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Mangal S, Carter E, Arcia A. Developing an educational resource for parents on pediatric catheter-associated urinary tract infection (CAUTI) prevention. Am J Infect Control 2022; 50:400-408. [PMID: 34543706 PMCID: PMC8959581 DOI: 10.1016/j.ajic.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Pediatric catheter-associated urinary tract infection (CAUTI) prevention guidelines encourage family engagement; however, there is a dearth of research on parent-facing CAUTI prevention resources. We aimed to meet the learning needs of parents about CAUTI prevention in the hospital by developing and refining an educational pamphlet with parents. METHODS Phase 1: We compiled existing evidence from CAUTI prevention guidelines and conducted a focus group with parents to form learning objectives. Phase 2: We developed prototype design elements, tested initial designs with a survey, and conducted qualitative participatory design sessions with parents to iteratively refine the pamphlet until design saturation was reached. RESULTS We identified the following key themes and preferences: (1) Clear boundaries for engagement (e.g., parents would not be emptying the catheter); (2) Positive, actionable framing (e.g., what should proper catheter positioning look like?); (3) What to expect (e.g., is the catheter painful for my child?); (4) Parents considered both their and their child's comprehension of the content when providing feedback. CONCLUSIONS Overall, we demonstrated the utility of remote participatory design methods in developing and refining a CAUTI prevention resource based on parents' preferences. Future research should consider adapting these methods and implementing formal evaluation for comprehension for eventual integration into clinical practice.
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Affiliation(s)
- Sabrina Mangal
- Columbia University School of Nursing, New York, NY; Weill Cornell Medicine, Department of Population Health Sciences, Division of Health Informatics, New York, NY.
| | - Eileen Carter
- Columbia University School of Nursing, New York, NY; University of Connecticut School of Nursing, Storrs, CT
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Krocová J, Prokešová R. Aspects of Prevention of Urinary Tract Infections Associated with Urinary Bladder Catheterisation and Their Implementation in Nursing Practice. Healthcare (Basel) 2022; 10:healthcare10010152. [PMID: 35052315 PMCID: PMC8782420 DOI: 10.3390/healthcare10010152] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 12/27/2022] Open
Abstract
In the case of the prevention of catheter-associated urinary tract infections (CAUTI) related to healthcare provision, high-quality and comprehensively provided nursing care is essential. Implementation of preventive strategies is based on recommended procedures, and the introduction of whole sets of measures has been shown to be effective. The objective of this research is to find out whether the providers of acute bed care have implemented the steps of CAUTI prevention, and specifically which measures leading to improved quality of care in the area of urinary infections are already in place. To determine this, we carried out quantitative research. Data were collected using a questionnaire-based investigation; we used two non-standardised and one standardised questionnaire, and the respondents were general nurses in management positions (n = 186). The results revealed that result-related CAUTI indicators are monitored by only one-third of the respondents, and records of catheterisation indication are not kept by 17.3% of general nurses. The results of the research showed deficiencies in the monitoring of CAUTI outcome and process indicators, and a weakness of the implemented preventive measures is the maintenance of catheterisation documentation. Periodic CAUTI prevention training is not implemented as recommended. It is positive that there are well-working teams of HAI prevention experts in hospitals.
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Affiliation(s)
- Jitka Krocová
- Faculty of Health and Social Sciences, University of South Bohemia in České Budějovice, 370 11 Czech Budejovice, Czech Republic;
- Department of Nursing and Midwifery, Faculty of Health Care Studies, University of West Bohemia, 301 00 Pilsen, Czech Republic
- Correspondence: ; Tel.: +420-605-827-678 or +420-377-633-701
| | - Radka Prokešová
- Faculty of Health and Social Sciences, University of South Bohemia in České Budějovice, 370 11 Czech Budejovice, Czech Republic;
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Mangal S, Pho A, Arcia A, Carter E. Patient and Family Engagement in Catheter-Associated Urinary Tract Infection (CAUTI) Prevention: A Systematic Review. Jt Comm J Qual Patient Saf 2021; 47:591-603. [PMID: 34215555 PMCID: PMC8506981 DOI: 10.1016/j.jcjq.2021.05.009] [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: 01/12/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are detrimental to health and are largely preventable with adherence to CAUTI prevention guidelines. Patient and family engagement in CAUTI prevention is often encouraged in these guidelines; however, little is known about how this engagement is operationalized in practice. A systematic review was conducted to synthesize the content, format, and outcomes of interventions that engage patients and/or families in CAUTI prevention. METHODS Two reviewers independently screened records from four databases up to March 2021 and searched reference lists of final articles. Included articles were primary research, tested an intervention, involved indwelling urinary catheters, and described at least one patient and/or family engagement method. Articles were appraised for quality using the Downs and Black checklist. RESULTS After 720 records were screened, 12 were included. Study quality ranged from good to poor, scoring lowest in internal validity. The most common formats of patient/family engagement were flyers/handouts (83.3%) and verbal education (58.3%). Common content areas were urinary catheter care and maintenance strategies. Most study outcomes (83.3%) measured CAUTI rates, and half measured patient/family-related outcomes. Improvements were seen in at least one outcome across all studies, but less than half (41.7%) showed statistically significant results. CONCLUSION The researchers found that most interventions lacked sufficient detail on the content, delivery, and/or outcome measurement of patient/family engagement, which limits transferability. More high-quality, generalizable trials are warranted in this area. Future research should focus on integrating publicly available resources into practice that can be tested for comprehension and revised based on feedback from target audiences.
