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Liu J, Hao X, Shang X, Chi R, Xu T. Incidence and risk factors of urinary tract infection in hospitalized patients with spinal cord injury in a hospital of China. Sci Rep 2024; 14:3579. [PMID: 38347072 PMCID: PMC10861502 DOI: 10.1038/s41598-024-54234-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/10/2024] [Indexed: 02/15/2024] Open
Abstract
Urinary tract infection (UTI) caused by spinal cord injury (SCI) can have significant morbidity. There is currently a lack of relevant data in China. This study explores incidence and risk factors of UTI in hospitalized patients with SCI in China, and will help healthcare professionals to make informed clinical decisions to reduce the incidence of UTI. This retrospective study analyzed the medical records of patients with SCI who were hospitalized at three campuses of a hospital in central China between August 2014 and August 2023. The files of patients with SCI were reviewed for demographics and clinical characteristics. Logistic regression analysis was performed to identify risk factors associated with UTI. A total of 538 patients were included in this study. The incidence of UTI was 49.8%. Sex, hypoproteinemia, urinary incontinence, bladder irrigation, timing of rehabilitation, duration of indwelling urinary catheter were risk factors of UTI. The implementation of specific preventive measures is anticipated to result in a decrease in the occurrence of UTI among individuals with SCI, consequently enhancing their overall quality of life and prognosis.
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Affiliation(s)
- Jiawei Liu
- Department of Rehabilitation, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Jiefang Avenue, No. 1095, Wuhan, 430030, Hubei, China
| | - Xiaoxia Hao
- Department of Rehabilitation, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Jiefang Avenue, No. 1095, Wuhan, 430030, Hubei, China
| | - Xingru Shang
- Department of Rehabilitation, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Jiefang Avenue, No. 1095, Wuhan, 430030, Hubei, China
| | - Ruimin Chi
- Department of Rehabilitation, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Jiefang Avenue, No. 1095, Wuhan, 430030, Hubei, China
| | - Tao Xu
- Department of Rehabilitation, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Jiefang Avenue, No. 1095, Wuhan, 430030, Hubei, China.
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Yarrington ME, Reynolds SS, Dunkerson T, McClellan F, Polage CR, Moehring RW, Smith BA, Seidelman JL, Lewis SS, Advani SD. Using clinical decision support to improve urine testing and antibiotic utilization. Infect Control Hosp Epidemiol 2023; 44:1582-1586. [PMID: 36987849 PMCID: PMC10539479 DOI: 10.1017/ice.2023.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVE Urine cultures collected from catheterized patients have a high likelihood of false-positive results due to colonization. We examined the impact of a clinical decision support (CDS) tool that includes catheter information on test utilization and patient-level outcomes. METHODS This before-and-after intervention study was conducted at 3 hospitals in North Carolina. In March 2021, a CDS tool was incorporated into urine-culture order entry in the electronic health record, providing education about indications for culture and suggesting catheter removal or exchange prior to specimen collection for catheters present >7 days. We used an interrupted time-series analysis with Poisson regression to evaluate the impact of CDS implementation on utilization of urinalyses and urine cultures, antibiotic use, and other outcomes during the pre- and postintervention periods. RESULTS The CDS tool was prompted in 38,361 instances of urine cultures ordered in all patients, including 2,133 catheterized patients during the postintervention study period. There was significant decrease in urine culture orders (1.4% decrease per month; P < .001) and antibiotic use for UTI indications (2.3% decrease per month; P = .006), but there was no significant decline in CAUTI rates in the postintervention period. Clinicians opted for urinary catheter removal in 183 (8.5%) instances. Evaluation of the safety reporting system revealed no apparent increase in safety events related to catheter removal or reinsertion. CONCLUSION CDS tools can aid in optimizing urine culture collection practices and can serve as a reminder for removal or exchange of long-term indwelling urinary catheters at the time of urine-culture collection.
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Affiliation(s)
- Michael E. Yarrington
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina
| | | | - Tray Dunkerson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina
| | - Fabienne McClellan
- Continuous Improvement Department, Duke University Health System, Durham, North Carolina
| | - Christopher R. Polage
- Clinical Microbiology Laboratory, Duke University Health System, Durham, North Carolina
- Department of Pathology, Duke University of Medicine, Durham, North Carolina
| | - Rebekah W. Moehring
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina
| | - Becky A. Smith
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina
| | - Jessica L. Seidelman
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina
| | - Sarah S. Lewis
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina
| | - Sonali D. Advani
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina
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Affiliation(s)
- Barbara Resnick
- School of Nursing, University of Maryland, 655 West Lombard Street, Baltimore, MD 21201, US.
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Work experience was associated with the knowledge and practice of catheter-associated urinary tract infection prevention among nurses at University of Gondar Comprehensive Specialized Hospital, northwest Ethiopia, 2021. BMC Womens Health 2023; 23:40. [PMID: 36717910 PMCID: PMC9885554 DOI: 10.1186/s12905-023-02176-8] [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: 09/13/2022] [Accepted: 01/16/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Catheter-associated urinary tract infection is the source of about 20% of episodes of health-care acquired infections in acute care facilities and it is over 50% in long-term care facilities. In Ethiopia, there is no published scientific research regarding knowledge and practice of nurses on catheter-associated urinary tract infections prevention. Therefore, this study aimed to assess knowledge, practice and associated factors of CAUTI prevention among nurses working at university of Gondar comprehensive specialized hospital, northwest Ethiopia, 2021. METHODS Institutional based cross sectional study was conducted at University of Gondar Comprehensive Specialized Referral Hospital from April 01 to May 01, 2021 among 423 nurses. Simple random sampling technique was used. Data were collected by using self-administered questionnaire then coded and entered into EPI- Data version 4.6 and then exported to SPSS version 23. Descriptive statistics was computed, and the result was summarized by texts, tables, and charts. All variables with P-value < 0.25 in the univariate analysis were included in the multivariable regression analysis. The degree of association was interpreted by using the adjusted odds ratio with 95% confidence intervals. RESULTS Good knowledge and practice of nurses towards CAUTI prevention was 37.7% and 51.8% respectively. Good knowledge was associated with sex [AOR = 1.84, 95% CI (1.09, 3.11)], work experience [AOR = 2.36, 95% CI (1.09, 5.10)], working unit [AOR = 6.9, 95% CI (2.11, 22.52)], training [AOR = 2.33, 95% CI (1.17, 4.65)] and had guideline [AOR = 2.78, 95% CI (1.59, 4.88)]. Good practice was associated with sex, work experience, attitude and knowledge towards CAUTI prevention [AOR = 2.19, 95% CI (1.23, 3.88)], [AOR = 5.44, 95% CI (1.66, 17.84)], [AOR = 3.06, 95% CI (1.65, 5.67)], and [AOR = 5.28, 95% CI (2.86, 9.76)] respectively. CONCLUSIONS Nearly one-third of nurses had good knowledge and more than half of nurses had good practice towards CAUTI prevention. Sex, work experience, work unit, presence of guideline, and training were significantly associated with knowledge. Sex, work experience, good attitude and, knowledge were associated with practice of nurses towards CAUTI prevention. The knowledge and practice towards catheter associated urinary tract infection prevention among nurses should be increased, so that the patients could enjoy and maintain the healthy lifestyle.
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A Retrospective, Observational Study of Catheter-Associated Urinary Tract Infection Events Post-Implementation of a Novel Urinary Catheter System with Active Drain Line Clearance and Automated Intra-Abdominal Pressure Monitoring. Life (Basel) 2022; 12:life12121950. [PMID: 36556315 PMCID: PMC9782014 DOI: 10.3390/life12121950] [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: 09/28/2022] [Revised: 10/30/2022] [Accepted: 11/12/2022] [Indexed: 11/24/2022] Open
Abstract
Objective: A quality improvement study to assess catheter-associated urinary tract infection (CAUTI) rate post-implementation of a bladder catheter with integrated active drain line urine clearance and automated intra-abdominal pressure monitoring in a burn intensive care unit (ICU). DESIGN: Eight-year retrospective before and after study (2015−2022). Setting: A single American Burn Association-verified Burn Center with 14 inpatient beds. Patients: Patients meeting criteria for admission to a Burn Center. Methods: Retrospective cohort study following the implementation of a novel urine output monitoring system with integrated drain line and urine clearance. Data from a 48-month (from January 2015−December 2018) historical control (period 1) were compared to data from a 28-month (from January 2020 to April 2022) post-implementation period (period 2). Pre- and post-implementation CAUTI event incidences were compared. Patients were transferred from outside hospitals with gravity bladder. A distinction in the chart between catheter types was impossible. Charts were reviewed to characterize patients with CAUTI events. Results: A total of 42 CAUTIs in 2243 patients were identified using the National Health and Safety Network (NHSN) definition during the analyzed period. There were 40 CAUTI events in period 1 and two CAUTIs in period 2. The incidence of CAUTI events pre-implementation was 0.030 (mean of 10 CAUTI events per year) compared to 0.002 (mean of 1 CAUTI event per year) post-implementation of an automatic drain line clearing UO monitoring system showing a significant reduction in CAUTI events (p < 0.01, risk ratio novel vs. gravity bladder catheter 0.071, 95% confidence interval: 0.017−0.294). Conclusions: CAUTIs were reduced in the period following the implementation of a novel urinary catheter system with an integrated active drain line and urine clearance in burn patients.
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Ling R, Giles M, Searles A. Budget impact analysis of a multifaceted nurse-led intervention to reduce indwelling urinary catheter use in New South Wales Hospitals. BMC Health Serv Res 2022; 22:1000. [PMID: 35932078 PMCID: PMC9356439 DOI: 10.1186/s12913-022-08313-7] [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: 02/25/2021] [Accepted: 06/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In hospitals, catheter acquired urinary tract infection causes significant resource waste and discomfort among admitted patients. An intervention for reducing indwelling catheterisations - No-CAUTI - was trialled across four hospitals in New South Wales, Australia. No-CAUTI includes: train-the-trainer workshops, site champions, compliance audits, and point prevalence surveys. The trial showed reductions on usual care catheterisation rates at 4- and 9-month post-intervention. This result was statistically non-significant; and post-intervention catheterisation rates rebounded between 4 and 9 months. However, No-CAUTI showed statistically significant catheterisation decreases for medical wards, female patients and for short-term catheterisations. This study presents a budget impact analysis of a projected five year No-CAUTI roll out across New South Wales public hospitals, from the cost perspective of the New South Wales Ministry of Health. METHODS Budget forecasts were made for five year roll outs of: i) No-CAUTI; and ii) usual care, among all public hospitals in New South Wales hosting overnight stays (n=180). The roll out design maintains intervention effectiveness with ongoing workshops, quality audits, and hospital surveys. Forecasts of catheterisations, procedures and treatments were modelled on No-CAUTI trial observations. Costs were sourced from trial records, the Medical Benefits Scheme, the Pharmaceutical Benefits Scheme and public wage awards. Cost and parameter uncertainties were considered with sensitivity scenarios. RESULTS The estimated five-year No-CAUTI roll-out cost was $1.5 million. It had an overall budget saving of $640,000 due to reductions of 100,100 catheterisations, 33,300 urine tests and 6,700 antibiotics administrations. Non-Metropolitan hospitals had a net saving of $1.2 million, while Metropolitan hospitals had a net cost of $0.54 million. CONCLUSIONS Compared to usual care, NO-CAUTI is expected to realise overall budget savings and decreases in catheterisations over five years. These findings allow a consideration of the affordability of a wide implementation. TRIAL REGISTRATION Registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12617000090314 ). First registered 17 January 2017, retrospectively. First enrolment, 15/11/2016.
