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Mrziglod L, Saydan S, Schwab F, Zohlnhöfer-Momm D, Gastmeier P, Hansen S. Reducing urinary catheter use in geriatric patients - results of a single-center champion-led intervention. BMC Infect Dis 2023; 23:94. [PMID: 36788487 PMCID: PMC9930210 DOI: 10.1186/s12879-023-08064-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Indwelling urinary tract catheters (UTC) are a well-known risk factor for urinary tract infections (UTI). Because geriatric patients are at high risk of infection, an intervention with a focus on appropriate and minimal UTC use was introduced in 4 acute care geriatric wards. METHODS Between 11/2018 and 1/2020, unit-based data on UTC use and nosocomial UTI was collected in accordance with the methods of the German national surveillance system KISS. From 6/2019 to 1/2020, a champion-led intervention was implemented which focused on: (i) feedback of surveillance data, (ii) education and training in aseptic UTC insertion and maintenance, (iii) HCW's daily assessment of UTC necessity based on a checklist and (iv) timely removal of unnecessary UTCs. UTC use, incidence, and incidence densities for catheter-associated UTI (CAUTI) were calculated before and during the intervention. In addition, we analyzed adherence to a scheduled daily assessment of UTC necessity. Rate ratios (RR) with 95% confidence intervals (95%CI) were calculated. Differences based on the quality of checklist completion were evaluated using the Kruskal Wallis test. RESULTS We analyzed the data of 3,564 patients with a total 53,954 patient days, 9,208 UTC days, and 61 CAUTI. Surveillance data showed a significant decrease in the pooled UTC utilization rate from 19.1/100 patient days to 15.2/100 patient days (RR = 0.80, 95%CI 0.77-0.83, p < 0.001). CAUTI per 100 patients dropped from 2.07 to 1.40 (RR = 0.68, 95%CI 0.41-1.12, p = 0.1279). Overall, 373 patients received a UTC during the intervention. Of those patients 351 patients had an UTC ≥ 2 days. The analysis of these patients showed that 186 patients (53%) received a checklist as part of their chart for daily evaluation of UTC necessity. 43 (23.1%) of the completed checklists were of good quality; 143 (76.9%) were of poor quality. Patients in the group whose checklists were of good quality had fewer UTC days (median 7 UTC days IQR (3-11)) than patients whose checklists were of poor quality (11 UTC days IQR (6-16), p = 0.001). CONCLUSION We conclude that a champion-led, surveillance-based intervention reduces the use of UTC among geriatric patients. Further research is needed to determine to what extent the use of checklists in daily medical UTC assessment affects the prevention of CAUTI. The fact that patients whose checklists were completed well had fewer UTC days should encourage a conscientious and thorough daily review of the need for UTC.
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Affiliation(s)
- L Mrziglod
- grid.6363.00000 0001 2218 4662Department of Infectious Diseases and Respiratory Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany ,Department of Internal Medicine - Geriatrics, Vivantes Wenckebach Klinikum, Berlin, Germany
| | - S Saydan
- grid.6363.00000 0001 2218 4662Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany ,German National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany
| | - F Schwab
- grid.6363.00000 0001 2218 4662Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany ,German National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany
| | - D Zohlnhöfer-Momm
- Department of Internal Medicine - Geriatrics, Vivantes Wenckebach Klinikum, Berlin, Germany
| | - P Gastmeier
- grid.6363.00000 0001 2218 4662Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany ,German National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany
| | - S Hansen
- Institute of Hygiene and Environmental Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany. .,German National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany.
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Using statistical process control charts to measure changes from a nurse-driven protocol to remove urinary catheters. Am J Infect Control 2022; 50:1355-1359. [PMID: 35278490 DOI: 10.1016/j.ajic.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Implementing a nurse-driven protocol (NDP) to remove indwelling urinary catheters is a strategy to reduce catheter-associated urinary tract infections (CAUTI). The purpose of this project was to implement a comprehensive NDP to reduce indwelling urinary catheter utilization and CAUTI rates at a large academic health system. METHODS Statistical process control charts, a quality improvement method, was used to identify special cause variation. A formal protocol was developed to provide guidance for nurses to remove indwelling urinary catheters when no longer indicated. Changes were also made within the electronic health record. RESULTS Signals of improvement were not noted on the Statistical process control charts for urinary catheter utilization or CAUTI rates. The frequency with which the NDP was documented (process measure) was assessed, showing it is used approximately 600 times each month. Of those catheters removed by the NDP, an average of 6% were reinserted within 48 hours (balancing measure). DISCUSSION Our findings differed from other literature as we did not see a reduction in urinary catheter utilization after implementing a NDP. However, our project adds to the literature as we also evaluated process and balancing measures. CONCLUSIONS A NDP for urinary catheter removal provides nurses with the autonomy to remove catheters when no longer indicated; however, other interventions should be added to a comprehensive CAUTI-prevention program.
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Jasperse N, Hernandez-Dominguez O, Deyell JS, Prasad JP, Yuan C, Tomy M, Kuza CM, Grigorian A, Nahmias J. A single institution pre-/post-comparison after introduction of an external urinary collection device for female medical patients. J Infect Prev 2022; 23:149-154. [PMID: 37256156 PMCID: PMC10226054 DOI: 10.1177/17571774211060423] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 08/31/2021] [Indexed: 09/20/2023] Open
Abstract
Background External urinary collection devices (EUCDs) may serve as an alternative to indwelling urinary catheters (IUCs) and decrease the rate of catheter associated urinary tract infections (CAUTIs). PureWick® is a novel female EUCD; however, no study has definitively proven benefit regarding reduction of CAUTIs. Aim We sought to compare the CAUTI rate and IUC days before and after availability of the PureWick® EUCD at a single institution. We provide a descriptive analysis of female medical patients receiving an EUCD. Methods A retrospective review of adult female patients admitted to a single institution on a medical service who received an IUC and/or an EUCD was performed. Patients who received an IUC in the 3 months before EUCD availability (PRE) were compared to patients who received an IUC and/or EUCD in the 12 months after (POST). Results Out of 848 female patients, 292 received an EUCD in the POST cohort and overall, 656 received an IUC (259 (100%) PRE vs. 397 (67.4%) POST). Compared to the PRE cohort, the POST cohort had a higher number of IUC days (median, 3 vs 2 days, p = 0.001) and a higher rate of CAUTI (infections per 1000 catheter days, 9.3 vs 2.3, p = 0.001). The rate of UTI associated with EUCD use was 9.8 infections per 1000 device days. Discussion While EUCDs might appear to be a promising alternative to IUCs for female patients, this single center pre-/post-analysis found that both the number of IUC days and the CAUTI rate increased after introduction of a female EUCD.
