associated Urinary Tract Infection in Nursing Home Residents. JAMA Intern Med 2017; 177:1154-1162. [PMID: 28525923 PMCID: PMC5710434 DOI: 10.1001/jamainternmed.2017.1689] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Catheter-associated urinary tract infection (UTI) in nursing home residents is a common cause of sepsis, hospital admission, and antimicrobial use leading to colonization with multidrug-resistant organisms. OBJECTIVE To develop, implement, and evaluate an intervention to reduce catheter-associated UTI. DESIGN, SETTING, AND PARTICIPANTS A large-scale prospective implementation project was conducted in community-based nursing homes participating in the Agency for Healthcare Research and Quality Safety Program for Long-Term Care. Nursing homes across 48 states, Washington DC, and Puerto Rico participated. Implementation of the project was conducted between March 1, 2014, and August 31, 2016. INTERVENTIONS The project was implemented over 12-month cohorts and included a technical bundle: catheter removal, aseptic insertion, using regular assessments, training for catheter care, and incontinence care planning, as well as a socioadaptive bundle emphasizing leadership, resident and family engagement, and effective communication. MAIN OUTCOMES AND MEASURES Urinary catheter use and catheter-associated UTI rates using National Healthcare Safety Network definitions were collected. Facility-level urine culture order rates were also obtained. Random-effects negative binomial regression models were used to examine changes in catheter-associated UTI, catheter utilization, and urine cultures and adjusted for covariates including ownership, bed size, provision of subacute care, 5-star rating, presence of an infection control committee, and an infection preventionist. RESULTS In 4 cohorts over 30 months, 568 community-based nursing homes were recruited; 404 met inclusion criteria for analysis. The unadjusted catheter-associated UTI rates decreased from 6.78 to 2.63 infections per 1000 catheter-days. With use of the regression model and adjustment for facility characteristics, the rates decreased from 6.42 to 3.33 (incidence rate ratio [IRR], 0.46; 95% CI, 0.36-0.58; P < .001). Catheter utilization was 4.5% at baseline and 4.9% at the end of the project. Catheter utilization remained unchanged (4.50 at baseline, 4.45 at conclusion of project; IRR, 0.95; 95% CI, 0.88-1.03; P = .26) in adjusted analyses. The number of urine cultures ordered for all residents decreased from 3.49 per 1000 resident-days to 3.08 per 1000 resident-days. Similarly, after adjustment, the rates were shown to decrease from 3.52 to 3.09 (IRR, 0.85; 95% CI, 0.77-0.94; P = .001). CONCLUSIONS AND RELEVANCE In a large-scale, national implementation project involving community-based nursing homes, combined technical and socioadaptive catheter-associated UTI prevention interventions successfully reduced the incidence of catheter-associated UTIs.
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Affiliation(s)
- Lona Mody
- Geriatric Research Education and Clinical Center, Ann Arbor Veteran Affairs Healthcare System, Ann Arbor, Michigan.,Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - M Todd Greene
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.,Center for Clinical Management Research, Ann Arbor Veteran Affairs Healthcare System, Ann Arbor, Michigan
| | - Jennifer Meddings
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.,Medicine Service, Ann Arbor Veteran Affairs Healthcare System, Ann Arbor, Michigan.,Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor
| | - Sarah L Krein
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.,Center for Clinical Management Research, Ann Arbor Veteran Affairs Healthcare System, Ann Arbor, Michigan
| | - Sara E McNamara
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Barbara W Trautner
- The Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, Texas.,Section of Infectious Diseases, Departments of Medicine and Surgery, Baylor College of Medicine, Houston, Texas
| | - David Ratz
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.,Center for Clinical Management Research, Ann Arbor Veteran Affairs Healthcare System, Ann Arbor, Michigan
| | - Nimalie D Stone
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lillian Min
- Geriatric Research Education and Clinical Center, Ann Arbor Veteran Affairs Healthcare System, Ann Arbor, Michigan.,Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | | | - Andrew J Rolle
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois
| | | | - Dale R Burwen