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Affiliation(s)
- Rod Ling
- Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia. .,University of Newcastle, School of Medicine and Public Health, Callaghan, NSW, 2308, Australia.
| | - Michelle Giles
- Hunter New England Local Health District, Nursing and Midwifery Centre, Gate Cottage James Fletcher Campus, 72 Watt Street, Newcastle, NSW, 2300, Australia
| | - Andrew Searles
- Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,University of Newcastle, School of Medicine and Public Health, Callaghan, NSW, 2308, Australia
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Sulaiman KA, Al Qahtani N, Al Muqrin M, Al Dossari M, Al Wabel A, Al Sulaiman T, Vishwakarma R, Alolayan A, Abudayah F, Korayem GB, Aljuhani O. The correlation between non-O blood group type and recurrent catheter-associated urinary tract infections in critically ill patients: A retrospective study. J Int Med Res 2022; 50:3000605221108082. [PMID: 35818158 PMCID: PMC9280803 DOI: 10.1177/03000605221108082] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To investigate the correlation between the ABO blood group and the risk of recurrent catheter-associated urinary tract infections (CA-UTI) and multi-drug resistant (MDR) organism reinfection in the critically ill. Methods This retrospective cohort study enrolled adult patients admitted to the intensive care unit (ICU) with confirmed CA-UTI to investigate the correlation between ABO type and the susceptibility to recurrent, reinfection and MDR reinfection. Patients were classified into two groups based on ABO type (O blood group versus non-O blood group). Results A total of 81 patients were included in the study: 37 in the O blood group and 44 in the non-O blood group. Patients in the O blood group were associated with significantly lower odds of recurrent CA-UTI (adjusted odds ratio 0.28; 95% confidence interval 0.08, 0.95), a shorter ICU length of stay (LOS) (estimate [SE] –0.24 [0.05]), hospital LOS (estimate [SE] –0.15 [0.03]) and mechanical ventilation duration (estimate [SE] –0.41 [0.07]) compared with the non-O blood group type. Conclusion Non-O blood group type might be a risk factor for recurrent CA-UTI and infection with MDR organism.
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Affiliation(s)
- Khalid Al Sulaiman
- Department of Pharmaceutical Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Centre/King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Saudi Critical Care Pharmacy Research (SCAPE) Platform, Riyadh, Saudi Arabia
| | - Nouf Al Qahtani
- Department of Pharmaceutical Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Mashael Al Muqrin
- Department of Pharmaceutical Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Maram Al Dossari
- Department of Pharmaceutical Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Ali Al Wabel
- Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Tareq Al Sulaiman
- Department of Orthopaedic Surgery, Imam Abdulrahman Alfaisal Hospital, Riyadh, Saudi Arabia
| | - Ramesh Vishwakarma
- Department of Statistics, European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Abdulaziz Alolayan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Fatimah Abudayah
- Faculty of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ghazwa B Korayem
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Ohoud Aljuhani
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
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Kim SR, Laframboise S, Nelson G, McCluskey SA, Avery L, Kujbid N, Zia A, Bernardini MQ, Ferguson SE, May T, Hogen L, Cybulska P, Bouchard-Fortier G. Implementation of a standardized voiding protocol after minimally invasive surgery: A quality improvement initiative. Int J Gynaecol Obstet 2022; 159:696-701. [PMID: 35490400 DOI: 10.1002/ijgo.14239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 03/21/2022] [Accepted: 04/28/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To assess the effects of the implementation of a standardized voiding protocol in patients undergoing minimally invasive hysterectomy at a single cancer center in terms of the urinary tract infection (UTI) rate, time to first void, and overnight stays secondary to urinary retention. METHODS We enrolled 102 consecutive patients undergoing minimally invasive hysterectomy at a single cancer center during a 12-month period. A pre-intervention cohort of 100 consecutive patients was identified for comparison. A multidisciplinary team developed and implemented a standardized voiding protocol using quality improvement methodology. We compared the demographics, time to first void, rate of urinary retention, and UTI rates between the pre- and post-intervention cohorts. RESULTS Our intervention led to a significant reduction in the time to first void (289 min vs. 566 min; P < 0.001), rate of urinary retention (2% vs. 10%; P = 0.015), and postoperative UTI (4% vs. 8%; P = 0.249). There was a similar rate of patients going home with a Foley catheter (9% vs. 11%; P = 0.850). CONCLUSIONS Implementation of a standardized voiding protocol was associated with a reduction in rate of UTI, time to first void, and overnight stays secondary to urinary retention.
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Affiliation(s)
- Soyoun Rachel Kim
- Division of Gynaecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health System, Toronto, Ontario, Canada.,Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada.,Translational Research Program, Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Stéphane Laframboise
- Division of Gynaecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health System, Toronto, Ontario, Canada.,Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Gregg Nelson
- Department of Obstetrics & Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stuart A McCluskey
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Lisa Avery
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Nastasia Kujbid
- Division of Gynaecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health System, Toronto, Ontario, Canada
| | - Aysha Zia
- Division of Gynaecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health System, Toronto, Ontario, Canada.,Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Marcus Q Bernardini
- Division of Gynaecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health System, Toronto, Ontario, Canada.,Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Sarah E Ferguson
- Division of Gynaecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health System, Toronto, Ontario, Canada.,Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Taymaa May
- Division of Gynaecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health System, Toronto, Ontario, Canada.,Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Liat Hogen
- Division of Gynaecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health System, Toronto, Ontario, Canada.,Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Paulina Cybulska
- Division of Gynaecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health System, Toronto, Ontario, Canada.,Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Geneviève Bouchard-Fortier
- Division of Gynaecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health System, Toronto, Ontario, Canada.,Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
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Frödin M, Ahlstrom L, Gillespie BM, Rogmark C, Nellgård B, Wikström E, Erichsen Andersson A. Effectiveness of implementing a preventive urinary catheter care bundle in hip fracture patients. J Infect Prev 2022; 23:41-48. [PMID: 35340925 PMCID: PMC8941588 DOI: 10.1177/17571774211060417] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 08/31/2021] [Indexed: 11/17/2022] Open
Abstract
Background Urinary catheter (UC)–associated infections are one of the most common
preventable healthcare-associated infections (HAIs) and they frequently
occur in older, frail populations. Aim The study aim was to describe the incidence of UC-associated infection in
elderly patients undergoing hip fracture surgery after implementing a
preventive care bundle. Methods A longitudinal prospective study using a before-and-after design. The bundle
was theory driven and involved the co-creation of a standard operational
procedure, education and practical training sessions. Prospectively
collected registry data were analysed. Univariable statistics and
multivariable logistic regressions were used for analyses. Results 2,408 patients with an acute hip fracture were included into the study. There
was an overall reduction in UC catheter associated-associated urinary tract
infections, from 18.5% (n = 75/406) over time to 4.2%
(n = 27/647). When adjusting for all identified
confounders, patients in phase 4 were 74% less likely to contract an
UC-associated infection (OR, 0.26; 95% CI, 0.15–0.45, p
< 0.0001). Discussion Bundled interventions can reduce UC-associated infections substantially, even
in elderly frail patients. Partnership and co-creation as implementation
strategies appear to be promising in the fight against HAI.
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Affiliation(s)
- Maria Frödin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Linda Ahlstrom
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Brigid M. Gillespie
- School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia
- Gold Coast University Hospital and Health Service, Southport, QLD, Australia
| | - Cecilia Rogmark
- Department of Orthopedics, Skane University Hospital, Lund University, Malmö, Sweden
- Swedish Hip Arthroplasty Register, Registercentrum VGR, Gothenburg, Sweden
| | - Bengt Nellgård
- Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ewa Wikström
- School of Business, Economics and Law, Department of Business Administration, University of Gothenburg, Gothenburg, Sweden
| | - Annette Erichsen Andersson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
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Stampas A, Hua J, Naumann H, Martinez C, Roberts D, Pedroza C. Quality improvement project of a closed catheter system to reduce catheter-associated urinary tract infections during acute inpatient rehabilitation using stepped-wedge design. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2022. [DOI: 10.4103/jisprm.jisprm-000142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
Catheter-associated urinary tract infection (CAUTI) remains one of the most prevalent, but preventable, health care-associated infections and predominantly occurs in patients with indwelling urinary catheters. Duration of urinary catheterization is the most important modifiable risk factor for development of CAUTI. Alternatives to indwelling catheters should be considered in appropriate patients. If indwelling catheterization is necessary, proper aseptic practices for catheter insertion and maintenance and use of a closed catheter collection system are essential for preventing CAUTI. The use of intervention bundles and collaboratives helps in the effective implementation of CAUTI prevention measures.
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Affiliation(s)
- Carol E Chenoweth
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, F4141 South University Hospital, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5226, USA.
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12
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Adherence to evidence-based guidelines for indwelling urinary catheter management: A cross-sectional study. Collegian 2021. [DOI: 10.1016/j.colegn.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Mitchell B, Curryer C, Holliday E, Rickard CM, Fasugba O. Effectiveness of meatal cleaning in the prevention of catheter-associated urinary tract infections and bacteriuria: an updated systematic review and meta-analysis. BMJ Open 2021; 11:e046817. [PMID: 34103320 PMCID: PMC8190044 DOI: 10.1136/bmjopen-2020-046817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE A systematic review on meatal cleaning prior to urinary catheterisation and post catheterisation and reduces the risk catheter-associated urinary tract infections (CAUTIs) and bacteriuria was published in 2017, with further studies undertaken since this time. The objective of this paper is to present an updated systematic review on the effectiveness of antiseptic cleaning of the meatal area for the prevention of CAUTIs and bacteriuria in patients who receive a urinary catheter. DESIGN Systematic review. DATA SOURCES Electronic databases Cochrane Library, PubMed, Embase, The Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline and Academic Search Complete were searched from 1 January 2016 and 29 February 2020. ELIGIBILITY CRITERIA Randomised controlled trials (RCTs) and quasi-experimental studies evaluating the use of antiseptic, antibacterial or non-medicated agents for cleaning the meatal, periurethral or perineal areas before indwelling catheter insertion or intermittent catheterisation or during routine meatal care. DATA EXTRACTION AND SYNTHESIS Data were extracted using the Cochrane Collaboration's data collection form for RCTs and non-RCTs. Data were extracted by one researcher and then checked for accuracy by a second researcher. RESULTS A total of 18 studies were included. Some potential benefit of using antiseptics, compared with non-antiseptics for meatal cleaning to prevent bacteriuria and or CAUTI was identified (OR 0.84, 95% CI 0.69 to 1.02; p=0.071). Antiseptics (chlorhexidine or povidine-iodine) may be of value for meatal cleaning on the incidence of CAUTI, compared with comparator agents (saline, soap or antimicrobial cloths) (OR=0.65, 95% CI 0.42 to 0.99; p=0.047). CONCLUSION There is emerging evidence of the role of some specific antiseptics (chlorhexidine) prior to urinary catheterisation, in reducing CAUTIs, and some potential benefit to the role of antiseptics more generally in reducing bacteriuria. PROSPERO REGISTRATION NUMBER CRD42015023741.