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Affiliation(s)
- Nathan Jasperse
- Department of Emergency Medicine, Los Angeles County Harbor-UCLA Medical
Center, Torrance, CA, USA
| | | | - Jacob S Deyell
- Department of Surgery, UC Irvine Healthcare, Orange, CA, USA
| | - Janani P Prasad
- Department of Surgery, UC Irvine Healthcare, Orange, CA, USA
| | - Charlene Yuan
- Department of Surgery, UC Irvine Healthcare, Orange, CA, USA
| | - Meril Tomy
- Department of Surgery, UC Irvine Healthcare, Orange, CA, USA
| | - Catherine M Kuza
- Department of Anesthesia, University of Southern California, Los Angeles, CA, USA
| | - Areg Grigorian
- Department of Surgery, UC Irvine Healthcare, Orange, CA, USA
| | - Jeffry Nahmias
- Department of Surgery, UC Irvine Healthcare, Orange, CA, USA
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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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Comparison of metrics used to track central-line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) across a regional network. Infect Control Hosp Epidemiol 2021; 43:1712-1714. [PMID: 34266514 DOI: 10.1017/ice.2021.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The paradoxical relationship between standardized infection ratio and standardized utilization ratio for catheter-associated urinary tract infections (CAUTIs) in contrast to central-line-associated bloodstream infections (CLABSIs), in addition to CAUTI definition challenges, incentivizes hospitals to focus their prevention efforts on urine culture stewardship rather than catheter avoidance and care.
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Sustained reduction in catheter-associated urinary tract infections using multi-faceted strategies led by champions: A quality improvement initiative. Infect Control Hosp Epidemiol 2021; 43:925-929. [PMID: 33858549 DOI: 10.1017/ice.2021.135] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
We reviewed the sustainability of a multifaceted intervention on catheter-associated urinary tract infection (CAUTI) in 3 intensive care units. During the 4-year postintervention period, we observed reductions in urine culture rates (from 80.9 to 47.5 per 1,000 patient days; P < .01), catheter utilization (from 0.68 to 0.58; P < .01), and CAUTI incidence rates (from 1.7 to 0.8 per 1,000 patient days; P = .16).
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Sustainably reducing device utilization and device-related infections with DeCATHlons, device alternatives, and decision support. Infect Control Hosp Epidemiol 2020; 41:1344-1347. [PMID: 32600491 DOI: 10.1017/ice.2020.295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Engagement of frontline staff, along with senior leadership, in competition-style healthcare-associated infection reduction efforts, combined with electronic clinical decision support tools, appeared to reduce antibiotic regimen initiations for urinary tract infections (P = .01). Mean monthly standardized infection and device utilization ratios also decreased (P < .003 and P < .0001, respectively).
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Hefner JL, Fareed N, Walker DM, Huerta TR, McAlearney AS. Central line infections in United States hospitals: An exploration of variation in central line device days and infection rates across hospitals that serve highly complex patient populations. Am J Infect Control 2019; 47:1032-1034. [PMID: 30638670 DOI: 10.1016/j.ajic.2018.12.001] [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: 09/19/2018] [Revised: 12/02/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
Abstract
Our descriptive analyses show a wide distribution in rates of central line device days and central line-associated bloodstream infections for a given standardized infection ratio-the measure linked to federal payment penalties-among 215 US hospitals serving highly complex patient populations. We established that the standardized infection ratio masks hospital-level variation in device use and associated patient safety.
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The case for a population standardized infection ratio (SIR): A metric that marries the device SIR to the standardized utilization ratio (SUR). Infect Control Hosp Epidemiol 2019; 40:979-982. [DOI: 10.1017/ice.2019.175] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AbstractBackground:The device standardized infection ratio (SIR) is used to compare unit and hospital performance for different publicly reported infections. Interventions to reduce unnecessary device use may select a higher-risk population, leading to a paradoxical increase in SIR for some high-performing facilities. The standardized utilization ratio (SUR) adjusts for device use for different units and facilities.Methods:We calculated the device SIR (calculated based on actual device days) and population SIR (defined as Σ observed events divided by Σ predicted events based on predicted device days), adjusting for the facility SUR for both central-line–associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) in 84 hospitals from a single system for calendar years 2016 and 2017.Results:The central-line SUR was 1.02 for 801,172 central-line days, with a device SIR of 0.76 and a population SIR of 0.78, a 1.6% relative increase. On the other hand, the urinary catheter SUR was 0.90 for 757,504 urinary catheter days, with a device SIR of 0.84 and a population SIR of 0.76, a 10.0% relative decrease. The cumulative attributable difference for CAUTI to a target SIR of 1 was −135.4 for the device SIR compared to −203.66 for the population SIR, a 50.8% increase in prevented events.Conclusion:Population SIR accounts for predicted device utilization; thus, it is an attractive metric with which to address overall risk of infection or harm to a patient population. It also reduces the risk of selection bias that may impact the device SIR with interventions to reduce device use.
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The evolution of catheter-associated urinary tract infection (CAUTI): Is it time for more inclusive metrics? Infect Control Hosp Epidemiol 2019; 40:681-685. [PMID: 30915925 DOI: 10.1017/ice.2019.43] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Catheter-associated urinary tract infection (CAUTI) has long been considered a preventable healthcare-associated infection. Many federal agencies, the Centers for Medicare and Medicaid Services (CMS), and public and private healthcare organizations have implemented strategies aimed at preventing CAUTIs. To monitor progress in CAUTI prevention, the National Healthcare Safety Network (NHSN) CAUTI metric has been adopted nationally as the primary outcome measure and has been refined over the past decades. However, this surveillance metric may underestimate infectious and noninfectious catheter harm. We suggest evolving to more inclusive performance metrics to better reflect quality improvement efforts underway in hospitals. The standardized device utilization ratio (SUR) provides a good surrogate for preventable catheter harm. On the other hand, a population-based metric that combines both standardized infection ratio (SIR) and SUR would address both infectious and noninfectious harm, while adjusting for population risk. Finally, electronically captured catheter-associated bacteriuria may contribute essential information on local testing stewardship.