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Affiliation(s)
- Sabrina Mangal
- Columbia University School of Nursing, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA (Present affiliation)
| | - Anthony Pho
- Columbia University School of Nursing, New York, NY, USA
- Stanford University School of Medicine, Stanford, CA, USA (Present affiliation)
| | - Adriana Arcia
- Columbia University School of Nursing, New York, NY, USA
| | - Eileen Carter
- Columbia University School of Nursing, New York, NY, USA
- University of Connecticut School of Nursing, Storrs, CT, USA (Present affiliation)
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Snopkova K, Dufkova K, Klimesova P, Vanerkova M, Ruzicka F, Hola V. Prevalence of bacteriocins and their co-association with virulence factors within Pseudomonas aeruginosa catheter isolates. Int J Med Microbiol 2020; 310:151454. [PMID: 33068882 DOI: 10.1016/j.ijmm.2020.151454] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 09/09/2020] [Accepted: 09/27/2020] [Indexed: 11/29/2022] Open
Abstract
Urinary tract infections represent common nosocomial infectious diseases. Bacteriocin production has been recently described as a putative virulence factor in these infections but studies focusing particularly on Pseudomonas aeruginosa are not available. Therefore, we assessed the prevalence of the bacteriocin genes, their co-occurrence and their co-association with previously detected virulence factors in a set of 135 P. aeruginosa strains from catheter-associated urinary tract infections (CAUTIs). The overall bacteriocinogeny reached 96.3 % with an average of 3.6 genes per strain. The most frequently detected determinants were the encoded pyocins S4 (76.3 %), R (69.6 %), and S2 (67.4 %). A statistically significant co-occurrence and a negative relationship were observed between several pyocin types. Particular pyocins exhibited associations with biofilm formation, production of pyochelin, pyocyanin, antibiotic-degrading enzymes, overall strain susceptibility and resistance, and motility of the strain. Co-occurrence of the pyocins S2 and S4 (p<<0.0001; Z = 13.15), both utilizating the ferripyoverdine receptor FpvAI, was found but no relation to pyoverdine production was detected. A negative association (p = 0.0047; Z=-2.83) was observed between pyochelin and pyocin S5 utilising the ferripyochelin receptor FptA. Pairwise assays resulted in 52.1 % inhibition which was equally distributed between soluble and particle types of antimicrobials. In conclusion, pyocin determinants appear to be important characteristics of CAUTI-related P. aeruginosa isolates and could contribute to their urovirulence.
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Affiliation(s)
- Katerina Snopkova
- Institute for Microbiology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital Brno, Pekarska 53, 656 91 Brno, Czech Republic
| | - Kristyna Dufkova
- Institute for Microbiology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital Brno, Pekarska 53, 656 91 Brno, Czech Republic
| | - Petra Klimesova
- Institute for Microbiology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital Brno, Pekarska 53, 656 91 Brno, Czech Republic
| | - Martina Vanerkova
- Molecular and Genetics Laboratory, Centre for Cardiovascular Surgery and Transplantation, Pekarska 53, 656 91 Brno, Czech Republic
| | - Filip Ruzicka
- Institute for Microbiology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital Brno, Pekarska 53, 656 91 Brno, Czech Republic
| | - Veronika Hola
- Institute for Microbiology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital Brno, Pekarska 53, 656 91 Brno, Czech Republic.