- Agency for Healthcare Research and Quality, Rockville, Maryland
| | - James Battles
- Agency for Healthcare Research and Quality, Rockville, Maryland
| | - Barbara Edson
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois
| | - Sanjay Saint
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.,Center for Clinical Management Research, Ann Arbor Veteran Affairs Healthcare System, Ann Arbor, Michigan.,Medicine Service, Ann Arbor Veteran Affairs Healthcare System, Ann Arbor, Michigan
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Definitional Change in NHSN CAUTI Was Associated with an Increase in CLABSI Events: Evaluation of a Large Health System. Infect Control Hosp Epidemiol 2017; 38:685-689. [PMID: 28330520 DOI: 10.1017/ice.2017.41] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The National Healthcare Safety Network (NHSN) catheter-associated urinary tract infection (CAUTI) definition was revised as of January 2015 to exclude funguria and lower bacteriuria levels. We evaluated the effect of the CAUTI definition change on NHSN-defined central-line-associated bloodstream infection (CLABSI) outcomes. METHODS We compared CAUTI and CLABSI NHSN-defined outcomes for calendar years 2014 and 2015 in the adult intensive care units (ICUs) of a single large health system. Changes in the event rates, the associated organisms, and the standardized infection ratio (SIR) were evaluated. RESULTS The study included 137 adult ICUs from 65 hospitals. The CAUTI SIR dropped from 1.04 in 2014 to 0.58 in 2015 (-44.2%), while the CLABSI SIR increased from 0.36 in 2014 to 0.47 in 2015 (+30.6%). CAUTI rates dropped 44.8% from 2.09 to 1.15 events per 1,000 device days (P<.001). Gram-positive-associated CAUTI rates dropped 36.7% from 0.34 to 0.22 per 1,000 device days (P=.007). CLABSI rates increased 27.1% from 0.71 to 0.90 per 1,000 device days (P=.027). Candida-associated CLABSI increased by 91.1% from 0.104 to 0.198 per 1,000 device days (P=.012), and Enterococcus-associated CLABSI increased by 121.6% from 0.071 to 0.16 per 1,000 device days (P=.008). CONCLUSIONS The revised CAUTI definition led to a large reduction in CAUTI rates and, in turn, an increase in candidemia and enterococcemia cases classified as CLABSI events. These findings have important implications on the perceived successes or failures to eliminate both infections. Infect Control Hosp Epidemiol 2017;38:685-689.
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Inpatient Urine Cultures Are Frequently Performed Without Urinalysis or Microscopy: Findings From a Large Academic Medical Center. Infect Control Hosp Epidemiol 2017; 38:455-460. [PMID: 28052781 DOI: 10.1017/ice.2016.311] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To describe the frequency of urine cultures performed in inpatients without additional testing for pyuria DESIGN Retrospective cohort study SETTING A 1,250-bed academic tertiary referral center PATIENTS Hospitalized adults METHODS This study included urine cultures drawn on 4 medical and 2 surgical wards from 2009 to 2013 and in the medical and surgical intensive care units (ICUs) from 2012 to 2013. Patient and laboratory data were abstracted from the hospital's medical informatics database. We identified catheter-associated urinary tract infections (CAUTIs) in the ICUs by routine infection prevention surveillance. Cultures without urinalysis or urine microscopy were defined as "isolated." The primary outcome was the proportion of isolated urine cultures obtained. We used multivariable logistic regression to assess predictors of isolated cultures. RESULTS During the study period, 14,743 urine cultures were obtained (63.5 cultures per 1,000 patient days) during 11,820 patient admissions. Of these, 2,973 cultures (20.2%) were isolated cultures. Of the 61 CAUTIs identified, 31 (50.8%) were identified by an isolated culture. Predictors for having an isolated culture included male gender (adjusted odds ratio [aOR], 1.22; 95%; confidence interval [CI], 1.11-1.35], urinary catheterization (aOR, 2.15; 95% CI, 1.89-2.46), ICU admission (medical ICU aOR, 1.72; 95% CI, 1.47-2.00; surgical ICU aOR, 1.82; 95% CI, 1.51-2.19), and obtaining the urine culture ≥1 calendar day after admission (1-7 days aOR, 1.91; 95% CI. 1.71-2.12; >7 days after admission aOR, 2.81; 95% CI, 2.37-3.34). CONCLUSIONS Isolated urine cultures are common in hospitalized patients, particularly in patients with urinary catheters and those in ICUs. Interventions targeting inpatient culturing practices may improve the diagnosis of urinary tract infections. Infect Control Hosp Epidemiol 2017;38:455-460.