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Reducing indwelling urinary catheter use through staged introduction of electronic clinical decision support in a multicenter hospital system. Infect Control Hosp Epidemiol 2018; 39:902-908. [DOI: 10.1017/ice.2018.114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ObjectiveTo integrate electronic clinical decision support tools into clinical practice and to evaluate the impact on indwelling urinary catheter (IUC) use and catheter-associated urinary tract infections (CAUTIs).Design, Setting, and ParticipantsThis 4-phase observational study included all inpatients at a multicampus, academic medical center between 2011 and 2015.InterventionsPhase 1 comprised best practices training and standardization of electronic documentation. Phase 2 comprised real-time electronic tracking of IUC duration. In phase 3, a triggered alert reminded clinicians of IUC duration. In phase 4, a new IUC order (1) introduced automated order expiration and (2) required consideration of alternatives and selection of an appropriate indication.ResultsOverall, 2,121 CAUTIs, 179,070 new catheters, 643,055 catheter days, and 2,186 reinsertions occurred in 3·85 million hospitalized patient days during the study period. The CAUTI rate per 10,000 patient days decreased incrementally in each phase from 9·06 in phase 1 to 1·65 in phase 4 (relative risk [RR], 0·182; 95% confidence interval [CI], 0·153–0·216; P<·001). New catheters per 1,000 patient days declined from 53·4 in phase 1 to 39·5 in phase 4 (RR, 0·740; 95% CI, 0·730; P<·001), and catheter days per 1,000 patient days decreased from 194·5 in phase 1 to 140·7 in phase 4 (RR, 0·723; 95% CI, 0·719–0·728; P<·001). The reinsertion rate declined from 3·66% in phase 1 to 3·25% in phase 4 (RR, 0·894; 95% CI, 0·834–0·959; P=·0017).ConclusionsThe phased introduction of decision support tools was associated with progressive declines in new catheters, total catheter days, and CAUTIs. Clinical decision support tools offer a viable and scalable intervention to target hospital-wide IUC use and hold promise for other quality improvement initiatives.
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Abstract
PURPOSE OF REVIEW Patients in the ICU are at higher risk for catheter-associated urinary tract infection (CAUTI) due to more frequent use of catheters and lower threshold for obtaining urine cultures. This review provides a summary of CAUTI reduction strategies that are specific to the intensive care setting. RECENT FINDINGS The surveillance definition for CAUTI is imprecise and measures catheter-associated bacteriuria rather than true infection. Alternatives have been proposed, but CAUTI rates measured by this definition are currently required to be reported to the Centers for Medicare and Medicaid Services and high CAUTI rates can result in financial penalties. Although CAUTI may not directly result in significant patient harm, it has several indirect patient safety implications and CAUTI reduction has several benefits. Various bundles have been successful at reducing CAUTI both in individual institutions and on larger scales such as healthcare networks and entire states. SUMMARY CAUTI reduction is possible in the ICU through a combination of reduced catheter usage, improved catheter care and stewardship of urine cultures.
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Assadi F. Strategies for Preventing Catheter-associated Urinary Tract Infections. Int J Prev Med 2018; 9:50. [PMID: 29963301 PMCID: PMC5998608 DOI: 10.4103/ijpvm.ijpvm_299_17] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 09/23/2017] [Indexed: 11/04/2022] Open
Affiliation(s)
- Farahnak Assadi
- Department of Pediatrics Section of Nephrology, Rush University Medical Center, Chicago, Illinois, USA
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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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Kim EJ, Kwak YG, Park SH, Kim SR, Shin MJ, Yoo HM, Han SH, Kim DW, Choi YH, Yoo JH. Trends in device utilization ratios in intensive care units over 10-year period in South Korea: device utilization ratio as a new aspect of surveillance. J Hosp Infect 2017; 100:e169-e177. [PMID: 29042233 DOI: 10.1016/j.jhin.2017.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 10/10/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Device-associated infection (DAI) is an important issue related to patient safety. It is important to reduce unnecessary device utilization in order to decrease DAI rates. AIM To investigate the time trend of device utilization ratios (DURs) of voluntarily participating hospitals, collected over a 10-year period through the Korean National Healthcare-associated Infections Surveillance System (KONIS). METHODS DURs from 2006 to 2015 in 190 intensive care units (ICUs) participating in KONIS were included in this study. DURs were calculated as the ratio of device-days to patient-days. The pooled incidences of DAIs and DURs were calculated for each year of participation, and the year-wise trends were analysed. FINDINGS Year-wise ventilator utilization ratio (V-DUR) increased significantly from 0.40 to 0.41 (F = 6.27, P < 0.01), urinary catheter utilization ratio (U-DUR) increased non-significantly from 0.83 to 0.84 (F = 1.66, P = 0.10), and C-line utilization ratio (CL-DUR) decreased non-significantly from 0.55 to 0.51 (F = 1.62, P = 0.11). In the subgroup analysis, 'medical ICU' (F = 2.79, P < 0.01) and 'hospital with >900 beds' (F = 3.07, P < 0.01) were associated with the significant increase in V-DUR. CONCLUSION In Korea, V-DUR showed a significant, year-wise increasing trend. The trends for U-DUR and CL-DUR showed no significant decrease. Efforts are required to ensure the reduction of DURs.
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Affiliation(s)
- E J Kim
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Y G Kwak
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - S H Park
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - S R Kim
- Infection Control Office, Korea University Guro Hospital, Seoul, Republic of Korea
| | - M J Shin
- Infection Control Office, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - H M Yoo
- Infection Control Office, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
| | - S H Han
- Department of Nursing, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - D W Kim
- Department of Policy Research Affairs, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Y H Choi
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Republic of Korea.
| | - J H Yoo
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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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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17
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Gundlapalli AV, Divita G, Redd A, Carter ME, Ko D, Rubin M, Samore M, Strymish J, Krein S, Gupta K, Sales A, Trautner BW. Detecting the presence of an indwelling urinary catheter and urinary symptoms in hospitalized patients using natural language processing. J Biomed Inform 2017; 71S:S39-S45. [DOI: 10.1016/j.jbi.2016.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/22/2016] [Accepted: 07/08/2016] [Indexed: 11/26/2022]
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Blondal K, Ingadottir B, Einarsdottir H, Bergs D, Steingrimsdottir I, Steindorsdottir S, Gudmundsdottir G, Hafsteinsdottir E. The effect of a short educational intervention on the use of urinary catheters: a prospective cohort study. Int J Qual Health Care 2016; 28:742-748. [PMID: 27664821 DOI: 10.1093/intqhc/mzw108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 08/18/2016] [Indexed: 12/14/2022] Open
Abstract
Objective To assess the effectiveness of implementation of evidence-based recommendations to reduce catheter-associated urinary tract infections (CAUTIs). Design Prospective cohort study, conducted in 2010-12, with a before and after design. Setting A major referral university hospital. Participants Data were collected before (n = 244) and 1 year after (n = 255) the intervention for patients who received urinary catheters. Intervention The intervention comprised two elements: (i) aligning doctors' and nurses' knowledge of indications for the use of catheters and (ii) an educational effort consisting of three 30- to 45-minute sessions on evidence-based practice regarding catheter usage for nursing personnel on 17 medical and surgical wards. Main Outcome Measures The main outcome measures were the proportion of (i) admitted patients receiving urinary catheters during hospitalization, (ii) catheters inserted without indication, (iii) inpatient days with catheter and (iv) the incidence of CAUTIs per 1000 catheter days. Secondary outcome measures were the proportion of (i) catheter days without appropriate indication and (ii) patients discharged with a catheter. Results There was a reduction in the proportion of inpatient days with a catheter, from 44% to 41% (P = 0.006). There was also a reduction in the proportion of catheter days without appropriate indication (P < 0.001) and patients discharged with a catheter (P = 0.029). The majority of catheters were inserted outside the study wards. Conclusions A short educational intervention was feasible and resulted in significant practice improvements in catheter usage but no reduction of CAUTIs. Other measures than CAUTI may be more sensitive to detecting important practice changes.