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An Examination of the Barriers to and Facilitators of Implementing Nurse-Driven Protocols to Remove Indwelling Urinary Catheters in Acute Care Hospitals. Jt Comm J Qual Patient Saf 2020; 46:691-698. [PMID: 32962904 DOI: 10.1016/j.jcjq.2020.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Urinary catheter nurse-driven protocols (UCNDPs) for removal of indwelling urinary catheters (IUCs) can potentially prevent catheter-associated urinary tract infections (CAUTIs). However, they are used inconsistently. The objective of this study was to examine the barriers to and facilitators of implementation of UCNDPs in acute care hospitals. METHODS Between September 2017 and January 2019, researchers interviewed 449 frontline staff (nurses, physicians), managers, and executives from 17 US hospitals to better understand their experiences implementing, using, and overseeing use of UCNDPs. Our semistructured interview guide included questions about management practices and policies regarding enactment of a UCNDP. RESULTS Although the features of UCNDPs differed across hospitals, the analysis revealed that hospitals experienced common issues related to implementing and consistently using UCNDPs as a result of three major barriers: (1) nurse deference to physicians, (2) physician push-back, and (3) miscommunication about IUC removal. Interviewees also described several important facilitators to help overcome these barriers: (1) training care team members to use the UCNDP, (2) discussing IUC necessity and UCNDP use during rounds, (3) reminding care team members to follow UCNDPs, and (4) developing buy-in for UCNDP use across the hospital. CONCLUSION Although UCNDPs are fundamental in efforts to reduce and prevent CAUTIs, hospitals can proactively support their implementation and use by developing the skills that care team members need to enact UCNDPs when patients meet the clinical indications for removal, and increasing awareness about the value and importance of such protocols for reducing CAUTIs and improving patient safety.
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Wanat M, Borek AJ, Atkins L, Sallis A, Ashiru-Oredope D, Beech E, Butler CC, Chadborn T, Hopkins S, Jones L, McNulty CAM, Roberts N, Shaw K, Taborn E, Tonkin-Crine S. Optimising Interventions for Catheter-Associated Urinary Tract Infections (CAUTI) in Primary, Secondary and Care Home Settings. Antibiotics (Basel) 2020; 9:E419. [PMID: 32709080 PMCID: PMC7399982 DOI: 10.3390/antibiotics9070419] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 11/17/2022] Open
Abstract
Catheter-associated urinary tract infections (CAUTI) are common yet preventable. Healthcare professional behaviours, such as reducing unnecessary catheter use, are key for preventing CAUTI. Previous research has focused on identifying gaps in the national response to CAUTI in multiple settings in England. This study aimed to identify how national interventions could be optimised. We conducted a multi-method study comprising: a rapid review of research on interventions to reduce CAUTI; a behavioural analysis of effective research interventions compared to national interventions; and a stakeholder focus group and survey to identify the most promising options for optimising interventions. We identified 37 effective research interventions, mostly conducted in United States secondary care. A behavioural analysis of these interventions identified 39 intervention components as possible ways to optimise national interventions. Seven intervention components were prioritised by stakeholders. These included: checklists for discharge/admission to wards; information for patients and relatives about the pros/cons of catheters; setting and profession specific guidelines; standardised nationwide computer-based documentation; promotion of alternatives to catheter use; CAUTI champions; and bladder scanners. By combining research evidence, behavioural analysis and stakeholder feedback, we identified how national interventions to reduce CAUTI could be improved. The seven prioritised components should be considered for future implementation.
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Affiliation(s)
- Marta Wanat
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; (A.J.B.); (C.C.B.); (S.T.-C.)
| | - Aleksandra J. Borek
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; (A.J.B.); (C.C.B.); (S.T.-C.)
| | - Lou Atkins
- Centre for Behaviour Change, University College London, London WC1E 6BT, UK;
| | - Anna Sallis
- Public Health England Behavioural Insights, London SE1 8UG, UK; (A.S.); (T.C.)
| | | | - Elizabeth Beech
- NHS England and NHS Improvement, London SE1 6LH, UK; (E.B.); (E.T.)
| | - Christopher C. Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; (A.J.B.); (C.C.B.); (S.T.-C.)
| | - Tim Chadborn
- Public Health England Behavioural Insights, London SE1 8UG, UK; (A.S.); (T.C.)
| | - Susan Hopkins
- Public Health England, London SE1 8UG, UK; (D.A.-O.); (S.H.); (K.S.)
| | - Leah Jones
- Primary Care and Interventions Unit, Public Health England, Gloucester GL1 1DQ, UK; (L.J.); (C.A.M.M.)
| | - Cliodna A. M. McNulty
- Primary Care and Interventions Unit, Public Health England, Gloucester GL1 1DQ, UK; (L.J.); (C.A.M.M.)