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Response to “Potential Misclassification of Urinary Tract Related Bacteremia Upon Applying the 2015 Catheter-Associated Urinary Tract Infection Surveillance Definition From the National Healthcare Safety Network”. Infect Control Hosp Epidemiol 2016; 37:1121. [DOI: 10.1017/ice.2016.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Saint S, Greene MT, Krein SL, Rogers MAM, Ratz D, Fowler KE, Edson BS, Watson SR, Meyer-Lucas B, Masuga M, Faulkner K, Gould CV, Battles J, Fakih MG. A Program to Prevent Catheter-Associated Urinary Tract Infection in Acute Care. N Engl J Med 2016; 374:2111-9. [PMID: 27248619 PMCID: PMC9661888 DOI: 10.1056/nejmoa1504906] [Citation(s) in RCA: 187] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Catheter-associated urinary tract infection (UTI) is a common device-associated infection in hospitals. Both technical factors--appropriate catheter use, aseptic insertion, and proper maintenance--and socioadaptive factors, such as cultural and behavioral changes in hospital units, are important in preventing catheter-associated UTI. METHODS The national Comprehensive Unit-based Safety Program, funded by the Agency for Healthcare Research and Quality, aimed to reduce catheter-associated UTI in intensive care units (ICUs) and non-ICUs. The main program features were dissemination of information to sponsor organizations and hospitals, data collection, and guidance on key technical and socioadaptive factors in the prevention of catheter-associated UTI. Data on catheter use and catheter-associated UTI rates were collected during three phases: baseline (3 months), implementation (2 months), and sustainability (12 months). Multilevel negative binomial models were used to assess changes in catheter use and catheter-associated UTI rates. RESULTS Data were obtained from 926 units (59.7% were non-ICUs, and 40.3% were ICUs) in 603 hospitals in 32 states, the District of Columbia, and Puerto Rico. The unadjusted catheter-associated UTI rate decreased overall from 2.82 to 2.19 infections per 1000 catheter-days. In an adjusted analysis, catheter-associated UTI rates decreased from 2.40 to 2.05 infections per 1000 catheter-days (incidence rate ratio, 0.86; 95% confidence interval [CI], 0.76 to 0.96; P=0.009). Among non-ICUs, catheter use decreased from 20.1% to 18.8% (incidence rate ratio, 0.93; 95% CI, 0.90 to 0.96; P<0.001) and catheter-associated UTI rates decreased from 2.28 to 1.54 infections per 1000 catheter-days (incidence rate ratio, 0.68; 95% CI, 0.56 to 0.82; P<0.001). Catheter use and catheter-associated UTI rates were largely unchanged in ICUs. Tests for heterogeneity (ICU vs. non-ICU) were significant for catheter use (P=0.004) and catheter-associated UTI rates (P=0.001). CONCLUSIONS A national prevention program appears to reduce catheter use and catheter-associated UTI rates in non-ICUs. (Funded by the Agency for Healthcare Research and Quality.).
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Affiliation(s)
- Sanjay Saint
- From the Hospital Outcomes Program of Excellence, Veterans Affairs (VA) Ann Arbor Healthcare System (S.S., M.T.G., S.L.K., D.R., K.E.F.), the Department of Internal Medicine, University of Michigan (UM) Medical School (S.S., M.T.G., S.L.K., M.A.M.R.), and the VA/UM Patient Safety Enhancement Program (S.S., M.T.G., S.L.K., M.A.M.R., D.R., K.E.F.), Ann Arbor, the Michigan Health and Hospital Association, Okemos (S.R.W., B.M.-L., M.M.), and St. John Hospital and Medical Center, Detroit (M.G.F.) - all in Michigan; the Health Research and Educational Trust, Chicago (B.S.E., K.F.); the Centers for Disease Control and Prevention, Atlanta (C.V.G.); and the Agency for Healthcare Research and Quality, Rockville, MD ( J.B.)
| | - M Todd Greene
- From the Hospital Outcomes Program of Excellence, Veterans Affairs (VA) Ann Arbor Healthcare System (S.S., M.T.G., S.L.K., D.R., K.E.F.), the Department of Internal Medicine, University of Michigan (UM) Medical School (S.S., M.T.G., S.L.K., M.A.M.R.), and the VA/UM Patient Safety Enhancement Program (S.S., M.T.G., S.L.K., M.A.M.R., D.R., K.E.F.), Ann Arbor, the Michigan Health and Hospital Association, Okemos (S.R.W., B.M.-L., M.M.), and St. John Hospital and Medical Center, Detroit (M.G.F.) - all in Michigan; the Health Research and Educational Trust, Chicago (B.S.E., K.F.); the Centers for Disease Control and Prevention, Atlanta (C.V.G.); and the Agency for Healthcare Research and Quality, Rockville, MD ( J.B.)
| | - Sarah L Krein
- From the Hospital Outcomes Program of Excellence, Veterans Affairs (VA) Ann Arbor Healthcare System (S.S., M.T.G., S.L.K., D.R., K.E.F.), the Department of Internal Medicine, University of Michigan (UM) Medical School (S.S., M.T.G., S.L.K., M.A.M.R.), and the VA/UM Patient Safety Enhancement Program (S.S., M.T.G., S.L.K., M.A.M.R., D.R., K.E.F.), Ann Arbor, the Michigan Health and Hospital Association, Okemos (S.R.W., B.M.-L., M.M.), and St. John Hospital and Medical Center, Detroit (M.G.F.) - all in Michigan; the Health Research and Educational Trust, Chicago (B.S.E., K.F.); the Centers for Disease Control and Prevention, Atlanta (C.V.G.); and the Agency for Healthcare Research and Quality, Rockville, MD ( J.B.)