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Affiliation(s)
- Katrin Blondal
- Surgical Division, Landspitali - The National University Hospital of Iceland, 13A, 101 Reykjavik, Iceland.,Faculty of Nursing, University of Iceland, Eiriksgotu 34, 101 Reykjavik, Iceland
| | - Brynja Ingadottir
- Surgical Division, Landspitali - The National University Hospital of Iceland, 13A, 101 Reykjavik, Iceland.,Faculty of Nursing, University of Iceland, Eiriksgotu 34, 101 Reykjavik, Iceland
| | - Hildur Einarsdottir
- Medical Division, Landspitali - The National University Hospital of Iceland, Eiriksgata 19, 101 Reykjavik, Iceland
| | - Dorothea Bergs
- Faculty of Nursing, University of Iceland, Eiriksgotu 34, 101 Reykjavik, Iceland.,Medical Division, Landspitali - The National University Hospital of Iceland, Eiriksgata 19, 101 Reykjavik, Iceland
| | - Ingunn Steingrimsdottir
- Department of Infection Control, Landspitali - The National University Hospital of Iceland, Eiríksgata 29, 101 Reykjavik, Iceland
| | - Sigrun Steindorsdottir
- Department of Urology, Landspitali - The National University Hospital of Iceland, 11A, 101 Reykjavik, Iceland
| | - Gudbjorg Gudmundsdottir
- Medical Division, Landspitali - The National University Hospital of Iceland, Eiriksgata 19, 101 Reykjavik, Iceland
| | - Elin Hafsteinsdottir
- Department of Quality Improvement, Landspitali - The National University Hospital of Iceland, Eiríksgata 5, 101 Reykjavik, Iceland
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Catheter Matters. Infect Control Hosp Epidemiol 2016; 37:334-6. [PMID: 26894623 DOI: 10.1017/ice.2015.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Affiliation(s)
- Susan S Huang
- From the Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine
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Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals: 2014 Update. Infect Control Hosp Epidemiol 2016. [DOI: 10.1017/s0899823x00193845] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their catheter-associated urinary tract infection (CAUTI) prevention efforts. This document updates “Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
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Fakih MG, Gould CV, Trautner BW, Meddings J, Olmsted RN, Krein SL, Saint S. Beyond Infection: Device Utilization Ratio as a Performance Measure for Urinary Catheter Harm. Infect Control Hosp Epidemiol 2016; 37:327-33. [PMID: 26894622 PMCID: PMC6502466 DOI: 10.1017/ice.2015.287] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Catheter-associated urinary tract infection (CAUTI) is considered a reasonably preventable event in the hospital setting, and it has been included in the US Department of Health and Human Services National Action Plan to Prevent Healthcare-Associated Infections. While multiple definitions for measuring CAUTI exist, each has important limitations, and understanding these limitations is important to both clinical practice and policy decisions. The National Healthcare Safety Network (NHSN) surveillance definition, the most frequently used outcome measure for CAUTI prevention efforts, has limited clinical correlation and does not necessarily reflect noninfectious harms related to the catheter. We advocate use of the device utilization ratio (DUR) as an additional performance measure for potential urinary catheter harm. The DUR is patient-centered and objective and is currently captured as part of NHSN reporting. Furthermore, these data are readily obtainable from electronic medical records. The DUR also provides a more direct reflection of improvement efforts focused on reducing inappropriate urinary catheter use.
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Affiliation(s)
- Mohamad G. Fakih
- St. John Hospital and Medical Center, Detroit, Michigan
- Wayne State University School of Medicine, Detroit, Michigan
| | - Carolyn V. Gould
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Barbara W. Trautner
- Houston VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
- Section of Infectious Diseases, Department of Medicine and Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Jennifer Meddings
- Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Russell N. Olmsted
- Infection Prevention and Control, Unified Clinical Organization, Trinity Health, Livonia, Michigan
| | | | - Sanjay Saint
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
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Halpin AL, Sinkowitz-Cochran R, Allen-Bridson K, Edwards JR, Pollock D, McDonald LC, Gould CV. Letter in Response to "Questionable validity of the catheter-associated urinary tract infection metric used for value-based purchasing". Am J Infect Control 2016; 44:369-70. [PMID: 26940597 DOI: 10.1016/j.ajic.2015.11.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 11/19/2015] [Indexed: 11/25/2022]
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Validation of a Sampling Method to Collect Exposure Data for Central-Line–Associated Bloodstream Infections. Infect Control Hosp Epidemiol 2016; 37:549-54. [DOI: 10.1017/ice.2015.344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVESurveillance of central-line–associated bloodstream infections requires the labor-intensive counting of central-line days (CLDs). This workload could be reduced by sampling. Our objective was to evaluate the accuracy of various sampling strategies in the estimation of CLDs in intensive care units (ICUs) and to establish a set of rules to identify optimal sampling strategies depending on ICU characteristics.DESIGNAnalyses of existing data collected according to the European protocol for patient-based surveillance of ICU-acquired infections in Belgium between 2004 and 2012.SETTING AND PARTICIPANTSCLD data were reported by 56 ICUs in 39 hospitals during 364 trimesters.METHODSWe compared estimated CLD data obtained from weekly and monthly sampling schemes with the observed exhaustive CLD data over the trimester by assessing the CLD percentage error (ie, observed CLDs – estimated CLDs/observed CLDs). We identified predictors of improved accuracy using linear mixed models.RESULTSWhen sampling once per week or 3 times per month, 80% of ICU trimesters had a CLD percentage error within 10%. When sampling twice per week, this was >90% of ICU trimesters. Sampling on Tuesdays provided the best estimations. In the linear mixed model, the observed CLD count was the best predictor for a smaller percentage error. The following sampling strategies provided an estimate within 10% of the actual CLD for 97% of the ICU trimesters with 90% confidence: 3 times per month in an ICU with >650 CLDs per trimester or each Tuesday in an ICU with >480 CLDs per trimester.CONCLUSIONSampling of CLDs provides an acceptable alternative to daily collection of CLD data.Infect Control Hosp Epidemiol 2016;37:549–554
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Stacy KM. Challenges in Hospital-Associated Infection Management. AACN Adv Crit Care 2015. [DOI: 10.4037/nci.0000000000000097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Maintaining a successful unit-based continuous quality improvement program for managing hospital-associated infections is a huge challenge and an overwhelming task. It requires strong organizational support and unit leadership, human and fiscal resources, time, and a dedicated and motivated nursing staff. A great deal of effort goes into implementing, monitoring, reporting, and evaluating quality improvement initiatives and can lead to significant frustration on the part of the leadership team and nursing staff when quality improvement efforts fail to produce the desired results. Each initiative presents its own unique set of challenges; however, common issues influence all initiatives. These common issues include organization and unit culture, current clinical practice guidelines being used to drive the initiatives, performance discrepancies on the part of nursing staff, availability of resources including equipment and supplies, monitoring of the data, and conflicting quality improvement priorities.