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford OX3 7LF, UK;
| | - Karen Shaw
- Public Health England, London SE1 8UG, UK; (D.A.-O.); (S.H.); (K.S.)
- University College London Hospitals, London NW1 2PG, UK
| | - Esther Taborn
- NHS England and NHS Improvement, London SE1 6LH, UK; (E.B.); (E.T.)
- NHS East Kent Clinical Commissioning Groups, Canterbury CT1 1YW, UK
| | - Sarah Tonkin-Crine
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; (A.J.B.); (C.C.B.); (S.T.-C.)
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford in Partnership with Public Health England, Oxford OX1 2JD, UK
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7
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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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Richards B, Sebastian B, Sullivan H, Reyes R, D'Agostino JF, Hagerty T. Decreasing Catheter-Associated Urinary Tract Infections in the Neurological Intensive Care Unit: One Unit's Success. Crit Care Nurse 2018; 37:42-48. [PMID: 28572100 DOI: 10.4037/ccn2017742] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Catheter-associated urinary tract infections are preventable adverse outcomes that increase hospital morbidity, mortality, and costs. These infections are particularly prevalent in intensive care units. OBJECTIVES To describe the success of an 18-bed neurological intensive care unit in using several nurse-implemented strategies that reduced the number of catheter-associated urinary tract infections. METHODS A prospective, interventional design with application of evidence-based practices to reduce catheter-associated urinary tract infections was used. RESULTS Before implementation of the strategies, 40 catheter-associated urinary tract infections were reported for 2012 and 38 for 2013. The standardized infection ratio was 2.04 for 2012 (95% CI, 1.456-2.775) and 2.34 (95% CI, 1.522-3.312) for 2013. After implementation of the strategies, significantly fewer catheter-associated urinary tract infections were reported. In 2014, a total of 15 infections were reported, and the standardized infection ratio was less than 1.0 (95% CI, 0.685-1.900). CONCLUSIONS Application of current evidence-based practices resulted in a substantial decrease in the number of catheter-associated urinary tract infections and a lower standardized infection ratio. These findings support current recommendations for "bundling" to maximize outcomes.
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Affiliation(s)
- Brenda Richards
- Brenda Richards is a registered nurse in the neurological intensive care unit at New York Presbyterian Hospital - Columbia Campus, New York, New York.,Bindhu Sebastian is a registered nurse in the neurological intensive care unit at New York Presbyterian Hospital - Columbia Campus.,Hillary Sullivan was a registered nurse in the neurological intensive care unit at New York Presbyterian Hospital - Columbia Campus when this project was done.,Rosemarie Reyes is a registered nurse in the neurological intensive care unit at New York Presbyterian Hospital - Columbia Campus.,John F. D'Agostino is a nurse epidemiologist in the Department of Infection Prevention & Control at New York Presbyterian Hospital - Columbia Campus.,Thomas Hagerty is a registered nurse in the neurological intensive care unit at New York Presbyterian Hospital - Columbia Campus
| | - Bindhu Sebastian
- Brenda Richards is a registered nurse in the neurological intensive care unit at New York Presbyterian Hospital - Columbia Campus, New York, New York.,Bindhu Sebastian is a registered nurse in the neurological intensive care unit at New York Presbyterian Hospital - Columbia Campus.,Hillary Sullivan was a registered nurse in the neurological intensive care unit at New York Presbyterian Hospital - Columbia Campus when this project was done.,Rosemarie Reyes is a registered nurse in the neurological intensive care unit at New York Presbyterian Hospital - Columbia Campus.,John F. D'Agostino is a nurse epidemiologist in the Department of Infection Prevention & Control at New York Presbyterian Hospital - Columbia Campus.,Thomas Hagerty is a registered nurse in the neurological intensive care unit at New York Presbyterian Hospital - Columbia Campus
| | - Hillary Sullivan
- Brenda Richards is a registered nurse in the neurological intensive care unit at New York Presbyterian Hospital - Columbia Campus, New York, New York.,Bindhu Sebastian is a registered nurse in the neurological intensive care unit at New York Presbyterian Hospital - Columbia Campus.,Hillary Sullivan was a registered nurse in the neurological intensive care unit at New York Presbyterian Hospital - Columbia Campus when this project was done.,Rosemarie Reyes is a registered nurse in the neurological intensive care unit at New York Presbyterian Hospital - Columbia Campus.,John F. D'Agostino is a nurse epidemiologist in the Department of Infection Prevention & Control at New York Presbyterian Hospital - Columbia Campus.,Thomas Hagerty is a registered nurse in the neurological intensive care unit at New York Presbyterian Hospital - Columbia Campus