| | - Mary A M Rogers
- From the Hospital Outcomes Program of Excellence, Veterans Affairs (VA) Ann Arbor Healthcare System (S.S., M.T.G., S.L.K., D.R., K.E.F.), the Department of Internal Medicine, University of Michigan (UM) Medical School (S.S., M.T.G., S.L.K., M.A.M.R.), and the VA/UM Patient Safety Enhancement Program (S.S., M.T.G., S.L.K., M.A.M.R., D.R., K.E.F.), Ann Arbor, the Michigan Health and Hospital Association, Okemos (S.R.W., B.M.-L., M.M.), and St. John Hospital and Medical Center, Detroit (M.G.F.) - all in Michigan; the Health Research and Educational Trust, Chicago (B.S.E., K.F.); the Centers for Disease Control and Prevention, Atlanta (C.V.G.); and the Agency for Healthcare Research and Quality, Rockville, MD ( J.B.)
| | - David Ratz
- From the Hospital Outcomes Program of Excellence, Veterans Affairs (VA) Ann Arbor Healthcare System (S.S., M.T.G., S.L.K., D.R., K.E.F.), the Department of Internal Medicine, University of Michigan (UM) Medical School (S.S., M.T.G., S.L.K., M.A.M.R.), and the VA/UM Patient Safety Enhancement Program (S.S., M.T.G., S.L.K., M.A.M.R., D.R., K.E.F.), Ann Arbor, the Michigan Health and Hospital Association, Okemos (S.R.W., B.M.-L., M.M.), and St. John Hospital and Medical Center, Detroit (M.G.F.) - all in Michigan; the Health Research and Educational Trust, Chicago (B.S.E., K.F.); the Centers for Disease Control and Prevention, Atlanta (C.V.G.); and the Agency for Healthcare Research and Quality, Rockville, MD ( J.B.)
| | - Karen E Fowler
- From the Hospital Outcomes Program of Excellence, Veterans Affairs (VA) Ann Arbor Healthcare System (S.S., M.T.G., S.L.K., D.R., K.E.F.), the Department of Internal Medicine, University of Michigan (UM) Medical School (S.S., M.T.G., S.L.K., M.A.M.R.), and the VA/UM Patient Safety Enhancement Program (S.S., M.T.G., S.L.K., M.A.M.R., D.R., K.E.F.), Ann Arbor, the Michigan Health and Hospital Association, Okemos (S.R.W., B.M.-L., M.M.), and St. John Hospital and Medical Center, Detroit (M.G.F.) - all in Michigan; the Health Research and Educational Trust, Chicago (B.S.E., K.F.); the Centers for Disease Control and Prevention, Atlanta (C.V.G.); and the Agency for Healthcare Research and Quality, Rockville, MD ( J.B.)
| | - Barbara S Edson
- From the Hospital Outcomes Program of Excellence, Veterans Affairs (VA) Ann Arbor Healthcare System (S.S., M.T.G., S.L.K., D.R., K.E.F.), the Department of Internal Medicine, University of Michigan (UM) Medical School (S.S., M.T.G., S.L.K., M.A.M.R.), and the VA/UM Patient Safety Enhancement Program (S.S., M.T.G., S.L.K., M.A.M.R., D.R., K.E.F.), Ann Arbor, the Michigan Health and Hospital Association, Okemos (S.R.W., B.M.-L., M.M.), and St. John Hospital and Medical Center, Detroit (M.G.F.) - all in Michigan; the Health Research and Educational Trust, Chicago (B.S.E., K.F.); the Centers for Disease Control and Prevention, Atlanta (C.V.G.); and the Agency for Healthcare Research and Quality, Rockville, MD ( J.B.)
| | - Sam R Watson
- From the Hospital Outcomes Program of Excellence, Veterans Affairs (VA) Ann Arbor Healthcare System (S.S., M.T.G., S.L.K., D.R., K.E.F.), the Department of Internal Medicine, University of Michigan (UM) Medical School (S.S., M.T.G., S.L.K., M.A.M.R.), and the VA/UM Patient Safety Enhancement Program (S.S., M.T.G., S.L.K., M.A.M.R., D.R., K.E.F.), Ann Arbor, the Michigan Health and Hospital Association, Okemos (S.R.W., B.M.-L., M.M.), and St. John Hospital and Medical Center, Detroit (M.G.F.) - all in Michigan; the Health Research and Educational Trust, Chicago (B.S.E., K.F.); the Centers for Disease Control and Prevention, Atlanta (C.V.G.); and the Agency for Healthcare Research and Quality, Rockville, MD ( J.B.)