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Affiliation(s)
- Brett Mitchell
- School of Nursing and Midwifery, The University of Newcastle-Central Coast Campus, Ourimbah, New South Wales, Australia
| | - Cassie Curryer
- School of Nursing and Midwifery, The University of Newcastle-Central Coast Campus, Ourimbah, New South Wales, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Claire M Rickard
- School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Herston Infectious Disease Institute, Metro North Hospitals and Health Service, Brisbane, Queensland, Australia
| | - Oyebola Fasugba
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Sydney, New South Wales, Australia
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14
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Antonelli G, Cappelli L, Cinelli P, Cuffaro R, Manca B, Nicchi S, Tondi S, Vezzani G, Viviani V, Delany I, Scarselli M, Schiavetti F. Strategies to Tackle Antimicrobial Resistance: The Example of Escherichia coli and Pseudomonas aeruginosa. Int J Mol Sci 2021; 22:4943. [PMID: 34066555 PMCID: PMC8125385 DOI: 10.3390/ijms22094943] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 12/11/2022] Open
Abstract
Traditional antimicrobial treatments consist of drugs which target different essential functions in pathogens. Nevertheless, bacteria continue to evolve new mechanisms to evade this drug-mediated killing with surprising speed on the deployment of each new drug and antibiotic worldwide, a phenomenon called antimicrobial resistance (AMR). Nowadays, AMR represents a critical health threat, for which new medical interventions are urgently needed. By 2050, it is estimated that the leading cause of death will be through untreatable AMR pathogens. Although antibiotics remain a first-line treatment, non-antibiotic therapies such as prophylactic vaccines and therapeutic monoclonal antibodies (mAbs) are increasingly interesting alternatives to limit the spread of such antibiotic resistant microorganisms. For the discovery of new vaccines and mAbs, the search for effective antigens that are able to raise protective immune responses is a challenging undertaking. In this context, outer membrane vesicles (OMV) represent a promising approach, as they recapitulate the complete antigen repertoire that occurs on the surface of Gram-negative bacteria. In this review, we present Escherichia coli and Pseudomonas aeruginosa as specific examples of key AMR threats caused by Gram-negative bacteria and we discuss the current status of mAbs and vaccine approaches under development as well as how knowledge on OMV could benefit antigen discovery strategies.
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Affiliation(s)
- Giada Antonelli
- GSK Vaccines, 53100 Siena, Italy; (G.A.); (L.C.); (P.C.); (R.C.); (B.M.); (S.N.); (S.T.); (G.V.); (V.V.); (I.D.)
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, 53100 Siena, Italy
| | - Luigia Cappelli
- GSK Vaccines, 53100 Siena, Italy; (G.A.); (L.C.); (P.C.); (R.C.); (B.M.); (S.N.); (S.T.); (G.V.); (V.V.); (I.D.)
- Department of Pharmacy and Biotechnology (FABIT), University of Bologna, 40126 Bologna, Italy
| | - Paolo Cinelli
- GSK Vaccines, 53100 Siena, Italy; (G.A.); (L.C.); (P.C.); (R.C.); (B.M.); (S.N.); (S.T.); (G.V.); (V.V.); (I.D.)
- Department of Pharmacy and Biotechnology (FABIT), University of Bologna, 40126 Bologna, Italy
| | - Rossella Cuffaro
- GSK Vaccines, 53100 Siena, Italy; (G.A.); (L.C.); (P.C.); (R.C.); (B.M.); (S.N.); (S.T.); (G.V.); (V.V.); (I.D.)
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, 53100 Siena, Italy
| | - Benedetta Manca
- GSK Vaccines, 53100 Siena, Italy; (G.A.); (L.C.); (P.C.); (R.C.); (B.M.); (S.N.); (S.T.); (G.V.); (V.V.); (I.D.)
- Department of Pharmacy and Biotechnology (FABIT), University of Bologna, 40126 Bologna, Italy
| | - Sonia Nicchi
- GSK Vaccines, 53100 Siena, Italy; (G.A.); (L.C.); (P.C.); (R.C.); (B.M.); (S.N.); (S.T.); (G.V.); (V.V.); (I.D.)
- Department of Pharmacy and Biotechnology (FABIT), University of Bologna, 40126 Bologna, Italy
| | - Serena Tondi
- GSK Vaccines, 53100 Siena, Italy; (G.A.); (L.C.); (P.C.); (R.C.); (B.M.); (S.N.); (S.T.); (G.V.); (V.V.); (I.D.)
- Department of Life Sciences, University of Siena, 53100 Siena, Italy
| | - Giacomo Vezzani
- GSK Vaccines, 53100 Siena, Italy; (G.A.); (L.C.); (P.C.); (R.C.); (B.M.); (S.N.); (S.T.); (G.V.); (V.V.); (I.D.)
- Department of Pharmacy and Biotechnology (FABIT), University of Bologna, 40126 Bologna, Italy
| | - Viola Viviani
- GSK Vaccines, 53100 Siena, Italy; (G.A.); (L.C.); (P.C.); (R.C.); (B.M.); (S.N.); (S.T.); (G.V.); (V.V.); (I.D.)
- Department of Pharmacy and Biotechnology (FABIT), University of Bologna, 40126 Bologna, Italy
| | - Isabel Delany
- GSK Vaccines, 53100 Siena, Italy; (G.A.); (L.C.); (P.C.); (R.C.); (B.M.); (S.N.); (S.T.); (G.V.); (V.V.); (I.D.)
| | - Maria Scarselli
- GSK Vaccines, 53100 Siena, Italy; (G.A.); (L.C.); (P.C.); (R.C.); (B.M.); (S.N.); (S.T.); (G.V.); (V.V.); (I.D.)
| | - Francesca Schiavetti
- GSK Vaccines, 53100 Siena, Italy; (G.A.); (L.C.); (P.C.); (R.C.); (B.M.); (S.N.); (S.T.); (G.V.); (V.V.); (I.D.)
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15
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Ionescu AC, Brambilla E, Sighinolfi MC, Mattina R. A new urinary catheter design reduces in-vitro biofilm formation by influencing hydrodynamics. J Hosp Infect 2021; 114:153-162. [PMID: 33932554 DOI: 10.1016/j.jhin.2021.01.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 11/25/2022]
Abstract
AIM To evaluate the performance of a new catheter design based on different hydrodynamics aiming to reduce the development of biofilm, and compare it with a conventional Foley catheter (FC). METHODS The new proposed design (NPD) catheter is a modification of the FC, based on asymmetric positioning of the balloon and additional drainage holes allowing continuous urine drainage and complete voiding of the bladder. A first experiment was undertaken to assess drainage capability, and a second experiment was performed using a bioreactor with a set-up simulating the bladder and using the test catheter as a flow-through system. The biofilm formation of five bacterial species associated with catheter-associated urinary tract infection (CAUTI) was determined after 24 h of incubation using an MTT assay. Morphological evaluation was performed using scanning electron microscopy. In-vitro determination of residual fluid, and quantitative and morphological data on biofilm formation on the intravesical and intraluminal parts of the tested catheters were assessed. RESULTS Residual fluid was significantly higher in the FC (5.60 ± 0.43 mL) compared with the NPD catheter (0.2 ± 0.03 mL). The NPD catheter showed significantly less biofilm formation (P<0.0001) than the FC. Catheter design had a variable effect on biofilm formation depending on the bacterial strain tested. There was significantly less intraluminal biomass compared with intravesical biomass in both catheters (P<0.0001). Multi-layered biofilms that covered the FC surfaces completely were seen for all tested strains, while the NPD catheter surfaces showed reduced biofilm formation. CONCLUSIONS Modifications of the hydrodynamic characteristics of a catheter can significantly reduce bacterial colonization. Integrated design approaches combining chemical, mechanical and topographical elements can help to reduce the occurrence of CAUTI.
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Affiliation(s)
- A C Ionescu
- Oral Microbiology and Biomaterials Laboratory, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - E Brambilla
- Oral Microbiology and Biomaterials Laboratory, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - M C Sighinolfi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.
| | - R Mattina
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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16
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El Taha L, Bazi T, Maalouf H, Hajjar R, Hasbini Y, El Ouweini H, Chamsy D. The clinical utility of intrapartum screening urinalysis for the prevention of postpartum pyelonephritis. Eur J Obstet Gynecol Reprod Biol 2021; 261:154-159. [PMID: 33940426 DOI: 10.1016/j.ejogrb.2021.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/18/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Urinary tract infection (UTI) is the most common bacterial infection to complicate pregnancy. Medical authorities recommend screening for asymptomatic bacteriuria (ASB) in pregnancy; albeit there is no consensus on ideal timing and frequency for testing. Due to the persistent physiologic changes of pregnancy postpartum, a recent trend to perform urinalysis upon presentation for delivery has been adopted at our institution and various satellite hospitals to putatively minimize cases of postpartum pyelonephritis. The aim of this study is to examine whether routine testing with urinalysis and screening for ASB following suspicious urinalysis with treatment can decrease the incidence of postpartum pyelonephritis, and to determine whether certain urinalysis parameters are more predictive of a positive urine culture. STUDY DESIGN A retrospective chart review study of all term deliveries was conducted over two years at the American University of Beirut Medical Center, a university teaching hospital. A total of 2359 deliveries of women with no increased susceptibility to UTIs were reviewed. None had urinary symptoms upon presentation. Urinary parameters including time of urinalysis and urine culture collection with respect to time of delivery, corresponding results and mode of urine collection were correlated to intrapartum course, incidence of ASB and of postpartum pyelonephritis. RESULTS The incidence of ASB among women presenting for delivery was 4.83 %, with Escherichia coli as the most commonly detected pathogen. The presence of nitrite on urinalysis was significantly associated with a positive urine culture (p-value<0.001). Women with history of antenatal ASB or UTI were more likely to have ASB intrapartum with an odds ratio of 3.14 (95 % CI 1.71-5.75, p-value <0.001). Intrapartum urinalysis with subsequent diagnosis and treatment of ASB did not significantly affect the incidence of postpartum pyelonephritis (p-value 0.280). Similarly, intrapartum urinalysis in the setting of positive history of antenatal ASB or UTI did not increase the incidence of postpartum pyelonephritis compared to women with no such history (p-value 0.659). CONCLUSIONS Urinalysis screening intrapartum does not decrease the incidence of postpartum pyelonephritis. Universal urinalysis screening intrapartum is not warranted and should be reserved for women reporting urinary symptoms and/or women at high risk of UTI.
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Affiliation(s)
- Lina El Taha
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Tony Bazi
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hala Maalouf
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rima Hajjar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Yasmin Hasbini
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Hala El Ouweini
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Dina Chamsy
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.