| | - Rosemarie Reyes
- Brenda Richards is a registered nurse in the neurological intensive care unit at New York Presbyterian Hospital - Columbia Campus, New York, New York.,Bindhu Sebastian is a registered nurse in the neurological intensive care unit at New York Presbyterian Hospital - Columbia Campus.,Hillary Sullivan was a registered nurse in the neurological intensive care unit at New York Presbyterian Hospital - Columbia Campus when this project was done.,Rosemarie Reyes is a registered nurse in the neurological intensive care unit at New York Presbyterian Hospital - Columbia Campus.,John F. D'Agostino is a nurse epidemiologist in the Department of Infection Prevention & Control at New York Presbyterian Hospital - Columbia Campus.,Thomas Hagerty is a registered nurse in the neurological intensive care unit at New York Presbyterian Hospital - Columbia Campus
| | - John F D'Agostino
- Brenda Richards is a registered nurse in the neurological intensive care unit at New York Presbyterian Hospital - Columbia Campus, New York, New York.,Bindhu Sebastian is a registered nurse in the neurological intensive care unit at New York Presbyterian Hospital - Columbia Campus.,Hillary Sullivan was a registered nurse in the neurological intensive care unit at New York Presbyterian Hospital - Columbia Campus when this project was done.,Rosemarie Reyes is a registered nurse in the neurological intensive care unit at New York Presbyterian Hospital - Columbia Campus.,John F. D'Agostino is a nurse epidemiologist in the Department of Infection Prevention & Control at New York Presbyterian Hospital - Columbia Campus.,Thomas Hagerty is a registered nurse in the neurological intensive care unit at New York Presbyterian Hospital - Columbia Campus
| | - Thomas Hagerty
- Brenda Richards is a registered nurse in the neurological intensive care unit at New York Presbyterian Hospital - Columbia Campus, New York, New York. .,Bindhu Sebastian is a registered nurse in the neurological intensive care unit at New York Presbyterian Hospital - Columbia Campus. .,Hillary Sullivan was a registered nurse in the neurological intensive care unit at New York Presbyterian Hospital - Columbia Campus when this project was done. .,Rosemarie Reyes is a registered nurse in the neurological intensive care unit at New York Presbyterian Hospital - Columbia Campus. .,John F. D'Agostino is a nurse epidemiologist in the Department of Infection Prevention & Control at New York Presbyterian Hospital - Columbia Campus. .,Thomas Hagerty is a registered nurse in the neurological intensive care unit at New York Presbyterian Hospital - Columbia Campus.
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Knobloch MJ, Chewning B, Musuuza J, Rees S, Green C, Patterson E, Safdar N. Leadership rounds to reduce health care-associated infections. Am J Infect Control 2018; 46:303-310. [PMID: 29102425 DOI: 10.1016/j.ajic.2017.08.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 08/29/2017] [Accepted: 08/30/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Evidence-based guidelines exist to reduce health care-associated infections (HAIs). Leadership rounds are one tool leaders can use to ensure compliance with guidelines, but have not been studied specifically for the reduction of HAIs. This study examines HAI leadership rounds at one facility. METHODS We explored unit-based HAI leadership rounds led by 2 hospital leaders at a large academic hospital. Leadership rounds were observed on 19 units, recorded, and coded to identify themes. Themes were linked to the Consolidated Framework for Implementation Research and used to guide interviews with frontline staff members. RESULTS Staff members disclosed unit-specific problems and readily engaged in problem-solving with top hospital leaders. These themes appeared over 350 times within 22 rounds. Findings revealed that leaders used words that demonstrated fallibility and modeled curiosity, 2 factors associated with learning climate and psychologic safety. These 2 themes appeared 115 and 142 times, respectively. The flexible nature of the rounds appeared to be conducive for reflection and evaluation, which was coded 161 times. CONCLUSIONS Each interaction between leaders and frontline staff can foster psychologic safety, which can lead to open problem-solving to reduce barriers to implementation. Discovering specific communication and structural factors that contribute to psychologic safety may be powerful in reducing HAIs.