| | - Barbara Meyer-Lucas
- From the Hospital Outcomes Program of Excellence, Veterans Affairs (VA) Ann Arbor Healthcare System (S.S., M.T.G., S.L.K., D.R., K.E.F.), the Department of Internal Medicine, University of Michigan (UM) Medical School (S.S., M.T.G., S.L.K., M.A.M.R.), and the VA/UM Patient Safety Enhancement Program (S.S., M.T.G., S.L.K., M.A.M.R., D.R., K.E.F.), Ann Arbor, the Michigan Health and Hospital Association, Okemos (S.R.W., B.M.-L., M.M.), and St. John Hospital and Medical Center, Detroit (M.G.F.) - all in Michigan; the Health Research and Educational Trust, Chicago (B.S.E., K.F.); the Centers for Disease Control and Prevention, Atlanta (C.V.G.); and the Agency for Healthcare Research and Quality, Rockville, MD ( J.B.)
| | - Marie Masuga
- From the Hospital Outcomes Program of Excellence, Veterans Affairs (VA) Ann Arbor Healthcare System (S.S., M.T.G., S.L.K., D.R., K.E.F.), the Department of Internal Medicine, University of Michigan (UM) Medical School (S.S., M.T.G., S.L.K., M.A.M.R.), and the VA/UM Patient Safety Enhancement Program (S.S., M.T.G., S.L.K., M.A.M.R., D.R., K.E.F.), Ann Arbor, the Michigan Health and Hospital Association, Okemos (S.R.W., B.M.-L., M.M.), and St. John Hospital and Medical Center, Detroit (M.G.F.) - all in Michigan; the Health Research and Educational Trust, Chicago (B.S.E., K.F.); the Centers for Disease Control and Prevention, Atlanta (C.V.G.); and the Agency for Healthcare Research and Quality, Rockville, MD ( J.B.)
| | - Kelly Faulkner
- From the Hospital Outcomes Program of Excellence, Veterans Affairs (VA) Ann Arbor Healthcare System (S.S., M.T.G., S.L.K., D.R., K.E.F.), the Department of Internal Medicine, University of Michigan (UM) Medical School (S.S., M.T.G., S.L.K., M.A.M.R.), and the VA/UM Patient Safety Enhancement Program (S.S., M.T.G., S.L.K., M.A.M.R., D.R., K.E.F.), Ann Arbor, the Michigan Health and Hospital Association, Okemos (S.R.W., B.M.-L., M.M.), and St. John Hospital and Medical Center, Detroit (M.G.F.) - all in Michigan; the Health Research and Educational Trust, Chicago (B.S.E., K.F.); the Centers for Disease Control and Prevention, Atlanta (C.V.G.); and the Agency for Healthcare Research and Quality, Rockville, MD ( J.B.)
| | - Carolyn V Gould
- From the Hospital Outcomes Program of Excellence, Veterans Affairs (VA) Ann Arbor Healthcare System (S.S., M.T.G., S.L.K., D.R., K.E.F.), the Department of Internal Medicine, University of Michigan (UM) Medical School (S.S., M.T.G., S.L.K., M.A.M.R.), and the VA/UM Patient Safety Enhancement Program (S.S., M.T.G., S.L.K., M.A.M.R., D.R., K.E.F.), Ann Arbor, the Michigan Health and Hospital Association, Okemos (S.R.W., B.M.-L., M.M.), and St. John Hospital and Medical Center, Detroit (M.G.F.) - all in Michigan; the Health Research and Educational Trust, Chicago (B.S.E., K.F.); the Centers for Disease Control and Prevention, Atlanta (C.V.G.); and the Agency for Healthcare Research and Quality, Rockville, MD ( J.B.)
| | - James Battles
- From the Hospital Outcomes Program of Excellence, Veterans Affairs (VA) Ann Arbor Healthcare System (S.S., M.T.G., S.L.K., D.R., K.E.F.), the Department of Internal Medicine, University of Michigan (UM) Medical School (S.S., M.T.G., S.L.K., M.A.M.R.), and the VA/UM Patient Safety Enhancement Program (S.S., M.T.G., S.L.K., M.A.M.R., D.R., K.E.F.), Ann Arbor, the Michigan Health and Hospital Association, Okemos (S.R.W., B.M.-L., M.M.), and St. John Hospital and Medical Center, Detroit (M.G.F.) - all in Michigan; the Health Research and Educational Trust, Chicago (B.S.E., K.F.); the Centers for Disease Control and Prevention, Atlanta (C.V.G.); and the Agency for Healthcare Research and Quality, Rockville, MD ( J.B.)
| | - Mohamad G Fakih
- From the Hospital Outcomes Program of Excellence, Veterans Affairs (VA) Ann Arbor Healthcare System (S.S., M.T.G., S.L.K., D.R., K.E.F.), the Department of Internal Medicine, University of Michigan (UM) Medical School (S.S., M.T.G., S.L.K., M.A.M.R.), and the VA/UM Patient Safety Enhancement Program (S.S., M.T.G., S.L.K., M.A.M.R., D.R., K.E.F.), Ann Arbor, the Michigan Health and Hospital Association, Okemos (S.R.W., B.M.-L., M.M.), and St. John Hospital and Medical Center, Detroit (M.G.F.) - all in Michigan; the Health Research and Educational Trust, Chicago (B.S.E., K.F.); the Centers for Disease Control and Prevention, Atlanta (C.V.G.); and the Agency for Healthcare Research and Quality, Rockville, MD ( J.B.)