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Affiliation(s)
- Kathleen M. Stacy
- Kathleen M. Stacy is Critical Care Clinical Nurse Specialist and Clinical Associate Professor, Hahn School of Nursing and Health Science, University of San Diego, 5998 Alcala Park, San Diego, CA 92110
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Wright MO, Robicsek A. Clinical decision support systems and infection prevention: to know is not enough. Am J Infect Control 2015; 43:554-8. [PMID: 25798779 DOI: 10.1016/j.ajic.2015.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 02/04/2015] [Accepted: 02/05/2015] [Indexed: 11/24/2022]
Abstract
Clinical decision support (CDS) systems are an increasingly used form of technology designed to guide health care providers toward established protocols and best practices with the intent of improving patient care. Utilization of CDS for infection prevention is not widespread and is particularly focused on antimicrobial stewardship. This article provides an overview of CDS systems and summarizes key attributes of successfully executed tools. A selection of published reports of CDS for infection prevention and antimicrobial stewardship are described. Finally, an individual organization describes its CDS infrastructure, process of prioritization, design, and development, with selected highlights of CDS tools specifically targeting common infection prevention quality improvement initiatives.
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Denominator doesn't matter: standardizing healthcare-associated infection rates by bed days or device days. Infect Control Hosp Epidemiol 2015; 36:710-6. [PMID: 25782986 DOI: 10.1017/ice.2015.42] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine the impact on infection rates and hospital rank for catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated pneumonia (VAP) using device days and bed days as the denominator DESIGN Retrospective survey from October 2010 to July 2013 SETTING: Veterans Health Administration medical centers providing acute medical and surgical care PATIENTS Patients admitted to 120 Veterans Health Administration medical centers reporting healthcare-associated infections METHODS We examined the importance of using device days and bed days as the denominator between infection rates and hospital rank for CAUTI, CLABSI, and VAP for each medical center. The relationship between device days and bed days as the denominator was assessed using a Pearson correlation, and changes in infection rates and device utilization were evaluated by an analysis of variance. RESULTS A total of 7.9 million bed days were included. From 2011 to 2013, CAUTI decreased whether measured by device days (2.32 to 1.64, P=.001) or bed days (4.21 to 3.02, P=.006). CLABSI decreased when measured by bed days (1.67 to 1.19, P=.04). VAP rates and device utilization ratios for CAUTI, CLABSI, and VAP were not statistically different across time. Infection rates calculated with device days were strongly correlated with infection rates calculated with bed days (r=0.79-0.94, P<.001). Hospital relative performance measured by ordered rank was also strongly correlated for both denominators (r=0.82-0.96, P<.001). CONCLUSIONS These findings suggest that device days and bed days are equally effective adjustment metrics for comparing healthcare-associated infection rates between hospitals in the setting of stable device utilization.
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Klompas M, Anderson D, Trick W, Babcock H, Kerlin MP, Li L, Sinkowitz-Cochran R, Ely EW, Jernigan J, Magill S, Lyles R, O'Neil C, Kitch BT, Arrington E, Balas MC, Kleinman K, Bruce C, Lankiewicz J, Murphy MV, E Cox C, Lautenbach E, Sexton D, Fraser V, Weinstein RA, Platt R. The preventability of ventilator-associated events. The CDC Prevention Epicenters Wake Up and Breathe Collaborative. Am J Respir Crit Care Med 2015; 191:292-301. [PMID: 25369558 PMCID: PMC5447286 DOI: 10.1164/rccm.201407-1394oc] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 11/03/2014] [Indexed: 01/08/2023] Open
Abstract
RATIONALE The CDC introduced ventilator-associated event (VAE) definitions in January 2013. Little is known about VAE prevention. We hypothesized that daily, coordinated spontaneous awakening trials (SATs) and spontaneous breathing trials (SBTs) might prevent VAEs. OBJECTIVES To assess the preventability of VAEs. METHODS We nested a multicenter quality improvement collaborative within a prospective study of VAE surveillance among 20 intensive care units between November 2011 and May 2013. Twelve units joined the collaborative and implemented an opt-out protocol for nurses and respiratory therapists to perform paired daily SATs and SBTs. The remaining eight units conducted surveillance alone. We measured temporal trends in VAEs using generalized mixed effects regression models adjusted for patient-level unit, age, sex, reason for intubation, Sequential Organ Failure Assessment score, and comorbidity index. MEASUREMENTS AND MAIN RESULTS We tracked 5,164 consecutive episodes of mechanical ventilation: 3,425 in collaborative units and 1,739 in surveillance-only units. Within collaborative units, significant increases in SATs, SBTs, and percentage of SBTs performed without sedation were mirrored by significant decreases in duration of mechanical ventilation and hospital length-of-stay. There was no change in VAE risk per ventilator day but significant decreases in VAE risk per episode of mechanical ventilation (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.42-0.97) and infection-related ventilator-associated complications (OR, 0.35; 95% CI, 0.17-0.71) but not pneumonias (OR, 0.51; 95% CI, 0.19-1.3). Within surveillance-only units, there were no significant changes in SAT, SBT, or VAE rates. CONCLUSIONS Enhanced performance of paired, daily SATs and SBTs is associated with lower VAE rates. Clinical trial registered with www.clinicaltrials.gov (NCT 01583413).