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17
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De La Franier B, Asker D, van den Berg D, Hatton B, Thompson M. Reduction of microbial adhesion on polyurethane by a sub-nanometer covalently-attached surface modifier. Colloids Surf B Biointerfaces 2021; 200:111579. [PMID: 33517152 DOI: 10.1016/j.colsurfb.2021.111579] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/23/2020] [Accepted: 01/11/2021] [Indexed: 01/03/2023]
Abstract
Indwelling urinary catheters are a common medical device used to relieve urinary retention. Many patients who undergo urinary catheterization develop urinary tract infections (UTIs), which can lead to severe medical complications and high cost of subsequent treatment. Recent years have seen a number of attempts at reducing the rate of UTIs in catheterized patients via catheter surface modifications. In this work, a low cost, robust anti-thrombogenic, and sterilizable anti-fouling layer based on a covalently-bound monoethylene glycol hydroxide (MEG-OH) was attached to polyurethane, a polymeric material commonly used to fabricate catheters. Modified polyurethane tubing was compared to bare tubing after exposure to a wide spectrum of pathogens including Gram-negative bacteria (Pesudomonas aeruginosa, Escherichia coli), Gram-positive bacteria (Staphylococcus aureus) and a fungus (Candida albicans). It has been demonstrated that the MEG-OH monolayer was able to significantly reduce the amount of adhesion of pathogens present on the material surface, with between 85 and 96 % reduction after 24 h of exposure. Additionally, similar reductions in surface fouling were observed following autoclave sterilization, long term storage of samples in air, and longer exposure up to 3 days.
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Affiliation(s)
- Brian De La Franier
- Department of Chemistry, University of Toronto, 80 St. George Street, Toronto, Ontario, M5S 3H6, Canada
| | - Dalal Asker
- Department of Materials Science, University of Toronto, 140-184 College St, Toronto, Ontario, M5S 3E4, Canada; Food Science & Technology Department, Faculty of Agriculture, Alexandria University, 21545 - El-Shatby, Alexandria, Egypt
| | - Desmond van den Berg
- Department of Materials Science, University of Toronto, 140-184 College St, Toronto, Ontario, M5S 3E4, Canada
| | - Benjamin Hatton
- Department of Materials Science, University of Toronto, 140-184 College St, Toronto, Ontario, M5S 3E4, Canada
| | - Michael Thompson
- Department of Chemistry, University of Toronto, 80 St. George Street, Toronto, Ontario, M5S 3H6, Canada.
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18
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Fordyce CB, Katz JN, Alviar CL, Arslanian-Engoren C, Bohula EA, Geller BJ, Hollenberg SM, Jentzer JC, Sims DB, Washam JB, van Diepen S. Prevention of Complications in the Cardiac Intensive Care Unit: A Scientific Statement From the American Heart Association. Circulation 2020; 142:e379-e406. [DOI: 10.1161/cir.0000000000000909] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Contemporary cardiac intensive care units (CICUs) have an increasing prevalence of noncardiovascular comorbidities and multisystem organ dysfunction. However, little guidance exists to support the development of best-practice principles specific to the CICU. This scientific statement evaluates strategies to avoid the potentially preventable complications encountered within contemporary CICUs, focusing on those that are most applicable to the CICU environment. This scientific statement reviews evidence-based practices derived in non–CICU populations, assesses their relevance to CICU practice, and highlights key knowledge gaps warranting further investigation to attenuate patient risk.
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19
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Foster CB, Ackerman K, Hupertz V, Mustin L, Sanders J, Sisson P, Wenthe RE. Catheter-Associated Urinary Tract Infection Reduction in a Pediatric Safety Engagement Network. Pediatrics 2020; 146:peds.2019-2057. [PMID: 32883806 DOI: 10.1542/peds.2019-2057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are a leading cause of health care-associated infection. Catheter insertion bundles (IBs) and maintenance bundles (MBs) have been developed to prevent CAUTIs but have not been extensively validated for use in pediatric populations. We report the CAUTI prevention efforts of a large network of children's hospitals. METHODS Children's hospitals joined the Children's Hospitals' Solutions for Patient Safety engagement network from 2011 to 2017, using an open start time engagement approach, and elected to participate in CAUTI prevention efforts, with 26 submitting data initially and 128 at the end. CAUTI prevention recommendations were first released in May 2012, and IBs and MBs were released in May 2014. Hospitals reported on CAUTIs, patient-days, and urinary catheter-line days and tracked reliability to each bundle. For the network, run charts or control charts were used to plot CAUTI rates, urinary catheter use, and reliability to each bundle component. RESULTS After the introduction of the pediatric CAUTI IBs and MBs, CAUTI rates across the network decreased 61.6%, from 2.55 to 0.98 infections per 1000 catheter-line days. Centerline shifts occurred both before and after the 2015 Centers for Disease Control and Prevention CAUTI definition change. Urinary catheter use rates did not decline during the intervention period. Network reliability to the IBs and MBs increased to 95.4% and 86.9%, respectively. CONCLUSIONS IBs and MBs aimed at preventing CAUTIs were introduced across a large network of children's hospitals. Across the network, the rate of urinary tract infections among hospitalized children with indwelling urinary catheters decreased 61.6%.
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Affiliation(s)
| | - Kathy Ackerman
- Cleveland Clinic Children's, Cleveland Clinic, Cleveland, Ohio.,Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vera Hupertz
- Cleveland Clinic Children's, Cleveland Clinic, Cleveland, Ohio
| | - Laurie Mustin
- Children's Hospitals' Solutions for Patient Safety, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
| | - Joann Sanders
- Cook Children's Health Care System, Fort Worth, Texas
| | - Patricia Sisson
- Children's Hospitals' Solutions for Patient Safety, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
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20
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Mena Lora AJ, Ali M, Krill C, Spencer S, Takhsh E, Bleasdale SC. Impact of a hospital-wide huddle on device utilisation and infection rates: a community hospital's journey to zero. J Infect Prev 2020; 21:228-233. [PMID: 33408760 DOI: 10.1177/1757177420939239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 05/31/2020] [Indexed: 11/16/2022] Open
Abstract
Background Device utilisation ratios (DUR) correlate with device-associated complications and rates of infection. We implemented a hospital-wide Daily Interdisciplinary Safety Huddle (DISH) with infection control and device components. The aim of this study was to evaluate the impact of DISH on DURs and rates of infection for indwelling urinary catheters (IUC) and central venous catheters (CVC). Methods A quasi-experimental study assessing DURs and rates of infection before and after implementation of DISH. At DISH, usage of IUC and CVC is reported by managers and the infection preventionist reviews indications and plans for removal. Data before and after implementation were compared. Paired T-test was used to assess for differences between both groups. Results DISH was successfully implemented at a community hospital. The average DUR for IUC in intensive care unit (ICU) and non-ICU settings was reduced from 0.56 to 0.35 and 0.27 to 0.12, respectively. CVC DUR decreased from 0.29 to 0.26 in the ICU and 0.14 to 0.12 in non-ICU settings. Catheter-associated urinary tract infections (CAUTIs) decreased by 87% and central line-associated bloodstream infections (CLABSIs) by 96%. Conclusion DISH was associated with hospital-wide reductions in DUR and device-associated healthcare-associated infections. Reduction of CLABSIs and CAUTIs had estimated cost savings of $688,050. The impact was more profound in non-ICU settings. To our knowledge, an infection prevention hospital-wide safety huddle has not been reported in the literature. DISH increased device removal, accountability and promoted a culture of safety.
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Affiliation(s)
- Alfredo J Mena Lora
- Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.,Quality Resources Department, Saint Anthony Hospital, Chicago, IL, USA
| | - Mirza Ali
- Quality Resources Department, Saint Anthony Hospital, Chicago, IL, USA
| | - Candice Krill
- Quality Resources Department, Saint Anthony Hospital, Chicago, IL, USA
| | - Sherrie Spencer
- Quality Resources Department, Saint Anthony Hospital, Chicago, IL, USA
| | - Eden Takhsh
- Quality Resources Department, Saint Anthony Hospital, Chicago, IL, USA
| | - Susan C Bleasdale
- Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
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21
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Schweiger A, Kuster SP, Maag J, Züllig S, Bertschy S, Bortolin E, John G, Sax H, Limacher A, Atkinson A, Schwappach D, Marschall J. Impact of an evidence-based intervention on urinary catheter utilization, associated process indicators, and infectious and non-infectious outcomes. J Hosp Infect 2020; 106:364-371. [PMID: 32653433 DOI: 10.1016/j.jhin.2020.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 07/02/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Multi-centre intervention studies tackling urinary catheterization and its infectious and non-infectious complications are lacking. AIM To decrease urinary catheterization and, consequently, catheter-associated urinary tract infections (CAUTIs) and non-infectious complications. METHODS Before/after non-randomized multi-centre intervention study in seven hospitals in Switzerland. Intervention bundle consisting of: (1) a concise list of indications for urinary catheterization; (2) daily evaluation of the need for ongoing catheterization; and (3) education on proper insertion and maintenance of urinary catheters. The primary outcome was urinary catheter utilization. Secondary outcomes were CAUTIs, non-infectious complications and process indicators (proportion of indicated catheters and frequency of catheter evaluation). FINDINGS In total, 25,880 patients were included in this study [13,171 at baseline (August-October 2016) and 12,709 post intervention (August-October 2017)]. Catheter utilization decreased from 23.7% to 21.0% (P=0.001), and catheter-days per 100 patient-days decreased from 17.4 to 13.5 (P=0.167). CAUTIs remained stable at a low level with 0.02 infections per 100 patient-days (baseline) and 0.02 infections (post intervention) (P=0.98). Measuring infections per 1000 catheter-days, the rate was 1.02 (baseline) and 1.33 (post intervention) (P=0.60). Non-infectious complications decreased significantly, from 0.79 to 0.56 events per 100 patient-days (P<0.001), and from 39.4 to 35.4 events per 1000 catheter-days (P=0.23). Indicated catheters increased from 74.5% to 90.0% (P<0.001). Re-evaluations increased from 168 to 624 per 1000 catheter-days (P<0.001). CONCLUSION A straightforward bundle of three evidence-based measures reduced catheter utilization and non-infectious complications, whereas the proportion of indicated urinary catheters and daily evaluations increased. The CAUTI rate remained unchanged, albeit at a very low level.
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Affiliation(s)
- A Schweiger
- Swissnoso, National Centre for Infection Control, Bern, Switzerland; Department of Infectious Diseases and Hospital Epidemiology, Basel University Hospital, Basel, Switzerland; Zug Cantonal Hospital, Zug, Switzerland
| | - S P Kuster
- Swissnoso, National Centre for Infection Control, Bern, Switzerland; Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital Zurich, Zurich, Switzerland
| | - J Maag
- Swissnoso, National Centre for Infection Control, Bern, Switzerland
| | - S Züllig
- Swiss Patient Safety Foundation, Zurich, Switzerland
| | - S Bertschy
- Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - E Bortolin
- Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - G John
- Department of Internal Medicine, Hôpital Neuchâtelois, Neuchâtel, Switzerland; University of Geneva, Geneva, Switzerland
| | - H Sax
- Swissnoso, National Centre for Infection Control, Bern, Switzerland; Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital Zurich, Zurich, Switzerland
| | - A Limacher
- CTU Bern, University of Bern, Bern, Switzerland
| | - A Atkinson
- Department of Infectious Diseases, Inselspital, Bern University Hospital, Bern, Switzerland
| | - D Schwappach
- Swiss Patient Safety Foundation, Zurich, Switzerland; Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - J Marschall
- Swissnoso, National Centre for Infection Control, Bern, Switzerland; Department of Infectious Diseases, Inselspital, Bern University Hospital, Bern, Switzerland.