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Sampathkumar P, Barth JW, Johnson M, Marosek N, Johnson M, Worden W, Lembke J, Twing H, Buechler T, Dhanorker S, Keigley D, Thompson R. Mayo Clinic Reduces Catheter-Associated Urinary Tract Infections Through a Bundled 6-C Approach. Jt Comm J Qual Patient Saf 2016; 42:254-61. [DOI: 10.1016/s1553-7250(16)42033-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Fakih MG, Gould CV, Trautner BW, Meddings J, Olmsted RN, Krein SL, Saint S. Beyond Infection: Device Utilization Ratio as a Performance Measure for Urinary Catheter Harm. Infect Control Hosp Epidemiol 2016; 37:327-33. [PMID: 26894622 PMCID: PMC6502466 DOI: 10.1017/ice.2015.287] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Catheter-associated urinary tract infection (CAUTI) is considered a reasonably preventable event in the hospital setting, and it has been included in the US Department of Health and Human Services National Action Plan to Prevent Healthcare-Associated Infections. While multiple definitions for measuring CAUTI exist, each has important limitations, and understanding these limitations is important to both clinical practice and policy decisions. The National Healthcare Safety Network (NHSN) surveillance definition, the most frequently used outcome measure for CAUTI prevention efforts, has limited clinical correlation and does not necessarily reflect noninfectious harms related to the catheter. We advocate use of the device utilization ratio (DUR) as an additional performance measure for potential urinary catheter harm. The DUR is patient-centered and objective and is currently captured as part of NHSN reporting. Furthermore, these data are readily obtainable from electronic medical records. The DUR also provides a more direct reflection of improvement efforts focused on reducing inappropriate urinary catheter use.
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Affiliation(s)
- Mohamad G. Fakih
- St. John Hospital and Medical Center, Detroit, Michigan
- Wayne State University School of Medicine, Detroit, Michigan
| | - Carolyn V. Gould
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Barbara W. Trautner
- Houston VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
- Section of Infectious Diseases, Department of Medicine and Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Jennifer Meddings
- Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Russell N. Olmsted
- Infection Prevention and Control, Unified Clinical Organization, Trinity Health, Livonia, Michigan
| | | | - Sanjay Saint
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
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Clinical Characteristics of Carbapenem-resistant Klebsiella pneumoniae Infections in Ill and Colonized Children in Colombia. Pediatr Infect Dis J 2016; 35:237-41. [PMID: 26569194 DOI: 10.1097/inf.0000000000000987] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Multidrug-resistant Gram-negative infections represent a growing problem and a serious global threat. Data in children are scarce. Klebsiella pneumoniae carbapenemases (KPC) are the most common mechanism of resistance this organism has developed. We report the clinical characteristics and outcomes from a cohort of children infected or colonized with carbapenem-resistant K. pneumoniae (CRKp) at a tertiary care center in Medellín, Colombia. METHODS We performed a retrospective chart review of all pediatric cases from whom CRKp isolates were obtained from 2008 to 2013. Clinical characteristics and outcomes were recorded. RESULTS A total of 34 infected children (median age, 22.8 months) with 43 episodes and 55 colonized patients (median age, 33 months) were identified. All patients had at least 1 risk factor previously related with multidrug-resistant Gram-negative infections (premorbid conditions, previous exposure to antibiotics, prolonged length of stay and use of indwelling devices). Urinary tract infections, abdominal infections and bacteremia were the most common clinical presentations. Overall mortality was 38%, and it was lower when a meropenem-containing regimen was used. Colistin was the most used antibiotic either alone or in combination and was associated with 8.8% of nephrotoxicity. CONCLUSION CRKp infections have high mortality in children and usually occur in children with comorbidities, prolonged hospital stay and prior antibiotic exposure. Combined therapy with meropenem-containing regimens seems to be the best option in severely ill children.
