1
|
Advani SD, Cawcutt K, Klompas M, Marschall J, Meddings J, Patel PK. The next frontier of healthcare-associated infection (HAI) surveillance metrics: Beyond device-associated infections. Infect Control Hosp Epidemiol 2024; 45:693-697. [PMID: 38221847 DOI: 10.1017/ice.2023.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
In recent years, it has become increasingly evident that surveillance metrics for invasive device-associated infections (ie, central-line-associated bloodstream infections, ventilator-associated pneumonias, and catheter-associated urinary tract infections) do not capture all harms; they capture only a subset of healthcare-associated infections (HAIs). Although prevention of device-associated infections remains critical, we need to address the full spectrum of potential harms from device use and non-device-associated infections. These include complications associated with additional devices, such as peripheral venous and arterial catheters, non-device-associated infections such as nonventilator hospital-acquired pneumonia, and noninfectious device complications such as trauma, thrombosis, and acute lung injury. As authors of the device-associated infection sections in the SHEA/IDSA/APIC Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals, we highlight catheter-associated urinary tract infection as an example of the strengths and limitations of the current emphasis on device-associated infection surveillance, suggest performance metrics that present a more comprehensive picture of patient harm, and provide a high-level overview of similar issues with other infection surveillance measures.
Collapse
Affiliation(s)
- Sonali D Advani
- Duke University School of Medicine, Durham, North Carolina, United States
| | - Kelly Cawcutt
- University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Michael Klompas
- Brigham and Women's Hospital and Harvard Medical School Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States
| | - Jonas Marschall
- Bern University Hospital, University of Bern, Bern, Switzerland
- Washington University School of Medicine, St. Louis, Missouri, United States
| | - Jennifer Meddings
- University of Michigan Medical School, Veterans' Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
| | - Payal K Patel
- Intermountain Healthcare, Salt Lake City, Utah, United States
| |
Collapse
|
2
|
Reducing Catheter-Associated Urinary Tract Infections Across a Hospital System Through Urine Culture Stewardship. Mayo Clin Proc Innov Qual Outcomes 2022; 6:488-495. [PMID: 36176423 PMCID: PMC9512841 DOI: 10.1016/j.mayocpiqo.2022.08.004] [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] [Indexed: 11/28/2022] Open
Abstract
Objective To evaluate the effectiveness and safety of an evidence-based urine culture stewardship program in reducing hospital catheter-associated urinary tract infections (CAUTIs) and the rate of CAUTIs across a 3-hospital system. Patients and Methods This is a prospective, 2-year quality improvement program conducted from October 1, 2018, to September 30, 2020. An evidence-based urine culture stewardship program was designed, which consisted of the following: criteria for allowing or restricting urine cultures from catheterized patients, a best practice advisory integrated into the ordering system of an electronic medical record, and a systematic provider education and feedback program to ensure compliance. The system-wide rates of CAUTIs (total CAUTIs/catheter days×1000), changes in intercepts, trends, mortality, length of stay, rates of device utilization, and rates of hospital-onset sepsis were compared for 3 years before and 2 years after the launch of the program. Results Catheter-associated urinary tract infections progressively decreased after the initiation of the program (B=−0.21, P=.001). When the trends before and after the initiation of the program were compared, there were no statistically significant increases in the ratio of actual to predicted hospital length of stay, intensive care unit length of stay, system-wide mortality, and intensive care unit mortality. Although the rates of hospital-acquired sepsis remained consistent after the implementation of the stewardship program through the first quarter of 2020, the rates showed an increase in the second and third quarters of 2020. However, hospital-onset sepsis events associated with the diagnosis of a urinary tract infection did not increase after the intervention. Conclusion Urine culture stewardship is a safe and effective way to reduce CAUTIs among patients in a large multihospital health care system. Patient safety indicators appeared unchanged after the implementation of the program, and ongoing follow-up will improve confidence in the long-term sustainability of this strategy.