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Affiliation(s)
- Mary Jo Knobloch
- Division of Infectious Disease, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI; William S. Middleton Memorial Veterans Hospital, Madison, WI.
| | | | - Jackson Musuuza
- Division of Infectious Disease, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI; William S. Middleton Memorial Veterans Hospital, Madison, WI
| | - Susan Rees
- University of Wisconsin Hospitals and Clinics, Madison, WI
| | | | - Erin Patterson
- Division of Infectious Disease, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI; William S. Middleton Memorial Veterans Hospital, Madison, WI
| | - Nasia Safdar
- Division of Infectious Disease, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI; William S. Middleton Memorial Veterans Hospital, Madison, WI
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10
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Durant DJ. Nurse-driven protocols and the prevention of catheter-associated urinary tract infections: A systematic review. Am J Infect Control 2017; 45:1331-1341. [PMID: 28982611 DOI: 10.1016/j.ajic.2017.07.020] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 07/23/2017] [Accepted: 07/24/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are one of the most common hospital-acquired conditions and no longer reimbursable from Medicare as of 2008. Nurse-driven protocols (NDPs), which provide a medically approved rubric for professional nurses to make autonomous care decisions, can facilitate appropriate catheter use and timely removal, as advised in the Centers for Disease Control and Prevention's 2009 CAUTI prevention guidelines. However, little attempt has been made to systematically evaluate their effect on clinical outcomes. METHODS A systematic review of studies published in the United States since 2006 was performed, following guidelines from the Institute of Medicine. Sources included CINAHL, Medline, professional agencies, hand-searching, and expert consultation. Clinical predictors and prevalence of CAUTI were examined and synthesized qualitatively; heterogeneity of outcomes made a statistical meta-analysis inappropriate. RESULTS Twenty-nine studies were found eligible for inclusion. All used a case-control (pre-post) approach, and all reported reductions in clinical predictors of CAUTI, particularly indwelling-urinary catheter utilization and CAUTI rates. However, the number of CAUTIs remained unchanged in 1 study. A formal quality assessment revealed a high risk of bias; included studies met an average of 4.9 out of 11 quality indicators. Specifically, many did not use standardized measures. CONCLUSIONS NDPs appear to have a positive impact on the clinical predictors and prevalence of CAUTI. However, this review identified need for improving the study design of quality improvement projects conducted within the patient care setting.
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Affiliation(s)
- Danielle J Durant
- Rockefeller College of Public Affairs & Policy, University at Albany-State University of New York, Albany, NY.
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11
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Abstract
Leadership engagement is an important aspect of integrating best practices at the bedside. The catheter-associated urinary tract infection (CAUTI) prevention workgroup at our academic medical center implemented leadership rounding in partnership with clinical staff to increase participation in CAUTI prevention initiatives on inpatient units. There was an associated decrease in urinary catheter utilization and CAUTI rates. Implementation of leadership rounds should be considered as a part of comprehensive CAUTI prevention efforts in health care settings.
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Hutchinson M, Higson M, Jackson D. Mapping trends in the concept of nurse rounding: A bibliometric analysis and research agenda. Int J Nurs Pract 2017; 23. [DOI: 10.1111/ijn.12584] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 05/11/2017] [Accepted: 07/31/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Marie Hutchinson
- School of Health and Human Science; Southern Cross University; Coffs Harbour New South Wales Australia
- Faculty of Health & Life Sciences; Oxford Brookes University; Oxford UK
| | - Mary Higson
- School of Health and Human Science; Southern Cross University; Coffs Harbour New South Wales Australia
| | - Debra Jackson
- Faculty of Health & Life Sciences; Oxford Brookes University; Oxford UK
- Nursing Research; Oxford University Hospitals NHS Trust; Oxford UK
- School of Health; University of New England; Armidale NSW Australia
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Effectiveness of a Nurse-Led Initiative, Peer-to-Peer Teaching, on Organizational CAUTI Rates and Related Costs. J Nurs Care Qual 2017; 32:324-330. [DOI: 10.1097/ncq.0000000000000249] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Knobloch MJ, Thomas KV, Patterson E, Zimbric ML, Musuuza J, Safdar N. Implementation in the midst of complexity: Using ethnography to study health care-associated infection prevention and control. Am J Infect Control 2017; 45:1058-1063. [PMID: 28774756 DOI: 10.1016/j.ajic.2017.06.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/21/2017] [Accepted: 06/22/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Contextual factors associated with health care settings make reducing health care-associated infections (HAIs) a complex task. The aim of this article is to highlight how ethnography can assist in understanding contextual factors that support or hinder the implementation of evidence-based practices for reducing HAIs. METHODS We conducted a review of ethnographic studies specifically related to HAI prevention and control in the last 5 years (2012-2017). RESULTS Twelve studies specific to HAIs and ethnographic methods were found. Researchers used various methods with video-reflexive sessions used in 6 of the 12 studies. Ethnography was used to understand variation in data reporting, identify barriers to adherence, explore patient perceptions of isolation practices and highlight the influence of physical design on infection prevention practices. The term ethnography was used to describe varied research methods. Most studies were conducted outside the United States, and authors indicate insights gained using ethnographic methods (whether observations, interviews, or reflexive video recording) as beneficial to unraveling the complexities of HAI prevention. CONCLUSIONS Ethnography is well-suited for HAI prevention, especially video-reflexive ethnography, for activating patients and clinicians in infection control work. In this era of increasing pressure to reduce HAIs within complex work systems, ethnographic methods can promote understanding of contextual factors and may expedite translation evidence to practice.