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22
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Pediatric ambulatory catheter-associated urinary tract infections (CAUTIs): Incidence, risk factors, and patient outcomes. Infect Control Hosp Epidemiol 2020; 41:891-899. [PMID: 32498724 DOI: 10.1017/ice.2020.204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Catheter-associated urinary tract infections (CAUTIs) occur frequently in pediatric inpatients, and they are associated with increased morbidity and cost. Few studies have investigated ambulatory CAUTIs, despite at-risk children utilizing home urinary catheterization. This retrospective cohort and case-control study determined incidence, risk factors, and outcomes of pediatric patients with ambulatory CAUTI. DESIGN Broad electronic queries identified potential patients with ambulatory urinary catheters, and direct chart review confirmed catheters and adjudicated whether ambulatory CAUTI occurred. CAUTI definitions included clean intermittent catheterization (CIC). Our matched case-control analysis assessed risk factors. SETTING Five urban, academic medical centers, part of the New York City Clinical Data Research Network. PATIENTS Potential patients were age <22 years who were seen between October 2010 and September 2015. RESULTS In total, 3,598 eligible patients were identified; 359 of these used ambulatory catheterization (representing186,616 ambulatory catheter days). Of these, 63 patients (18%) experienced 95 ambulatory CAUTIs. The overall ambulatory CAUTI incidence was 0.51 infections per 1,000 catheter days (1.35 for indwelling catheters and 0.47 for CIC; incidence rate ratio, 2.88). Patients with nonprivate medical insurance (odds ratio, 2.5; 95% confidence interval, 1.1-6.3) were significantly more likely to have ambulatory CAUTIs in bivariate models but not multivariable models. Also, 45% of ambulatory CAUTI resulted in hospitalization (median duration, 3 days); 5% resulted in intensive care admission; 47% underwent imaging; and 88% were treated with antibiotics. CONCLUSIONS Pediatric ambulatory CAUTIs occur in 18% of patients with catheters; they are associated with morbidity and healthcare utilization. Ambulatory indwelling catheter CAUTI incidence exceeded national inpatient incidence. Future quality improvement research to reduce these harmful infections is warranted.
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Zalewska-Piątek B, Piątek R. Phage Therapy as a Novel Strategy in the Treatment of Urinary Tract Infections Caused by E. Coli. Antibiotics (Basel) 2020; 9:antibiotics9060304. [PMID: 32517088 PMCID: PMC7344395 DOI: 10.3390/antibiotics9060304] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 12/14/2022] Open
Abstract
Urinary tract infections (UTIs) are regarded as one of the most common bacterial infections affecting millions of people, in all age groups, annually in the world. The major causative agent of complicated and uncomplicated UTIs are uropathogenic E. coli strains (UPECs). Huge problems with infections of this type are their chronicity and periodic recurrences. Other disadvantages that are associated with UTIs are accompanying complications and high costs of health care, systematically increasing resistance of uropathogens to routinely used antibiotics, as well as biofilm formation by them. This creates the need to develop new approaches for the prevention and treatment of UTIs, among which phage therapy has a dominant potential to eliminate uropathogens within urinary tract. Due to the growing interest in such therapy in the last decade, the bacteriophages (natural, genetically modified, engineered, or combined with antibiotics or disinfectants) represent an innovative antimicrobial alternative and a strategy for managing the resistance of uropathogenic microorganisms and controlling UTIs.
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Abstract
Background: Infection is the most common complication and cause of death in patients suffering burn injuries. These patients are susceptible to infection and burn wound sepsis secondary to the alterations in their physiology. Diagnosis and management of infections rely on physical examination, cultures, and the pathology of the burn wound. Method: We performed an electronic search for articles in the Google Scholar and PubMed databases using the search terms "burn sepsis," "burn infection," and "burn critical care." Results: Multiple factors increase burn patients' risk of invasive infection and sepsis, including underlying factors and co-morbidities, the percent total body surface area of the burn, delays in burn wound excision, and microbial virulence/bacterial count. Organisms causing burn wound infection differ, depending on the time since injury and its location; and diagnosis is multi-factorial. The most common pathogens remain Staphylococcus and Pseudomonas spp. Conclusion: Overall, the recognition of burn sepsis is based on clinical findings. Treatment consists of a combination of local dressings, early burn excision, and systemic antimicrobial therapy. The mortality rate has decreased significantly over the past 10 years, but continued efforts at timely management and infection prevention are essential.
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Affiliation(s)
- Josephine A D'Abbondanza
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Shahriar Shahrokhi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Etyang C, Nambozi G, Brennaman L. A Nurse-Led Low-Cost Intervention Effectively Traces Prevalence of Catheter Associated Urinary Tract Infections at a Low-Resourced Regional Referral Hospital in Western Uganda: A Case for Policy Change. Policy Polit Nurs Pract 2020; 21:4-11. [PMID: 31711356 DOI: 10.1177/1527154419886289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Catheter associated urinary tract infection (CAUTI) is the most common hospital-acquired infection worldwide. Low- and middle-income countries (LMICs) with limited resources for health care have not allocated resources to adequately monitor or prevent CAUTIs. The infection is associated with several adverse clinical outcomes, including antibiotic resistance, septicemia, and prolonged hospital stays, that burden the already resource-constrained health systems in LMICs with increased morbidity, health care costs, and deaths. Owing to the lack of resource allocation, little is known about the prevalence of CAUTI in the government-owned and operated hospitals in LIMCs. The purpose of this research was to test a method of CAUTI prevalence surveillance suitable to the resource-constrained health system in a LMIC and to determine the prevalence of CAUTI among hospitalized patients at the study site. In an intermittent 4-week data collection plan, the sample of 68 catheterized adult participants was evaluated for the presence of CAUTI using the three-pronged screening criteria of American Urological Society. CAUTI prevalence in the sample was 17.6%. The high prevalence of CAUTI in this sample represents a substantial risk of consequences to hospitalized patients and to the resource-constrained health system in this LMIC. This first report of CAUTI surveillance using readily available and affordable tools provides evidence to health ministry policymakers of the need for and value of monitoring and prevention programs for hospital-acquired infections in LMICs. We recommend LMIC health policymakers to establish infection prevention teams in hospitals and provide resources to continue surveillance and prevention of CAUTI and other hospital-acquired infections.
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Affiliation(s)
- Charles Etyang
- Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Uganda
| | - Grace Nambozi
- Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Uganda
| | - Laura Brennaman
- Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Uganda
- Ron and Kathy Assaf College of Nursing, Nova Southeastern University, Fort Myers, FL, USA
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26
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Reducing the Risk of Indwelling Catheter–Associated Urinary Tract Infection in Female Patients by Implementing an Alternative Female External Urinary Collection Device. J Wound Ostomy Continence Nurs 2020; 47:50-53. [DOI: 10.1097/won.0000000000000601] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Pilot Ex Vivo and In Vitro Evaluation of a Novel Foley Catheter with Antimicrobial Periurethral Irrigation for Prevention of Extraluminal Biofilm Colonization Leading to Catheter-Associated Urinary Tract Infections (CAUTIs). BIOMED RESEARCH INTERNATIONAL 2019; 2019:2869039. [PMID: 31976318 PMCID: PMC6959145 DOI: 10.1155/2019/2869039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/31/2019] [Indexed: 12/27/2022]
Abstract
CAUTI remains a serious healthcare issue for incontinent patients whose urine drainage is managed by catheters. A novel double-balloon Foley catheter was developed which was capable of irrigating the extraluminal catheter surfaces within the periurethral space between the urethral-bladder junction and meatus. The catheter has a retention cuff that is inflated to secure the catheter in the bladder and a novel irrigation cuff proximal to the urethral-bladder junction capable of providing periurethral irrigation from the urethral-bladder junction to the meatus. Uniform periurethral irrigation was demonstrated in an ex vivo porcine model by adding a dye to the antimicrobial urethral irrigation solution. An in vitro biofilm colonization model was adapted to study the ability of periurethral irrigation with a newly developed antimicrobial combination consisting of polygalacturonic acid + caprylic acid (PG + CAP) to prevent axial colonization of the extraluminal urethral indwelling catheter shaft by common uropathogens. The extraluminal surface of control catheters that were not irrigated formed biofilms along the entire axial urethral tract after 24 hours. Significant (p < 0.001) inhibition of colonization was seen against multidrug-resistant Pseudomonas aeruginosa (PA), carbapenem-resistant Escherichia coli (EC), and carbapenem-resistant Klebsiella pneumoniae (KB). For other common uropathogens including Candida albicans (CA), Proteus mirabilis (PR), and Enterococcus faecalis (EF), a first irrigation treatment completely inhibited colonization of half of the indwelling catheter closest to the bladder and a second treatment largely disinfected the remaining intraurethral portion of the catheter towards the meatus. The novel Foley catheter and PG + CAP antimicrobial irrigant prevented biofilm colonization in an in vitro CAUTI model and merits further testing in an in vivo CAUTI prevention model.
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28
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Meddings J, Manojlovich M, Fowler KE, Ameling JM, Greene L, Collier S, Bhatt J, Saint S. A Tiered Approach for Preventing Catheter-Associated Urinary Tract Infection. Ann Intern Med 2019; 171:S30-S37. [PMID: 31569226 DOI: 10.7326/m18-3471] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jennifer Meddings
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (J.M., S.S.)
| | | | - Karen E Fowler
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (K.E.F.)
| | | | - Linda Greene
- University of Rochester Highland Hospital, Rochester, New York (L.G.)
| | - Sue Collier
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois (S.C., J.B.)
| | - Jay Bhatt
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois (S.C., J.B.)
| | - Sanjay Saint
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (J.M., S.S.)