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Jones K, Sibai J, Battjes R, Fakih MG. How and when nurses collect urine cultures on catheterized patients: A survey of 5 hospitals. Am J Infect Control 2016; 44:173-6. [PMID: 26492819 DOI: 10.1016/j.ajic.2015.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/03/2015] [Accepted: 09/04/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Obtaining a specimen for urine culture is a key element in evaluating for catheter-associated urinary tract infections (CAUTIs). Evaluating nurses' knowledge regarding appropriate reasons and methods to obtain urine culture specimens are the first steps to improving practice. METHODS Nurses at 5 hospitals completed a 40-question survey regarding their knowledge, training, and practices of appropriate reasons for obtaining urine cultures. The survey included different scenarios of patients with urinary catheters and when they would expect to obtain urine cultures. A 12-point scoring system calculated responses regarding urine collection appropriateness. RESULTS There were 394 nurses who responded to the survey. Of them, 76.1% reported receiving education on CAUTI risk reduction within the last 12 months. Although 327 (83%) of all nurses surveyed reported that they never collect urine samples by draining directly from the drainage bag, only 58.4% viewed others to be fully compliant with that standard (P < .001). Nurses who considered their knowledge to be above average to excellent had similar knowledge assessment scores (out of 12 points) for triggers to obtain urine cultures (mean score, 4.9 ± 1.72) compared with those that reported average to poor knowledge (mean score, 4.64 ± 1.78; P = .15). CONCLUSIONS Important opportunities exist for nurses to optimize the decisions to obtain urine cultures and the process for obtaining them. Addressing nurses' knowledge and practice may lead to more appropriate use of urine cultures.
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Affiliation(s)
- Karen Jones
- Department of Infection Prevention, St John Hospital and Medical Center, Detroit, MI
| | - Jehad Sibai
- Division of Infectious Diseases, St John Hospital and Medical Center, Detroit, MI
| | - Rebecca Battjes
- Department of Infection Prevention, St John Hospital and Medical Center, Detroit, MI
| | - Mohamad G Fakih
- Department of Infection Prevention, St John Hospital and Medical Center, Detroit, MI; Division of Infectious Diseases, St John Hospital and Medical Center, Detroit, MI; Wayne State University School of Medicine, Detroit, MI.
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Effect of body surface decolonisation on bacteriuria and candiduria in intensive care units: an analysis of a cluster-randomised trial. THE LANCET. INFECTIOUS DISEASES 2016; 16:70-79. [DOI: 10.1016/s1473-3099(15)00238-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 07/16/2015] [Accepted: 07/22/2015] [Indexed: 01/19/2023]
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Mavin C, Mills G. Using quality improvement methods to prevent catheter-associated UTI. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2015; 24:S22-8. [PMID: 26450817 DOI: 10.12968/bjon.2015.24.sup18.s22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Catheter-associated urinary tract infection (CAUTI) is considered to be reasonably preventable and there is an abundance of published guidance, all of which details similar CAUTI-prevention strategies. Many strategies and methods have been applied to reduce CAUTI; this article describes a quality improvement (QI) approach to the implementation of CAUTI prevention strategies, which can provide better patient experience and outcomes for patients.
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Affiliation(s)
- Claire Mavin
- Previously Healthcare Associated Infection Quality Improvement Facilitator, NHS Greater Glasgow and Clyde, now Associate Improvement Advisor, Acute Adult Programme, Scottish Patient Safety Programme
| | - Gillian Mills
- Previously Healthcare Associated Infection Quality Improvement Facilitator, now Senior Infection Prevention and Control Nurse, NHS Greater Glasgow and Clyde
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Allen-Bridson K, Pollock D, Gould CV. Promoting prevention through meaningful measures: improving the Centers for Disease Control and Prevention's National Healthcare Safety Network urinary tract infection surveillance definitions. Am J Infect Control 2015; 43:1096-8. [PMID: 26190383 DOI: 10.1016/j.ajic.2015.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 06/02/2015] [Accepted: 06/03/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Katherine Allen-Bridson
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Daniel Pollock
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Carolyn V Gould
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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Catheter-Associated Urinary Tract Infections in Intensive Care Unit Patients. Infect Control Hosp Epidemiol 2015; 36:1330-4. [PMID: 26190686 DOI: 10.1017/ice.2015.172] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To delineate the epidemiology of catheter-associated urinary tract infections (CAUTIs) and to better understand the value of urine cultures for evaluation of fever in the intensive care unit (ICU) setting DESIGN Two-year retrospective review (2012-2013) SETTING: A single tertiary center with 1,200 hospital beds and 158 adult ICU beds PATIENTS ICU patients with a CAUTI event METHODS The cohort was identified from a prospective infection prevention database. Charts were reviewed to characterize the patients. CAUTI rates and device utilization ratio (DUR) were calculated. Clinical outcomes were recorded. RESULTS A total of 105 CAUTIs were identified using the National Health and Safety Network (NHSN) definition. Fever was the primary indication for obtaining urine culture in 102 patients (97%). Of these 105 patients, 51 (51%) had an alternative infection to explain the fever, with pneumonia (55%) being the most common followed by bloodstream infection (22%). A total of 18 patients (18%) had fever due to noninfectious cause, and 32 patients (32%) had no alternative explanation. Of these, 66% received appropriate empiric antimicrobial therapy, but no targeted therapy changes were made based on urine culture results. The other 34% did not receive antimicrobial therapy at all. Only 6% of all CAUTIs resulted in blood cultures positive for the same organism within 2 days. The urinary tract was not definitely established as the source of bloodstream infection. CONCLUSIONS Urine cultures obtained for evaluation of fever form the basis for identification of CAUTIs in the ICU. However, most patients with CAUTIs are eventually found to have alternative explanations for fever. CAUTI is associated with a low complication rate.