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Affiliation(s)
- Michael Klompas
- 1 Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts
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Trick WE, Samore M. Denominators for Device Infections: Who and How to Count. Infect Control Hosp Epidemiol 2015; 32:641-3. [DOI: 10.1086/660766] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Evidence-Based Prevent Catheter-Associated Urinary Tract Infections Guidelines and Burn-Injured Patients. J Burn Care Res 2015; 36:e1-6. [DOI: 10.1097/bcr.0000000000000193] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lo E, Nicolle LE, Coffin SE, Gould C, Maragakis LL, Meddings J, Pegues DA, Pettis AM, Saint S, Yokoe DS. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014; 35:464-79. [PMID: 24709715 DOI: 10.1086/675718] [Citation(s) in RCA: 236] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their catheter-associated urinary tract infection (CAUTI) prevention efforts. This document updates “Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA). the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
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Affiliation(s)
- Evelyn Lo
- St. Boniface General Hospital and University of Manitoba, Winnipeg, Manitoba, Canada
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Pad weighing for reduction of indwelling urinary use and catheter-associated urinary tract infection: a quality improvement project. J Wound Ostomy Continence Nurs 2014; 41:604-8. [PMID: 25377111 DOI: 10.1097/won.0000000000000068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Catheter-associated urinary tract infections pose a significant risk to hospitalized patients. Measuring accurate urinary output is a common reason for indwelling catheterizations in acutely ill patients. The risk of catheter-associated infections may be eliminated while maintaining ability to measure urinary output of incontinent patients through the use of a highly absorbent pad and weighing postincontinence. The dry pad weight is subtracted from the wet pad weight and the resulting difference (expressed in grams) equals the volume of urine leaked into the pad in milliliters. We found that using this system of improved measurement of urine output when compared to documenting the number of incontinent episodes while allowing removal of indwelling urethral catheters as soon as possible.
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Abstract
It is critical for health care personnel to recognize and appreciate the detrimental impact of intensive care unit (ICU)-acquired infections. The economic, clinical, and social expenses to patients and hospitals are overwhelming. To limit the incidence of ICU-acquired infections, aggressive infection control measures must be implemented and enforced. Researchers and national committees have developed and continue to develop evidence-based guidelines to control ICU infections. A multifaceted approach, including infection prevention committees, antimicrobial stewardship programs, daily reassessments-intervention bundles, identifying and minimizing risk factors, and continuing staff education programs, is essential. Infection control in the ICU is an evolving area of critical care research.
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Affiliation(s)
- Mohamed F Osman
- Division of Trauma/Burns and Critical Care, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St. Boston, MA 02115, USA
| | - Reza Askari
- Division of Trauma/Burns and Critical Care, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St. Boston, MA 02115, USA.
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Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals: 2014 Update. Infect Control Hosp Epidemiol 2014. [DOI: 10.1017/s0195941700095382] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their catheter-associated urinary tract infection (CAUTI) prevention efforts. This document updates “Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
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Baillie CA, Epps M, Hanish A, Fishman NO, French B, Umscheid CA. Usability and impact of a computerized clinical decision support intervention designed to reduce urinary catheter utilization and catheter-associated urinary tract infections. Infect Control Hosp Epidemiol 2014; 35:1147-55. [PMID: 25111923 DOI: 10.1086/677630] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the usability and effectiveness of a computerized clinical decision support (CDS) intervention aimed at reducing the duration of urinary tract catheterizations. DESIGN Retrospective cohort study. SETTING Academic healthcare system. PATIENTS All adult patients admitted from March 2009 through May 2012. INTERVENTION A CDS intervention was integrated into a commercial electronic health record. Providers were prompted at order entry to specify the indication for urinary catheter insertion. On the basis of the indication chosen, providers were alerted to reassess the need for the urinary catheter if it was not removed within the recommended time. Three time periods were examined: baseline, after implementation of the first intervention (stock reminder), and after a second iteration (homegrown reminder). The primary endpoint was the usability of the intervention as measured by the proportion of reminders through which providers submitted a remove urinary catheter order. Secondary endpoints were the urinary catheter utilization ratio and the rate of hospital-acquired catheter-associated urinary tract infections (CAUTIs). RESULT The first intervention displayed limited usability, with 2% of reminders resulting in a remove order. Usability improved to 15% with the revised reminder. The catheter utilization ratio declined over the 3 time periods (0.22, 0.20, and 0.19, respectively; P < .001), as did CAUTIs per 1,000 patient-days (0.84, 0.70, and 0.51, respectively; P < .001). CONCLUSIONS A urinary catheter removal reminder system was successfully integrated within a healthcare system's electronic health record. The usability of the reminder was highly dependent on its user interface, with a homegrown version of the reminder resulting in higher impact than a stock reminder.
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Affiliation(s)
- Charles A Baillie
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Shepard J, Hadhazy E, Frederick J, Nicol S, Gade P, Cardon A, Wilson J, Vetteth Y, Madison S. Using electronic medical records to increase the efficiency of catheter-associated urinary tract infection surveillance for National Health and Safety Network reporting. Am J Infect Control 2014; 42:e33-6. [PMID: 24581026 DOI: 10.1016/j.ajic.2013.12.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 12/04/2013] [Accepted: 12/04/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Streamlining health care-associated infection surveillance is essential for health care facilities owing to the continuing increases in reporting requirements. METHODS Stanford Hospital, a 583-bed adult tertiary care center, used their electronic medical record (EMR) to develop an electronic algorithm to reduce the time required to conduct catheter-associated urinary tract infection (CAUTI) surveillance in adults. The algorithm provides inclusion and exclusion criteria, using the National Healthcare Safety Network definitions, for patients with a CAUTI. The algorithm was validated by trained infection preventionists through complete chart review for a random sample of cultures collected during the study period, September 1, 2012, to February 28, 2013. RESULTS During the study period, a total of 6,379 positive urine cultures were identified. The Stanford Hospital electronic CAUTI algorithm identified 6,101 of these positive cultures (95.64%) as not a CAUTI, 191 (2.99%) as a possible CAUTI requiring further validation, and 87 (1.36%) as a definite CAUTI. Overall, use of the algorithm reduced CAUTI surveillance requirements at Stanford Hospital by 97.01%. CONCLUSIONS The electronic algorithm proved effective in increasing the efficiency of CAUTI surveillance. The data suggest that CAUTI surveillance using the National Healthcare Safety Network definitions can be fully automated.
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Gupta A, Kapil A, Kabra SK, Lodha R, Sood S, Dhawan B, Das BK, Sreenivas V. Assessing the impact of an educational intervention on ventilator-associated pneumonia in a pediatric critical care unit. Am J Infect Control 2014; 42:111-5. [PMID: 24485367 DOI: 10.1016/j.ajic.2013.09.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 09/20/2013] [Accepted: 09/20/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ongoing educational programs targeting health care professionals have shown positive outcomes by reducing the morbidity and mortality associated with health care-associated infections (HAIs). We undertook this study to measure the impact of such a program in a pediatric critical care unit of a developing country. METHODS This prospective study was conducted in 2 time periods of 6 months each, with an educational intervention for resident doctors and nurses in between. The rates of ventilator-associated pneumonia (VAP) during the preintervention and postintervention periods were estimated by active surveillance. RESULTS The incidence density of VAP was reduced by 28% (20.2 vs 14.6 per 1,000 ventilator-days; P = .21, Z test) despite a significant increase in the ventilator utilization ratio during the postintervention period (0.64 vs 0.88; P < .0001, Pearson's χ² test). There was a statistically significant reduction in mortality among patients who received mechanical ventilation for ≥48 hours in the postintervention period (49.3% vs 31.4%; P = .029, Pearson's χ² test). CONCLUSIONS Educational programs have a positive impact on reducing the morbidity and mortality associated with HAIs. Incidence rates based on device-days should be compared by keeping the variations in device utilization ratio in mind.