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Advani SD, Gao CA, Datta R, Sann L, Smith C, Leapman MS, Hittelman AB, Sabetta J, Dembry LM, Martinello RA, Juthani-Mehta M. Knowledge and Practices of Physicians and Nurses Related to Urine Cultures in Catheterized Patients: An Assessment of Adherence to IDSA Guidelines. Open Forum Infect Dis 2019; 6:5532507. [PMID: 31375836 PMCID: PMC6677670 DOI: 10.1093/ofid/ofz305] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 06/25/2019] [Indexed: 12/22/2022] Open
Abstract
Background A positive urine culture often drives initiation of antimicrobials even in the absence of symptoms. Our objectives were to evaluate the knowledge and practice patterns related to ordering urine cultures in patients with indwelling urinary catheters. Methods We performed chart reviews of catheter-associated urinary tract infections (CAUTIs) at our academic health care system between October 1, 2015, and September 30, 2017, to assess practice patterns related to the assessment of potential CAUTIs. Following this, we surveyed physicians and nurses about indications for ordering urine cultures in catheterized patients between January 11, 2018, and April 17, 2018. The accuracy of these indications was assessed based on Infectious Diseases Society of America CAUTI and asymptomatic bacteriuria guidelines. Results On chart review, we identified 184 CAUTIs in 2 years. In 159 episodes (86%), urine cultures were ordered inappropriately. In 114 episodes (62%), CAUTI criteria were met by “pan-culturing” rather than symptom-directed testing. Twenty cases (11%) experienced partial or delayed management of other infections, drug adverse events, and Clostridioides difficile infections (CDIs). On our survey, we received 405 responses, for a response rate of 45.3%. Mean scores varied by occupation and level of training. Nurses were more likely than physicians to consider change in appearance (61% vs 23%; P < .05) and odor (74% vs 42%; P < .05) of urine as indications to order urine cultures. Conclusions Our data reveal specific knowledge gaps among physicians and nurses related to ordering urine cultures in catheterized patients. The practice of pan-culturing and inappropriate urine culture orders may contribute to overdiagnosis of surveillance CAUTIs, delay in diagnosis of alternative infections, and excess CDIs.
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Affiliation(s)
- Sonali D Advani
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Department of Infection Prevention, Yale New Haven Health, New Haven, Connecticut
| | - Catherine A Gao
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Rupak Datta
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Lawrence Sann
- Section of General Surgery, Trauma and Surgical Critical Care, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Cindy Smith
- Department of Infection Prevention, Yale New Haven Health, New Haven, Connecticut
| | - Michael S Leapman
- Department of Urology, Yale School of Medicine, New Haven, Connecticut
| | - Adam B Hittelman
- Department of Urology, Yale School of Medicine, New Haven, Connecticut.,Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | | | - Louise-Marie Dembry
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,VA Connecticut Healthcare System, West Haven, Connecticut.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Richard A Martinello
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Department of Infection Prevention, Yale New Haven Health, New Haven, Connecticut.,Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Manisha Juthani-Mehta
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
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Yakusheva O, Costa DK, Bobay KL, Parada JP, Weiss ME. Variability in catheter-associated asymptomatic bacteriuria rates among individual nurses in intensive care units: An observational cross-sectional study. PLoS One 2019; 14:e0218755. [PMID: 31291280 PMCID: PMC6619985 DOI: 10.1371/journal.pone.0218755] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/09/2019] [Indexed: 12/04/2022] Open
Abstract
Catheter-associated asymptomatic bacteriuria (CAABU) is frequent in intensive care units (ICUs) and contributes to the routine use of antibiotics and to antibiotic-resistant infections. While nurses are responsible for the implementation of CAABU-prevention guidelines, variability in how individual nurses contribute to CAABU-free rates in ICUs has not been previously explored. This study's objective was to examine the variability in CAABU-free outcomes of individual ICU nurses. This observational cross-sectional study used shift-level nurse-patient data from the electronic health records from two ICUs in a tertiary medical center in the US between July 2015 and June 2016. We included all adult (18+) catheterized patients with no prior CAABU during the hospital encounter and nurses who provided their care. The CAABU-free outcome was defined as a 0/1 indicator identifying shifts where a previously CAABU-free patient remained CAABU-free (absence of a confirmed urine sample) 24-48 hours following end of shift. The analytical approach used Value-Added Modeling and a split-sample design to estimate and validate nurse-level CAABU-free rates while adjusting for patient characteristics, shift, and ICU type. The sample included 94 nurses, 2,150 patients with 256 confirmed CAABU cases, and 21,729 patient shifts. Patients were 55% male, average age was 60 years. CAABU-free rates of individual nurses varied between 94 and 100 per 100 shifts (Wald test: 227.88, P<0.001) and were robust in cross-validation analyses (correlation coefficient: 0.66, P<0.001). Learning and disseminating effective CAABU-avoidance strategies from top-performers throughout the nursing teams could improve quality of care in ICUs.
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Affiliation(s)
- Olga Yakusheva
- School of Nursing, School of Public Health, Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI, United States of America
| | - Deena K. Costa
- School of Nursing, Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI, United States of America
| | - Kathleen L. Bobay
- School of Nursing, Loyola University Chicago, Chicago, IL, United States of America
| | - Jorge P. Parada
- Department of Infection Control, Loyola University Medical Center, Chicago, IL, United States of America
| | - Marianne E. Weiss
- Marquette University College of Nursing, WI, United States of America
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Gammon J, Hunt J, Williams S, Daniel S, Rees S, Matthewson S. Infection prevention control and organisational patient safety culture within the context of isolation: study protocol. BMC Health Serv Res 2019; 19:296. [PMID: 31068203 PMCID: PMC6507018 DOI: 10.1186/s12913-019-4126-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 04/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthcare associated infection (HCAI) is a major cause of morbidity and mortality. In recent years, there have been high profile successes in infection prevention control (IPC), such as the dramatic reductions in methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (which is viewed as one proxy indicator of overall harm) and Clostridium difficile in the UK. Nevertheless, HCAI remains a costly burden to health services, a source of concern to patients and the public and at present, is receiving priority from policy makers as it contributes to the global threat of antimicrobial resistance. METHODS The study involves qualitative case studies within isolation settings at two National Health Service (NHS) district general hospitals (DGHs) in Wales, in the UK. The 18-month study incorporates Manchester Patient Safety Framework (MaPSaF) workshops with health workers and other hospital staff, in depth interviews with patients and their relative / informal carer, health workers and hospital staff, and periods of hospital ward observation. DISCUSSION The present study aims to investigate the ways in which engagement of health workers with IPC strategies and principles, shape and inform organisational patient safety culture within the context of isolation in surgical, medical and admission hospital settings; and vice-versa. We want to understand the meaning of IPC 'ownership' for health workers; the ways in which IPC is promoted, how IPC teams operate as new challenges arise, how their effectiveness is assessed and the positioning of IPC within the broader context of organisational patient safety culture, within hospital isolation settings.
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Affiliation(s)
- John Gammon
- College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, SA2 8PP Wales, UK
| | - Julian Hunt
- College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, SA2 8PP Wales, UK
| | - Sharon Williams
- College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, SA2 8PP Wales, UK
| | - Sharon Daniel
- Infection Prevention and Control, Hywel Dda University Health Board, Carmarthen, Wales, UK
| | - Sue Rees
- Infection Prevention and Control, Hywel Dda University Health Board, Carmarthen, Wales, UK
| | - Sian Matthewson
- Infection Prevention and Control, Hywel Dda University Health Board, Carmarthen, Wales, UK
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Spencer TS, Flynn Makic MB, Shaw K. Decreasing Catheter-Associated Urinary Tract Infections in Urologic Oncology Patients Discharged With an Indwelling Urinary Catheter: A Quality Improvement Project. J Perianesth Nurs 2019; 34:394-402. [DOI: 10.1016/j.jopan.2018.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/27/2018] [Accepted: 07/05/2018] [Indexed: 01/04/2023]
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Chastain DB, Cluck DB, Stover KR, Lusardi KT, Marx A, Green S, Faulkner-Fennell C, Turner M, Chahine EB, Bookstaver PB, Bland CM. A Baker's Dozen of Top Antimicrobial Stewardship Intervention Publications in 2017. Open Forum Infect Dis 2019; 6:ofz133. [PMID: 31041343 PMCID: PMC6483124 DOI: 10.1093/ofid/ofz133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/21/2019] [Indexed: 12/01/2022] Open
Abstract
With an increasing number of antimicrobial stewardship-related articles published each year, attempting to stay current is challenging. The Southeastern Research Group Endeavor (SERGE-45) identified antimicrobial stewardship-related peer-reviewed literature that detailed an "actionable" intervention for 2017. The top 13 publications were selected using a modified Delphi technique. These manuscripts were reviewed to highlight the "actionable" intervention used by antimicrobial stewardship programs to provide key stewardship literature for training and teaching and identify potential intervention opportunities within their institutions.
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Affiliation(s)
| | - David B Cluck
- Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, Tennessee
| | - Kayla R Stover
- University of Mississippi School of Pharmacy, Jackson, Mississippi
| | | | - Ashley Marx
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina
| | - Sarah Green
- Novant Health Forsyth Medical Center, Winston-Salem, North Carolina
| | | | | | - Elias B Chahine
- Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, Florida
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Letica-Kriegel AS, Salmasian H, Vawdrey DK, Youngerman BE, Green RA, Furuya EY, Calfee DP, Perotte R. Identifying the risk factors for catheter-associated urinary tract infections: a large cross-sectional study of six hospitals. BMJ Open 2019; 9:e022137. [PMID: 30796114 PMCID: PMC6398917 DOI: 10.1136/bmjopen-2018-022137] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
MOTIVATION Catheter-associated urinary tract infections (CAUTI) are a common and serious healthcare-associated infection. Despite many efforts to reduce the occurrence of CAUTI, there remains a gap in the literature about CAUTI risk factors, especially pertaining to the effect of catheter dwell-time on CAUTI development and patient comorbidities. OBJECTIVE To examine how the risk for CAUTI changes over time. Additionally, to assess whether time from catheter insertion to CAUTI event varied according to risk factors such as age, sex, patient type (surgical vs medical) and comorbidities. DESIGN Retrospective cohort study of all patients who were catheterised from 2012 to 2016, including those who did and did not develop CAUTIs. Both paediatric and adult patients were included. Indwelling urinary catheterisation is the exposure variable. The variable is interval, as all participants were exposed but for different lengths of time. SETTING Urban academic health system of over 2500 beds. The system encompasses two large academic medical centres, two community hospitals and a paediatric hospital. RESULTS The study population was 47 926 patients who had 61 047 catheterisations, of which 861 (1.41%) resulted in a CAUTI. CAUTI rates were found to increase non-linearly for each additional day of catheterisation; CAUTI-free survival was 97.3% (CI: 97.1 to 97.6) at 10 days, 88.2% (CI: 86.9 to 89.5) at 30 days and 71.8% (CI: 66.3 to 77.8) at 60 days. This translated to an instantaneous HR of. 49%-1.65% in the 10-60 day time range. Paraplegia, cerebrovascular disease and female sex were found to statistically increase the chances of a CAUTI. CONCLUSIONS Using a very large data set, we demonstrated the incremental risk of CAUTI associated with each additional day of catheterisation, as well as the risk factors that increase the hazard for CAUTI. Special attention should be given to patients carrying these risk factors, for example, females or those with mobility issues.