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Association of National Healthcare Safety Network--defined catheter-associated urinary tract infections with alternate sources of fever. Infect Control Hosp Epidemiol 2015; 36:1236-8. [PMID: 26094688 DOI: 10.1017/ice.2015.149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Presented in part: 20th Annual Meeting of the Society for Healthcare Epidemiology of America; Dallas, Texas; April 1-4, 2011.
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Rhodes D, Kennon J, Aitchison S, Watson K, Hornby L, Land G, Bass P, McLellan S, Karki S, Cheng AC, Worth LJ. Improvements in process with a multimodal campaign to reduce urinary tract infections in hospitalised Australian patients. ACTA ACUST UNITED AC 2014. [DOI: 10.1071/hi14024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Wooten D, Ramsey J, Miller LG. Redefining the National Healthcare Safety Network’s Definition of Catheter-Associated Urinary Tract Infections: The Hazard of Including Candida Species. Infect Control Hosp Epidemiol 2014; 35:1433-4. [DOI: 10.1086/678431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Challenges and proposed improvements for reviewing symptoms and catheter use to identify National Healthcare Safety Network catheter-associated urinary tract infections. Am J Infect Control 2014; 42:S236-41. [PMID: 25239716 DOI: 10.1016/j.ajic.2014.05.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 05/08/2014] [Accepted: 05/08/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Retrospective medical record review is used to categorize urinary tract infections (UTIs) as symptomatic, catheter-associated, and/or healthcare-associated to generate National Healthcare Safety Network (NHSN) surveillance and claims data. We assessed how often patients with UTI diagnoses in claims data had a catheter in place, had documented symptoms, or met the NHSN criteria for catheter-associated UTI (CAUTI). METHODS Two physicians retrospectively reviewed medical records for 294 randomly selected patients hospitalized with UTI as a secondary diagnosis, discharged between October 2008 and September 2009 from the University of Michigan. We applied a modification of recent NHSN criteria to estimate how often UTIs in claims data may be an NHSN CAUTI. RESULTS The 294 patients included 193 women (66%). The mean patient age was 63 years, and the median length of hospital stay was 7.5 days. Catheter use was noted for 216 of 294 postadmission records (74%), including 126 (43%) with a Foley catheter. NHSN symptoms were noted in 113 records (38%); 62 (21%) had symptoms other than fever. Of 136 hospitalizations meeting urine culture criteria, 17 (5.8%) met the criteria for a potential NHSN CAUTI. CONCLUSIONS Retrospective medical record review to identify symptoms and catheter use is complicated and resource-intensive. Requiring standard documentation of symptoms and catheter status when ordering urine cultures could simplify and improve CAUTI surveillance and its fidelity as a hospital quality indicator.
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Blodgett TJ, Gardner SE, Blodgett NP, Peterson LV, Pietraszak M. A Tool to Assess the Signs and Symptoms of Catheter-Associated Urinary Tract Infection: Development and Reliability. Clin Nurs Res 2014; 24:341-56. [PMID: 25246536 DOI: 10.1177/1054773814550506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this pilot study was to determine the inter-rater reliability of four clinical manifestations of catheter-associated urinary tract infections (CAUTI) among hospitalized adults with short-term indwelling urinary catheters using a tool developed for this purpose: the CAUTI Assessment Profile (CAP). Study participants included 30 non-pregnant English-speaking adults, recruited from two community hospitals. Three nurses assessed each participant for fever, suprapubic tenderness, flank tenderness, and delirium using standardized techniques. Based on the generalized Kappa statistic and 95% confidence intervals, there was evidence of strong inter-rater reliability for fever (K = 1.00, 0.793-1.207), suprapubic tenderness (K = 0.39, 0.185-0.598), and delirium (K = 0.58, 0.379-0.792), but not for flank tenderness (K = 0.29, -0.036 to 0.617). This study provides preliminary evidence that the CAP can be used to consistently identify these clinical signs and symptoms of CAUTI in hospitalized adults.
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Predictive factors for extended-spectrum beta-lactamase producing Enterobacteriaceae causing infection among intensive care unit patients with prior colonization. Infection 2014; 42:945-6. [PMID: 25160041 DOI: 10.1007/s15010-014-0680-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 08/19/2014] [Indexed: 10/24/2022]
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