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15
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Impact of Altered Medication Administration Time on Interdisciplinary Bedside Rounds on Academic Medical Ward. J Nurs Care Qual 2017; 32:218-225. [PMID: 27611580 DOI: 10.1097/ncq.0000000000000233] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Interdisciplinary rounds provide a valuable venue for delivering patient-centered care but are difficult to implement due to time constraints and coordination challenges. In this article, we describe a unique model for fostering a culture of bedside interdisciplinary rounds through adjustment of the morning medication administration time, auditing physician communication with nurses, and displaying physician performance in public areas. Implementation of this model led to measurable improvements in physician-to-nurse communication on rounds, teamwork climate, and provider job satisfaction.
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Kelley K, Johnson T, Burgess J, Novosel TJ, Weireter L, Collins JN. Effect of Implementation of Intermittent Straight Catheter Protocol on Rate of Urinary Tract Infections in a Trauma Population. Am Surg 2017. [DOI: 10.1177/000313481708300732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Catheter-associated urinary tract infections (UTIs) are a significant negative outcome. There are previous studies showing advantages in removing Foleys early but no studies of the effect of using intermittent as opposed to Foley catheterization in a trauma population. This study evaluates the effectiveness of a straight catheter protocol implemented in February 2015. A retrospective chart review was performed on all patients admitted to the trauma service at a single institution who had a UTI one year before and one year after protocol implementation on February 18, 2015. The protocol involved removing Foley catheters early and using straight catheterization. Rates were compared with Fisher's exact test and continuous data were compared using student's t test. There were 1477 patients admitted to the trauma service in the control year and 1707 in the study year. The control year had a total of 43 patients with a UTI, 28 of these met inclusion criteria. The intervention year had a total of 35 patients with a UTI and 17 met inclusion criteria. The rate of patients having a UTI went from 0.019 to 0.010 (p = 0.035). In females this rate went from 0.033 to 0.009 (p = 0.007), whereas in males it went from 0.012 to 0.010 (p = 0.837). This study shows a statistically significant improvement in the rate of UTIs after implementing an intermittent catheterization protocol suggesting that this protocol could improve the rate of UTIs in other trauma centers. We use this for all trauma patients, and it is being looked at for use hospital-wide.
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Williams L. Zeroing in on Safety: A Pediatric Approach to Preventing Catheter-Associated Urinary Tract Infections. AACN Adv Crit Care 2016; 27:372-378. [DOI: 10.4037/aacnacc2016297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Lori Williams
- Lori Williams is Clinical Nurse Specialist, Universal Care Unit, American Family Children’s Hospital, University of Wisconsin Hospital and Clinics, Mail Code C850, 1675 Highland Avenue, Madison, WI 53792
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Affiliation(s)
- Christina M Papageorge
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, BX7375 Clinical Science Center - H4, Madison, WI 53792, USA
| | - Gregory D Kennedy
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, BX7375 Clinical Science Center - H4, Madison, WI 53792, USA.