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Affiliation(s)
| | - Hojjat Salmasian
- Department of Quality and Safety, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Division of General Internal Medicine, Harvard Medical School, New York, USA
| | - David K Vawdrey
- Value Institute, NewYork-Presbyterian Hospital, New York, USA
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, USA
| | - Brett E Youngerman
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, USA
| | - Robert A Green
- Department of Quality and Patient Safety, NewYork-Presbyterian Hospital, New York, USA
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, USA
| | - E Yoko Furuya
- Department of Medicine, Columbia University Irving Medical Center, New York, USA
- Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, USA
| | - David P Calfee
- Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, USA
- Department of Medicine, Weill Cornell Medicine, New York, USA
| | - Rimma Perotte
- Value Institute, NewYork-Presbyterian Hospital, New York, USA
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, USA
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Zurmehly J. Implementing a Nurse-Driven Protocol to Reduce Catheter-Associated Urinary Tract Infections in a Long-Term Acute Care Hospital. J Contin Educ Nurs 2019; 49:372-377. [PMID: 30053308 DOI: 10.3928/00220124-20180718-08] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 11/13/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are the second most common health care-associated infection. CAUTIs represent a serious threat to chronic critically ill patients in long-term acute care hospitals (LTACHs). Evidence-based guidelines have been shown to reduce the risk of infection in acute care settings but are not well documented in LTACHs. METHOD An evidence-based urinary catheter protocol was developed and implemented across three units in a large LTACH. RNs were oriented to the new protocol through online educational modules. During the evaluation period, 120 patients were admitted with a urinary catheter who qualified for chart review for CAUTI incidence. Overall catheter-days and CAUTI rates were compared, and changes in practice were noted. RESULTS After the education intervention, overall urinary catheter-days decreased by 10.1%, and CAUTI incidence decreased by 74% (4.82 CAUTI per 1,000 patient-days to 1.24). The absolute risk reduction was 3.58 infections per 1,000 catheter-days. The findings were statistically significant (z = 1.00, p < .03). CONCLUSION Significant reductions were noted in total catheter-days, and CAUTI rates improved after implementation of an education program and an evidence-based urinary catheter protocol in an LTACH. J Contin Educ Nurs. 2018;49(8):372-377.
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Skelton-Dudley F, Doan J, Suda K, Holmes SA, Evans C, Trautner B. Spinal Cord Injury Creates Unique Challenges in Diagnosis and Management of Catheter-Associated Urinary Tract Infection. Top Spinal Cord Inj Rehabil 2019; 25:331-339. [PMID: 31844385 PMCID: PMC6907033 DOI: 10.1310/sci2504-331] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: Catheter-associated urinary tract infection (CAUTI) is associated with increased morbidity and mortality and influences the quality of life of patients with spinal cord injury (SCI). Objectives: This clinical review aims to highlight the unique surveillance, prevention, diagnosis, and management challenges of CAUTI in the SCI population. Methods: Narrative review of the current literature on catheter use in persons with SCI was conducted to determine gaps in knowledge and opportunities for improvement. Results: Surveillance of CAUTI is challenging in the SCI population as the ability to detect symptoms used to diagnose CAUTI (ie, suprapubic pain, dysuria) is impaired. In terms of prevention of CAUTI, current strategies refocus on appropriate catheter insertion and care and early removal of catheters, which is not always feasible for persons with SCI. Prophylactic antibiotics, nutraceuticals, and coated catheters show limited efficacy in infection prevention. Diagnosing CAUTI after SCI is challenging, often resulting in an overdiagnosis of CAUTI when truly asymptomatic bacteriuria exists. In the management of CAUTI in patients with SCI, the use of multiple antibiotics over time in an individual increases the rate of multidrug-resistant organisms; therefore, the exploration of novel non-antibiotic treatments is of importance. The patient experience should be at the center of all these efforts. Conclusion: Better diagnostic tools or biomarkers are needed to define true CAUTI in people with SCI. SCI-specific evidence to inform catheter management and CAUTI treatment guidelines is needed, with the goal to minimize catheter-related harm, reduce antibiotic resistance, and improve satisfaction and overall quality of life for SCI patients.
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Affiliation(s)
- Felicia Skelton-Dudley
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - James Doan
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Katie Suda
- Center for Innovation for Complex Chronic HealthCare (CINCCH), Edward Hines Jr. VA Hospital, Chicago, Illinois
- University of Illinois at Chicago, Chicago, Illinois
| | - S. Ann Holmes
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Charlesnika Evans
- Center for Innovation for Complex Chronic HealthCare (CINCCH), Edward Hines Jr. VA Hospital, Chicago, Illinois
- Northwestern University, Department of Preventive Medicine and Center for Health Care Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Chicago, Illinois
| | - Barbara Trautner
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
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Tabak YP, Sung AH, Ye G, Vankeepuram L, Gupta V, McCann E. Attributable clinical and economic burden of carbapenem-non-susceptible Gram-negative infections in patients hospitalized with complicated urinary tract infections. J Hosp Infect 2018; 102:37-44. [PMID: 30503367 DOI: 10.1016/j.jhin.2018.11.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/23/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Gram-negative complicated urinary tract infections (cUTIs) can have serious consequences for patients and hospitals. AIM To examine the clinical and economic burden attributable to Gram-negative carbapenem-non-susceptible (C-NS; resistant/intermediate) infections compared with carbapenem-susceptible (C-S) infections in 78 US hospitals. METHODS All non-duplicate C-NS and C-S urine source isolates were analysed. A subset had principal diagnosis ICD-9-CM codes denoting cUTI. Collection time (<3 vs ≥3 days after admission) determined isolate classification as community or hospital onset. Mortality, 30-day re-admissions, length of stay (LOS), hospital cost and net gain/loss in US dollars were determined for C-NS and C-S cases, with the C-NS-attributable burden estimated through propensity score matching. Three subgroups with adequate patient numbers were analysed: cUTI principal diagnosis, community onset; other principal diagnosis, community onset; and other principal diagnosis, hospital onset. FINDINGS The C-NS-attributable mortality risk was significantly higher (58%) for the other principal diagnosis, hospital-onset subgroup alone (odds ratio 1.58, 95% confidence interval 1.14-2.20; P < 0.01). The C-NS-attributable risk for 30-day re-admission ranged from 29% to 55% (all P < 0.05). The average attributable economic impact of C-NS was 1.1-3.9 additional days LOS (all P < 0.05), US$1512-10,403 additional total cost (all P < 0.001) and US$1582-11,848 net loss (all P < 0.01); overall burden and C-NS-attributable burden were greatest in the other principal diagnosis, hospital-onset subgroup. CONCLUSION Greater clinical and economic burden was observed in propensity-score-matched patients with C-NS infections compared with C-S infections, regardless of whether cUTI was the principal diagnosis, and this burden was most severe in hospital-onset infections.
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Affiliation(s)
- Y P Tabak
- Becton, Dickinson and Company, Franklin Lakes, NJ, USA
| | - A H Sung
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - G Ye
- Becton, Dickinson and Company, Franklin Lakes, NJ, USA
| | - L Vankeepuram
- Becton, Dickinson and Company, Franklin Lakes, NJ, USA
| | - V Gupta
- Becton, Dickinson and Company, Franklin Lakes, NJ, USA
| | - E McCann
- Merck & Co., Inc., Kenilworth, NJ, USA.
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Vallverdú Vidal M, Barcenilla Gaite F. Antiseptic urinary catheterization and maintenance of the bladder catheter. Med Intensiva 2018; 43 Suppl 1:48-52. [PMID: 30396793 DOI: 10.1016/j.medin.2018.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/14/2018] [Accepted: 09/20/2018] [Indexed: 11/17/2022]
Abstract
Catheter-related urinary tract infections are very common both in the community and in the acute hospital care setting, particularly in the critical care environment. In order to minimize this problem, it is essential to adopt a correct approach from insertion to withdrawal of the urinary catheter, and always perform proper antisepsis. There is too much information on antisepsis measures with no consistent results. The present article reviews the existing scientific evidence on the subject and establishes recommendations based on the evidence, in order to optimize outcomes. The entire process is complemented with considerations on how to secure proper management of the indwelling urinary catheter. This article is part of a supplement entitled "Antisepsis in the critical patient", which is sponsored by Becton Dickinson.
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Affiliation(s)
- M Vallverdú Vidal
- Servicio de Medicina Intensiva, Hospital Universitario Arnau de Vilanova, Lleida, España.
| | - F Barcenilla Gaite
- Unidad Funcional de Infección Nosocomial (UFIN), Hospital Universitario Arnau de Vilanova, Lleida, España
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Abstract
Catheter-associated urinary tract infection remains one of the most prevalent, yet preventable, health care-associated infections. General prevention strategies include strict adherence to hand hygiene and antimicrobial stewardship. Duration of urinary catheterization is the most important modifiable risk factor. Targeted prevention strategies include limiting urinary catheter use; physician reminder systems, nurse-initiated discontinuation protocols, and automatic stop orders have successfully decreased catheter duration. Alternatives should be considered. If catheterization is necessary, proper aseptic practices for insertion and maintenance and closed catheter collection systems are essential for prevention. The use of bladder bundles and collaboratives aids in the effective implementation of prevention measures.
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Affiliation(s)
- Emily K Shuman
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine, F4007 University Hospital South, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5226, USA; Department of Infection Prevention and Epidemiology, Michigan Medicine, 300 North Ingalls Building 8B06, Ann Abror, MI 48109-5479, USA.
| | - Carol E Chenoweth
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine, F4007 University Hospital South, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5226, USA; Antimicrobial Stewardship Program, Michigan Medicine, F4141 University Hospital South, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5226, USA
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Ahiawodzi PD, Kelly K, Massengill A, Thompson DK. Risk factors for sepsis morbidity in a rural hospital population: A case-control study. Am J Infect Control 2018; 46:1041-1046. [PMID: 29609853 DOI: 10.1016/j.ajic.2018.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/17/2018] [Accepted: 02/20/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of the study was to identify risk factors for sepsis morbidity in a rural hospital population. METHODS We used a case-control study design. Patients included adult admissions to a rural health system between January 1, 2012, and December 31, 2015. Case selection was by electronic medical record search for codes of the ICD-9-CM. Cases were validated against Quick Sequential Organ Failure Assessment criteria. Multiple logistic regression modeling was performed to determine which predefined variables were significantly associated with sepsis diagnosis. RESULTS A total of 220 patients were studied (110 cases and 110 controls). Cases had an in-hospital mortality of 20% compared with 0% of the controls. Indwelling medical device use during hospitalization (adjusted odds ratio [OR], 3.02; 95% confidence interval [CI], 1.44-6.30; P = .003), coronary heart disease (adjusted OR, 2.59; 95% CI, 1.13-5.97; P = .03), and type of health insurance (adjusted OR, 2.36; 95% CI, 1.13-4.93; P = .02) were independently associated with sepsis diagnosis after adjusting for potential confounders. CONCLUSIONS This study underscores the need for implementation and maintenance of infection control measures during management of patients with indwelling medical devices at a rural hospital.