Collapse
|
3
|
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.
Collapse
|
4
|
Migowski SA, Gavronski I, Libânio CDS, Migowski ER, Duarte FD. Efficiency Losses in Healthcare Organizations Caused by Lack of Interpersonal Relationships. RAC: REVISTA DE ADMINISTRAÇÃO CONTEMPORÂNEA 2019. [DOI: 10.1590/1982-7849rac2019170396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Despite all quality management and integration literature prescriptions to implement strategies for a better organizational performance, healthcare organizations support a model that is inefficient, expensive, and unsustainable over time. This work aims to examine the interpersonal relationships in three large hospitals located in Southern Brazil and its relation with organizational efficiency. Through a qualitative and explanatory research, semi-structured interviews were applied to 32 professionals, in addition to a document analysis. The data analysis shows that integration occurs at the formal leadership level only in one of the organizations and does not involve the medical and operational professionals. Quality management seems not to be fully incorporated into care routines, and are related to efficiency losses. This scenario is probably related to the lack of integration among the professionals and the consolidation of trust, leadership, and communication.
Collapse
Affiliation(s)
| | | | | | - Eliana Rustick Migowski
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brasil; Universidade Feevale, Brasil
| | | |
Collapse
|
5
|
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.
Collapse
|
6
|
Hoehn RS, Paquette IM. The hospital-acquired condition reduction program for colorectal surgery: Current initiatives and implications for the future. SEMINARS IN COLON AND RECTAL SURGERY 2018. [DOI: 10.1053/j.scrs.2018.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
7
|
Harris SK, Mitchell EL, Lasarev MR, Attia F, Hunter JG, Sheppard BC. Effect of a hospital-associated urinary tract infection reduction policy on general surgery patients. Am J Surg 2017; 215:658-662. [PMID: 29275909 DOI: 10.1016/j.amjsurg.2017.11.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 11/03/2017] [Accepted: 11/06/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hospital-associated UTI rates in surgery patients have not improved despite recommendations for reducing indwelling catheter days. METHODS We performed a retrospective review of institutional NSQIP general surgery patient data, 2006-2015. During this time, a UTI-reduction policy was implemented. Demographics, HA-UTI incidence, CA-UTI incidence, indwelling catheter days, straight catheterization rates, and mortality were examined. RESULTS Females had significantly higher risk of HA-UTI. There was no significant change in HA-UTI (X12 = 0.02, p = .878) or indwelling catheter days (5.18 ± 1.12 days v 3.73 ± 0.39 days, p = .23). Straight catheterizations among those with HA-UTI increased (0.04 ± 0.04 v 0.32 ± 0.12, p = .029). There was no change in CA-UTI (1.38 v 1.11 CAUTI/1000 patient hospital-days P = .555) or in initial indwelling catheter days of patients with CA-UTI (7.2 SD 8.89 v 47.0 SD 7.04 days P = .961) after policy implementation. CONCLUSIONS The reduction policy increased the number of straight catheterizations for patients developing HA-UTI, but did not reduce the number of initial indwelling catheter days, HA-UTI rates, or CA-UTI rates.
Collapse
Affiliation(s)
- Sheena K Harris
- Oregon Health & Science University, Department of Surgery, Portland, OR, USA
| | - Erica L Mitchell
- Oregon Health & Science University, Department of Surgery, Portland, OR, USA
| | - Michael R Lasarev
- Oregon Health & Science University, Biostatistics and Design Program, Portland, OR, USA
| | - Fouad Attia
- Oregon Health & Science University, Department of Surgery, Portland, OR, USA
| | - John G Hunter
- Oregon Health & Science University, Department of Surgery, Portland, OR, USA
| | - Brett C Sheppard
- Oregon Health & Science University, Department of Surgery, Portland, OR, USA.