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20
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Understanding Inpatient Perceptions of Indwelling Urinary Catheters Using the Health Belief Model. Infect Control Hosp Epidemiol 2016; 37:1098-100. [DOI: 10.1017/ice.2016.120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Patient interviews using the Health Belief Model framework identified thematic patient perceptions of indwelling urinary catheters and catheter-associated urinary tract infections. Generally, patients perceived catheters as convenient and were unaware of catheter alternatives and risks for infection. Better patient education is needed to reduce urinary catheter use and infections.Infect Control Hosp Epidemiol 2016;37:1098–1100
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21
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Yatim J, Wong KS, Ling ML, Tan SB, Tan KY, Hockenberry M. A nurse-driven process for timely removal of urinary catheters. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2016. [DOI: 10.1111/ijun.12113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Kok-Seng Wong
- Internal Medicine, Singapore General Hospital; Singapore Singapore
| | - Moi-Lin Ling
- Infection Control, Singapore General Hospital; Singapore Singapore
| | | | - Kwee-Yuen Tan
- Infection Control, Singapore General Hospital; Singapore Singapore
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22
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Minami CA, Sheils CR, Bilimoria KY, Johnson JK, Berger ER, Berian JR, Englesbe MJ, Guillamondegui OD, Hines LH, Cofer JB, Flum DR, Thirlby RC, Kazaure HS, Wren SM, O'Leary KJ, Thurk JL, Kennedy GD, Tevis SE, Yang AD. Process improvement in surgery. Curr Probl Surg 2015; 53:62-96. [PMID: 26806271 DOI: 10.1067/j.cpsurg.2015.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 11/10/2015] [Indexed: 11/22/2022]
Affiliation(s)
- Christina A Minami
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Healthcare Studies in the Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Catherine R Sheils
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, IL; University of Rochester School of Medicine, University of Rochester, Rochester, NY
| | - Karl Y Bilimoria
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Healthcare Studies in the Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Julie K Johnson
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Healthcare Studies in the Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Elizabeth R Berger
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Surgery, Loyola University Medical Center, Maywood, IL
| | - Julia R Berian
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Surgery, University of Chicago Medical Center, Chicago, IL
| | - Michael J Englesbe
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI
| | | | - Leonard H Hines
- Department of Surgery, University of Tennessee College of Medicine, Knoxville, TN
| | - Joseph B Cofer
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, TN
| | - David R Flum
- Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | | | - Hadiza S Kazaure
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - Sherry M Wren
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - Kevin J O'Leary
- Division of Hospital Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jessica L Thurk
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Gregory D Kennedy
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Sarah E Tevis
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Anthony D Yang
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Healthcare Studies in the Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
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23
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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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24
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Rhodes D, Kennon J, Aitchison S, Watson K, Hornby L, Land G, Bass P, McLellan S, Karki S, Cheng AC, Worth LJ. Improvements in process with a multimodal campaign to reduce urinary tract infections in hospitalised Australian patients. ACTA ACUST UNITED AC 2014. [DOI: 10.1071/hi14024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Tominaga GT, Dhupa A, McAllister SM, Calara R, Peters SA, Stuck A. Eliminating catheter-associated urinary tract infections in the intensive care unit: is it an attainable goal? Am J Surg 2014; 208:1065-70; discussion 1069-70. [PMID: 25440489 DOI: 10.1016/j.amjsurg.2014.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 08/16/2014] [Accepted: 08/19/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Purpose of this study is to determine strategies to decrease catheter-associated urinary tract infection (CAUTI) in intensive care unit (ICU) patients. METHODS ICU patients with an indwelling urinary catheter (UC) in one tertiary hospital were monitored for CAUTI. Interventions were implemented sequentially with quarterly data collection. Outcome measures were infection ratio (IR = number of infections/catheter days [CD] × 1000) and device utilization rate (DUR = catheter days/patient days). RESULTS CDs and DUR decreased (fiscal year 2008: CD, 11,414; DUR, .85 vs fiscal year 2013: CD, 8,144; DUR, .70). IR increased with suspension of prepackaged baths (IR, 3.2 to 3.5 to 4.9 to 5.0), twice daily UC care (IR, 4.8 to 6.7), emptying UC bags at 400 mL (IR, 6.7 to 9.2). Two-person UC placement (IR, 5.6 to 4.8), physician notification of CAUTI (IR, 6.1 to 4.8), and reinstitution of prepackaged baths and daily UC care (IR, 4.8 to 3.7) decreased CAUTI rates. CONCLUSIONS Decreasing CAUTI in the ICU requires diligent monitoring and constant practice re-evaluation. Elimination of CAUTI in the ICU may not be possible.
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Affiliation(s)
- Gail T Tominaga
- Trauma Service, Scripps Memorial Hospital La Jolla, 9888 Genesee Avenue, LJ601, La Jolla, CA 92037, USA.
| | - Achal Dhupa
- Critical Care Service, Scripps Memorial Hospital La Jolla, 9888 Genesee Avenue, LJ601, La Jolla, CA 92037, USA
| | - Sonja M McAllister
- Critical Care Service, Scripps Memorial Hospital La Jolla, 9888 Genesee Avenue, LJ601, La Jolla, CA 92037, USA
| | - Robin Calara
- Critical Care Service, Scripps Memorial Hospital La Jolla, 9888 Genesee Avenue, LJ601, La Jolla, CA 92037, USA
| | - Stacie A Peters
- Infection Control, Scripps Memorial Hospital La Jolla, 9888 Genesee Avenue, LJ601, La Jolla, CA 92037, USA
| | - Amy Stuck
- Infection Control, Scripps Memorial Hospital La Jolla, 9888 Genesee Avenue, LJ601, La Jolla, CA 92037, USA
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