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Affiliation(s)
- Ayush Gupta
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Sushil Kumar Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Sood
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Benu Dhawan
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Bimal K Das
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
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McKinnell JA, Miller LG, Eells SJ, Cui E, Huang SS. A systematic literature review and meta-analysis of factors associated with methicillin-resistant Staphylococcus aureus colonization at time of hospital or intensive care unit admission. Infect Control Hosp Epidemiol 2013; 34:1077-86. [PMID: 24018925 DOI: 10.1086/673157] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Screening for methicillin-resistant Staphylococcus aureus (MRSA) in high-risk patients is a legislative mandate in 9 US states and has been adopted by many hospitals. Definitions of high risk differ among hospitals and state laws. A systematic evaluation of factors associated with colonization is lacking. We performed a systematic review of the literature to assess factors associated with MRSA colonization at hospital admission. DESIGN We searched MEDLINE from 1966 to 2012 for articles comparing MRSA colonized and noncolonized patients on hospital or intensive care unit (ICU) admission. Data were extracted using a standardized instrument. Meta-analyses were performed to identify factors associated with MRSA colonization. RESULTS We reviewed 4,381 abstracts; 29 articles met inclusion criteria (n = 76,913 patients). MRSA colonization at hospital admission was associated with recent prior hospitalization (odds ratio [OR], 2.4 [95% confidence interval (CI), 1.3-4.7]; P < .01), nursing home exposure (OR, 3.8 [95% CI, 2.3-6.3]; P < .01), and history of exposure to healthcare-associated pathogens (MRSA carriage: OR, 8.0 [95% CI, 4.2-15.1]; Clostridium difficile infection: OR, 3.4 [95% CI, 2.2-5.3]; vancomycin-resistant Enterococci carriage: OR, 3.1 [95% CI, 2.5-4.0]; P < .01 for all). Select comorbidities were associated with MRSA colonization (congestive heart failure, diabetes, pulmonary disease, immunosuppression, and renal failure; P < .01 for all), while others were not (human immunodeficiency virus, cirrhosis, and malignancy). ICU admission was not associated with an increased risk of MRSA colonization (OR, 1.1 [95% CI, 0.6-1.8]; P = .87). CONCLUSIONS MRSA colonization on hospital admission was associated with healthcare contact, previous healthcare-associated pathogens, and select comorbid conditions. ICU admission was not associated with MRSA colonization, although this is commonly used in state mandates for MRSA screening. Infection prevention programs utilizing targeted MRSA screening may consider our results to define patients likely to have MRSA colonization.
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Affiliation(s)
- James A McKinnell
- Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute at Harbor-University of California-Los Angeles Medical Center, Torrance, California
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Fagan RP, Edwards JR, Park BJ, Fridkin SK, Magill SS. Incidence trends in pathogen-specific central line-associated bloodstream infections in US intensive care units, 1990-2010. Infect Control Hosp Epidemiol 2013; 34:893-9. [PMID: 23917902 DOI: 10.1086/671724] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To quantify historical trends in rates of central line-associated bloodstream infections (CLABSIs) in US intensive care units (ICUs) caused by major pathogen groups, including Candida spp., Enterococcus spp., specified gram-negative rods, and Staphylococcus aureus. DESIGN Active surveillance in a cohort of participating ICUs through the Centers for Disease Control and Prevention, the National Nosocomial Infections Surveillance system during 1990-2004, and the National Healthcare Safety Network during 2006-2010. Setting. ICUs. Participants. Patients who were admitted to participating ICUs. RESULTS The CLABSI incidence density rate for S. aureus decreased annually starting in 2002 and remained lower than for other pathogen groups. Since 2006, the annual decrease for S. aureus CLABSIs in nonpediatric ICU types was -18.3% (95% confidence interval [CI], -20.8% to -15.8%), whereas the incidence density rate for S. aureus among pediatric ICUs did not change. The annual decrease for all ICUs combined since 2006 was -17.8% (95% CI, -19.4% to -16.1%) for Enterococcus spp., -16.4% (95% CI, -18.2% to -14.7%) for gram-negative rods, and -13.5% (95% CI, -15.4% to -11.5%) for Candida spp. CONCLUSIONS Patterns of ICU CLABSI incidence density rates among major pathogen groups have changed considerably during recent decades. CLABSI incidence declined steeply since 2006, except for CLABSI due to S. aureus in pediatric ICUs. There is a need to better understand CLABSIs that still do occur, on the basis of microbiological and patient characteristics. New prevention approaches may be needed in addition to central line insertion and maintenance practices.
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Affiliation(s)
- Ryan P Fagan
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30329, USA.
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Trautner BW, Patterson JE, Petersen NJ, Hysong S, Horwitz D, Chen GJ, Grota P, Naik AD. Quality gaps in documenting urinary catheter use and infectious outcomes. Infect Control Hosp Epidemiol 2013; 34:793-9. [PMID: 23838219 DOI: 10.1086/671267] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe the frequency of use of all types of urinary catheters, including but not limited to indwelling catheters, as well as positive cultures associated with the various types. We also determined the accuracy of catheter-days reporting at our institution. DESIGN Prospective, observational trial based on patient-level review of the electronic medical record. Chart review was compared with standard methods of catheter surveillance and reporting by infection control personnel. SETTING Ten internal medicine and 5 long-term care wards in 2 tertiary care Veterans Affairs hospitals in Texas from July 2010 through June 2011. PARTICIPANTS The study included 7,866 inpatients. METHODS Measurements included patient bed-days; days of use of indwelling, external, suprapubic, and intermittent urinary catheters; number of urine cultures obtained and culture results; and infection control reports of indwelling catheter-days. RESULTS We observed 7,866 inpatients with 128,267 bed-days on acute medicine and extended care wards during the study. A urinary catheter was used on 36.9% of the total bed-days observed. Acute medicine wards collected more urine cultures per 1,000 bed-days than did the extended care wards (75.9 and 10.4 cultures per 1,000 bed-days, respectively; P<.001). Catheter-days were divided among indwelling-catheter-days (47.8%), external-catheter-days (48.4%), and other (intermittent- and suprapubic-catheter-days, 3.8%). External catheters contributed to 376 (37.3%) of the 1,009 catheter-associated positive urine cultures. Urinary-catheter-days reported to the infection control department missed 20.1% of the actual days of indwelling catheter use, whereas 12.0% of their reported catheter-days were false. CONCLUSIONS Urinary catheter use was extremely common. External catheters accounted for a large portion of catheter-associated bacteriuria, and standard practices for tracking urinary-catheter-days were unreliable. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01052545.