| |
Collapse
|
8
|
Metersky ML, Eldridge N, Wang Y, Mortensen EM, Meddings J. National trends in the frequency of bladder catheterization and physician-diagnosed catheter-associated urinary tract infections: Results from the Medicare Patient Safety Monitoring System. Am J Infect Control 2017. [PMID: 28625702 DOI: 10.1016/j.ajic.2017.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND It is unclear if bladder catheterization and catheter-associated urinary tract infection (CAUTI) rates have changed since the implementation of public reporting in 2011. METHODS We analyzed data from the Medicare Patient Safety Monitoring System, a national, chart abstraction-based surveillance system, for hospitalized adults with a principal discharge diagnosis of heart failure (HF), acute myocardial infarction (AMI), or pneumonia and patients who had undergone certain major surgeries. We assessed bladder catheterization frequency (percentage of patients catheterized) and risk-adjusted CAUTI frequency (percentage of catheterized patients developing CAUTI) from 2009-2014. RESULTS Bladder catheterization frequency declined significantly (6.6% for AMI patients, 8.0% for HF patients, and 5.7% for surgical patients). For pneumonia patients, there was a nonsignificant increase of 1.1%. The risk-adjusted CAUTI rate among AMI patients decreased by 9.7% each year relative to the year before. For surgical patients, the decrease was 9.1% per year. There was no significant decline among HF or pneumonia patients. The overall burden of CAUTI among surgical patients was higher than for the other conditions because surgical patients were more likely to be catheterized. CONCLUSIONS There were statistically significant declines in observed bladder catheterization frequency and adjusted CAUTI frequency in some patient populations between 2009 and 2014.
Collapse
|
9
|
Kaplan JA, Carter JT. Near-perfect compliance with SCIP Inf-9 had no effect on catheter utilization or urinary tract infections at an academic medical center. Am J Surg 2017; 215:23-27. [PMID: 28400048 DOI: 10.1016/j.amjsurg.2017.03.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 03/14/2017] [Accepted: 03/22/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND The Joint Commission's SCIP Inf-9 mandated early removal of indwelling urinary catheters (IUCs), but the impact of compliance on catheter-associated urinary tract infection (CAUTI) and postoperative urinary retention (POUR) are unknown. METHODS Retrospective pre- and post-intervention study at a single tertiary academic medical center of all patients undergoing general surgery procedures with an IUC placed at the time of surgery who were admitted for at least two days before and after a Best Practice Advisory was put in place to improve compliance with SCIP Inf-9. RESULTS A total of 1036 patients were included (468 pre-intervention; 568 post-intervention). POUR occurred in 13% of patients and CAUTI in 0.8%. There was no change in POUR, CAUTI, or catheter utilization after the Best Practice Advisory was initiated. Both POUR and CAUTI predicted longer lengths of stay. CONCLUSIONS Near-perfect SCIP Inf-9 compliance had no effect on the CAUTI rate at our institution.
Collapse
Affiliation(s)
- Jennifer A Kaplan
- University of California San Francisco, Department of Surgery, San Francisco, CA, USA.
| | - Jonathan T Carter
- University of California San Francisco, Department of Surgery, San Francisco, CA, USA
| |
Collapse
|
10
|
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]
|
11
|
Halpin AL, Sinkowitz-Cochran R, Allen-Bridson K, Edwards JR, Pollock D, McDonald LC, Gould CV. Letter in Response to "Questionable validity of the catheter-associated urinary tract infection metric used for value-based purchasing". Am J Infect Control 2016; 44:369-70. [PMID: 26940597 DOI: 10.1016/j.ajic.2015.11.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 11/19/2015] [Indexed: 11/25/2022]
|
12
|
Jenkins TR. The use of quality metrics in health care: primum non nocere and the law of unintended consequences. Am J Obstet Gynecol 2016; 214:143-144. [PMID: 26851487 DOI: 10.1016/j.ajog.2015.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 10/19/2015] [Indexed: 10/22/2022]
|