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Wu G, Cheon E. Meropenem-vaborbactam for the treatment of complicated urinary tract infections including acute pyelonephritis. Expert Opin Pharmacother 2018; 19:1495-1502. [DOI: 10.1080/14656566.2018.1512586] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Gary Wu
- Department of Pharmacy, NewYork-Presbyterian Brooklyn Methodist Hospital, New York, NY, USA
| | - Eunah Cheon
- Department of Pharmacy, NewYork-Presbyterian Brooklyn Methodist Hospital, New York, NY, USA
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Murphy C. Innovating urinary catheter design: An introduction to the engineering challenge. Proc Inst Mech Eng H 2018; 233:48-57. [PMID: 29792114 DOI: 10.1177/0954411918774348] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Every day, people around the world rely on intermittent and indwelling urinary catheters to manage bladder dysfunction, but the potential or actual harm caused by these devices is well-recognised. Current catheter designs can cause urinary tract infection and septicaemia, bladder and urethral trauma and indwelling devices frequently become blocked. Furthermore, the devices can severely disrupt users' lives, limiting their daily activities and can be costly to manage for healthcare providers. Despite this, little significant design innovation has taken place in the last 80 years. In this article current catheter designs and their limitations are reviewed, common catheter-associated problems are outlined and areas of design ripe for improvement proposed. The potential to relieve the individual and economic burden of catheter use is high.
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Affiliation(s)
- Cathy Murphy
- Clinical Academic Facility, Faculty of Health Sciences, University of Southampton, Southampton, UK
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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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Factors Associated With Healthcare-Acquired Catheter-Associated Urinary Tract Infections: Analysis Using Multiple Data Sources and Data Mining Techniques. J Wound Ostomy Continence Nurs 2018. [PMID: 29521928 DOI: 10.1097/won.0000000000000409] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to identify factors associated with healthcare-acquired catheter-associated urinary tract infections (HA-CAUTIs) using multiple data sources and data mining techniques. SUBJECTS AND SETTING Three data sets were integrated for analysis: electronic health record data from a university hospital in the Midwestern United States was combined with staffing and environmental data from the hospital's National Database of Nursing Quality Indicators and a list of patients with HA-CAUTIs. METHODS Three data mining techniques were used for identification of factors associated with HA-CAUTI: decision trees, logistic regression, and support vector machines. RESULTS Fewer total nursing hours per patient-day, lower percentage of direct care RNs with specialty nursing certification, higher percentage of direct care RNs with associate's degree in nursing, and higher percentage of direct care RNs with BSN, MSN, or doctoral degree are associated with HA-CAUTI occurrence. The results also support the association of the following factors with HA-CAUTI identified by previous studies: female gender; older age (>50 years); longer length of stay; severe underlying disease; glucose lab results (>200 mg/dL); longer use of the catheter; and RN staffing. CONCLUSIONS Additional findings from this study demonstrated that the presence of more nurses with specialty nursing certifications can reduce HA-CAUTI occurrence. While there may be valid reasons for leaving in a urinary catheter, findings show that having a catheter in for more than 48 hours contributes to HA-CAUTI occurrence. Finally, the findings suggest that more nursing hours per patient-day are related to better patient outcomes.
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Dawson CH, Gallo M, Prevc K. TWOC around the clock: a multimodal approach to improving catheter care. J Infect Prev 2017; 18:57-64. [PMID: 28989506 DOI: 10.1177/1757177416668584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 08/06/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Urinary tract infections (UTI) are the second-largest group of healthcare-associated infections (HCAI). The Saving Lives Urinary Catheter Care Bundle was introduced to reduce catheter-associated urinary tract infections (CAUTI). In response, we implemented a catheter care group to examine ways to improve catheter care in an acute hospital NHS Trust. METHODS We adopted a multimodal approach, revolving around four components: (1) Catheter Care Pathway; (2) HOUDINI checklist; (3) catheter magnets; and (4) use of bladder ultrasound scanners. RESULTS The yearly CAUTI prevalence survey showed an annual reduction in CAUTI from 2012-2013 to 2014-2015 (3.5% to 2.4%). Evaluations of the multimodal approach have highlighted limitations, leading to priorities being established around provision of tools, education, and use of measurement and feedback. CONCLUSIONS Our multimodal approach demonstrates CAUTI rate improvements are achievable, directly benefiting patients. However, long-term maintenance of multimodal components is required to ensure sustained benefit. Engagement and accountability have emerged as significant challenges to the effectiveness and longevity of the catheter care group. We suggest greater emphasis on such challenges if long-term national or international improvement is to be achieved.
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Affiliation(s)
- Carolyn H Dawson
- Infection Prevention and Control Team, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Melanie Gallo
- Infection Prevention and Control Team, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Kate Prevc
- Infection Prevention and Control Team, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Abstract
Catheter-associated urinary tract infection (CAUTI) remains one of the most prevalent, yet preventable, health care-associated infections and predominantly occurs in patients with indwelling urinary catheters. Targeted strategies for prevention of CAUTI include limiting urinary catheter use; physician reminder systems, nurse-initiated discontinuation protocols, and automatic stop orders have successfully decreased catheter duration. Alternatives to indwelling catheters should be considered in appropriate patients. If indwelling catheterization is necessary, proper aseptic practices for catheter insertion and maintenance and closed catheter collection system is essential for preventing CAUTI. The use of "bladder bundles" and collaboratives aids in the effective implementation of CAUTI prevention measures.
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Affiliation(s)
- Carol E Chenoweth
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
| | - Sanjay Saint
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA; Division of General Medicine, Department of Internal Medicine, University of Michigan Health System, 2800 Plymouth Road, Building 16, Room 430 West, Ann Arbor, MI 48109-2800, USA; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
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Kauf TL, Prabhu VS, Medic G, Borse RH, Miller B, Gaultney J, Sen SS, Basu A. Cost-effectiveness of ceftolozane/tazobactam compared with piperacillin/tazobactam as empiric therapy based on the in-vitro surveillance of bacterial isolates in the United States for the treatment of complicated urinary tract infections. BMC Infect Dis 2017; 17:314. [PMID: 28454524 PMCID: PMC5410095 DOI: 10.1186/s12879-017-2408-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 04/18/2017] [Indexed: 11/27/2022] Open
Abstract
Background A challenge in the empiric treatment of complicated urinary tract infection (cUTI) is identifying the initial appropriate antibiotic therapy (IAAT), which is associated with reduced length of stay and mortality compared with initial inappropriate antibiotic therapy (IIAT). We evaluated the cost-effectiveness of ceftolozane/tazobactam compared with piperacillin/tazobactam (one of the standard of care antibiotics), for the treatment of hospitalized patients with cUTI. Methods A decision-analytic Monte Carlo simulation model was developed to compare the costs and effectiveness of empiric treatment with either ceftolozane/tazobactam or piperacillin/tazobactam in hospitalized adult patients with cUTI infected with Gram-negative pathogens in the US. The model applies the baseline prevalence of resistance as reported by national in-vitro surveillance data. Results In a cohort of 1000 patients, treatment with ceftolozane/tazobactam resulted in higher total costs compared with piperacillin/tazobactam ($36,413 /patient vs. $36,028/patient, respectively), greater quality-adjusted life years (QALYs) (9.19/patient vs. 9.13/patient, respectively) and an incremental cost-effectiveness ratio (ICER) of $6128/QALY. Ceftolozane/tazobactam remained cost-effective at a willingness to pay of $100,000 per QALY compared to piperacillin/tazobactam over a range of input parameter values during one-way and probabilistic sensitivity analysis. Conclusions Model results show that ceftolozane/tazobactam is likely to be cost-effective compared with piperacillin/tazobactam for the empiric treatment of hospitalized cUTI patients in the United States. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2408-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Vimalanand S Prabhu
- Merck & Co., Inc., Kenilworth, NJ, USA. .,Merck & Co., Inc., 2000 Galloping Hill Rd., Kenilworth, NJ, 07033, USA.
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Naik AD, Skelton F, Amspoker AB, Glasgow RA, Trautner BW. A fast and frugal algorithm to strengthen diagnosis and treatment decisions for catheter-associated bacteriuria. PLoS One 2017; 12:e0174415. [PMID: 28350833 PMCID: PMC5370115 DOI: 10.1371/journal.pone.0174415] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 03/08/2017] [Indexed: 02/02/2023] Open
Abstract
Objectives Guidelines for managing catheter-associated urinary tract infection (CAUTI) and asymptomatic bacteria (ASB) are poorly translated into routine care due in part to cognitive diagnostic errors. This study determines if the accuracy for CAUTI and ASB diagnosis and treatment improves after implementation of a fast and frugal algorithm compared with traditional education methods. Materials and methods A pre and post-intervention with contemporaneous comparison site involving inpatient and long term care wards at two regional Veterans Affairs Systems in United States. Participants included 216 internal medicine residents and 16 primary care clinicians. Intervention clinicians received training with a fast and frugal algorithm. Comparison site clinicians received guidelines education. Diagnosis and treatment accuracy compared with a criterion standard was assessed during similar three-month, pre- and post-intervention periods. Sensitivity, specificity, and likelihood ratios were compared for both periods at each site. Results Bacteriuria management was evaluated against criterion standard in 196 cases pre-implementation and 117 cases post-implementation. Accuracy of bacteriuria management among intervention participants was significantly higher, post-implementation, than those at the comparison site (Intervention: positive likelihood ratio (LR+) = 8.5, specificity = 0.89, 95% confidence interval (CI) = 0.78−1.00; comparison: LR+ = 4.62, specificity (95%CI) = 0.79 (0.63−0.95). Further, improvements at the intervention site were statistically significant (pre-implementation: LR+ = 2.1, specificity (95%CI) = 0.60 (0.50−0.71); post-implementation: LR+ = 8.5, specificity (95%CI) = 0.89 (0.78−1.00). At both sites, there were similar improvements in negative LR from pre- to post-implementation: [Intervention site = 0.28 to 0.08; comparison site = 0.13 to 0.04]. Inappropriate management of ASB declined markedly from 32 (40%) to 3 (11%) cases at the intervention site. Conclusions A fast and frugal algorithm improves diagnosis and treatment accuracy for CAUTI and reduces inappropriate treatment of ASB. Fast and frugal algorithms that realign diagnostic intuitions and treatment norms can enhance translation of evidence into practice.
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Affiliation(s)
- Aanand D. Naik
- Houston Center of Innovations in Quality, Effectiveness, and Safety, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas, United States of America
- Health Services Research Section, Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- * E-mail: (AN); (BT)
| | - Felicia Skelton
- Houston Center of Innovations in Quality, Effectiveness, and Safety, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas, United States of America
- Health Services Research Section, Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Amber B. Amspoker
- Houston Center of Innovations in Quality, Effectiveness, and Safety, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas, United States of America
- Health Services Research Section, Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Russell A. Glasgow
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado, United States of America
| | - Barbara W. Trautner
- Houston Center of Innovations in Quality, Effectiveness, and Safety, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas, United States of America
- Health Services Research Section, Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- * E-mail: (AN); (BT)
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Impact of Changes to the National Healthcare Safety Network (NHSN) Definition on Catheter-Associated Urinary Tract Infection (CAUTI) Rates in Intensive Care Units at an Academic Medical Center. Infect Control Hosp Epidemiol 2017; 38:621-623. [PMID: 28279231 DOI: 10.1017/ice.2017.26] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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50
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Anti-adhesive antimicrobial peptide coating prevents catheter associated infection in a mouse urinary infection model. Biomaterials 2017; 116:69-81. [DOI: 10.1016/j.biomaterials.2016.11.047] [Citation(s) in RCA: 161] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/14/2016] [Accepted: 11/24/2016] [Indexed: 12/21/2022]
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