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Affiliation(s)
- Barbara W Trautner
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas 77030, USA.
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Mestre G, Berbel C, Tortajada P, Alarcia M, Coca R, Fernández MM, Gallemi G, García I, Aguilar MC, Rodríguez-Baño J, Martinez JA. Successful multifaceted intervention aimed to reduce short peripheral venous catheter-related adverse events: a quasiexperimental cohort study. Am J Infect Control 2013; 41:520-6. [PMID: 23084473 DOI: 10.1016/j.ajic.2012.07.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 07/12/2012] [Accepted: 07/12/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Data concerning the effectiveness of strategies implemented to reduce short peripheral vein catheter (PVC)-related adverse events are scarce. METHODS A quasiexperimental study (2004-2011) was conducted to evaluate an intervention to reduce peripheral vein phlebitis (PVP) and PVC-related bloodstream infections (BSIs). Bundle intervention consisted of health care worker education and training, withdrawal of unnecessary catheters, exchange catheter policy, withdrawal of catheters at early stages of PVP, use of scales as a measuring tool, and repeated period-prevalence surveillance of PVC adverse events on wards. A Poisson exponentially weighted moving average control chart was used to assess time series analysis. RESULTS One thousand six hundred thirty-one patients with 2,325 short catheters inserted were prospectively followed. PVP decreased by 48% (12.1% [95% confidence interval (CI): 10.7-13.2] during the intervention period versus 23.3% [95% CI: 16.4-30.1] in preintervention period; P < .05), and no reduction of PVP measured as 1,000 catheter-days was noted (48.6 [95% CI: 46.1-51.2] vs 37.9 [95% CI: 24.5-51.4], P > .05). A significant incidence reduction in PVC-related BSIs and health care-acquired Staphylococcus aureus BSIs was also achieved. CONCLUSION A comprehensive multifaceted hospital approach was successful in reducing PVC-related adverse effects. Poisson exponentially weighted moving average control chart fits well as time series using Poisson data when very few events are present.
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Affiliation(s)
- Gabriel Mestre
- Nosocomial Infection Control Unit, Delfos Medical Center, Barcelona, Spain.
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Lewis SS, Knelson LP, Moehring RW, Chen LF, Sexton DJ, Anderson DJ. Comparison of non-intensive care unit (ICU) versus ICU rates of catheter-associated urinary tract infection in community hospitals. Infect Control Hosp Epidemiol 2013; 34:744-7. [PMID: 23739080 DOI: 10.1086/671000] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We describe and compare the epidemiology of catheter-associated urinary tract infection (CAUTI) occurring in non-intensive care unit (ICU) versus ICU wards in a network of community hospitals over a 2-year period. Overall, 72% of cases of CAUTI occurred in non-ICU patients, which indicates that this population is an important target for dedicated surveillance and prevention efforts.
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Affiliation(s)
- Sarah S Lewis
- Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Chenoweth C, Saint S. Preventing catheter-associated urinary tract infections in the intensive care unit. Crit Care Clin 2013. [PMID: 23182525 DOI: 10.1016/j.ccc.2012.10.005] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Urinary tract infection remains one of the most common healthcare-associated infections in the intensive care unit and predominantly occurs in patients with indwelling urinary catheters. Duration of catheterization is the most important risk factor for developing catheter-associated urinary tract infection (CAUTI). General strategies for preventing CAUTI include measures such as adherence to hand hygiene. Targeted strategies for preventing CAUTI include limiting the use and duration of urinary catheters, using aseptic technique for catheter insertion, and adhering to proper catheter care. Anti-infective catheters may be considered in some settings. Successful implementation of these measures has decreased urinary catheter use and CAUTI.
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Affiliation(s)
- Carol Chenoweth
- Division of Infectious Diseases, Departments of Internal Medicine and Infection Control and Epidemiology, University of Michigan Health System, Ann Arbor, MI 48109-5378, USA.
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Trick WE. Decision Making During Healthcare-Associated Infection Surveillance: A Rationale for Automation. Clin Infect Dis 2013; 57:434-40. [DOI: 10.1093/cid/cit249] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Quori A, Trujillo-Alemán S, Molina-Cabrillana J, Ojeda-García I, Dorta-Hung E, Ojeda-Vargas MM. [Improvement in urinary tract infections rates in a department of internal medicine]. REVISTA DE CALIDAD ASISTENCIAL : ORGANO DE LA SOCIEDAD ESPANOLA DE CALIDAD ASISTENCIAL 2013; 28:36-41. [PMID: 22867949 DOI: 10.1016/j.cali.2012.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 06/14/2012] [Accepted: 06/16/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To evaluate the impact on the urinary tract infections (UTI) rates of an intervention implemented in the Department of Internal Medicine of the Hospital Universitario Insular de Gran Canaria. MATERIAL AND METHODS Infection control practitioners implemented a three phase project, each lasting two months, focusing on surveillance and feed-back, between 2009 and 2011. During phases 1 and 2, the 2004 Centers for Disease Control and Prevention (CDC)-diagnostic criteria for nosocomial infections were followed, and only rates of infections were calculated. For phase 3, the criteria published in 2009 were used, and rates of infections plus processes rates were obtained. The cumulative incidence of UTI in the three periods was compared using a chi-square for trends test. RESULTS The total number of catheter days, as well as the cumulative incidence of UTI dropped from phase 1 to 3. Nevertheless, in phase 2 the mean urinary catheter days increased. We detected a decrease in the UTI rates and urinary catheter days mean after introducing an electronic reminder in the patient electronic charts. CONCLUSIONS A multidisciplinary approach, including surveillance, reminders, and feed-back, has proved useful in controlling UTI rates in our hospital.
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Affiliation(s)
- A Quori
- Servicio de Medicina Preventiva, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain.
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Lin MY, Bonten MJM. The dilemma of assessment bias in infection control research. Clin Infect Dis 2012; 54:1342-7. [PMID: 22337824 DOI: 10.1093/cid/cis016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Infection control studies often rely on infection endpoints to determine whether interventions are effective. However, many infection outcomes, including those defined by standardized surveillance criteria, involve some subjective judgment for determination. Studies that use unblinded ascertainment of subjective infection endpoints are at risk of assessment bias. Unfortunately, infection control studies have not routinely accounted for assessment bias. To ensure validity, infection control studies should incorporate study design elements to control assessment bias, such as blinded assessment or use of objective outcome measures.
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Affiliation(s)
- Michael Y Lin
- Department of Internal Medicine, Section of Infectious Diseases, Rush University Medical Center, Chicago, Illinois 60612, USA.
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