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Beeson T, Pittman J, Davis CR. Effectiveness of an External Urinary Device for Female Anatomy and Trends in Catheter-Associated Urinary Tract Infections. J Wound Ostomy Continence Nurs 2023; 50:137-141. [PMID: 36867037 PMCID: PMC9990593 DOI: 10.1097/won.0000000000000951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
PURPOSE The purpose of this study was to examine the effectiveness of an external female urinary management system (external urinary device for female anatomy [EUDFA]) in critically ill women unable to self-toilet and to identify rates of indwelling catheter use, catheter-associated urinary tract infections (CAUTIs), urinary incontinence (UI), and incontinence-associated dermatitis (IAD) before and after the introduction of the EUDFA. DESIGN Prospective, observational, and quasi-experimental design. SUBJECTS AND SETTING The sample comprised 50 adult female patients in 4 critical/progressive care units using an EUDFA at a large academic hospital in the Midwestern United States. All adult patients in these units were included in the aggregate data. METHODS Prospective data collected from the adult female patients over 7 days included urine diverted from the device to a canister and total leakage. Aggregate unit rates of indwelling catheter use, CAUTIs, UI, and IAD were retrospectively examined during 2016, 2018, and 2019. Means and percentages were compared using t tests or chi-square tests. RESULTS The EUDFA successfully diverted 85.5% of patients' urine. Indwelling urinary catheter use was significantly lower in 2018 (40.6%) and 2019 (36.6%) compared with 2016 (43.9%) (P < .01). The rate of CAUTIs was lower in 2019 than in 2016, but not significantly (1.34 per 1000 catheter-days vs 0.50, P = .08). The percentage of incontinent patients with IAD was 69.2% in 2016 and 39.5% in 2018-2019 (P = .06). CONCLUSIONS The EUDFA was effective in diverting urine from critically ill female incontinent patients and indwelling catheter utilization.
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Affiliation(s)
- Terrie Beeson
- Correspondence: Terrie Beeson, MSN, RN, CCRN, ACNS-BC, Indiana University Health Academic Health Center, 1030 West Michigan St, Indianapolis, IN, 46202 ()
| | - Joyce Pittman
- Terrie Beeson, MSN, RN, CCRN, ACNS-BC, Indiana University Health Academic Health Center, Indianapolis
- Joyce Pittman, PhD, RN, ANP-BC, FNP-BC, CWOCN, FAAN, College of Nursing, University of South Alabama, Mobile
- Carmen R. Davis, MSN, RN, CCRN, CNS-BC, Indiana University Health Academic Health Center, Indianapolis
| | - Carmen R. Davis
- Terrie Beeson, MSN, RN, CCRN, ACNS-BC, Indiana University Health Academic Health Center, Indianapolis
- Joyce Pittman, PhD, RN, ANP-BC, FNP-BC, CWOCN, FAAN, College of Nursing, University of South Alabama, Mobile
- Carmen R. Davis, MSN, RN, CCRN, CNS-BC, Indiana University Health Academic Health Center, Indianapolis
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Jones AE, Nagle C, Ahern T, Smyth W. Evidence for a nurse-led protocol for removing urinary catheters: A scoping review. Collegian 2022. [DOI: 10.1016/j.colegn.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
BACKGROUND Postoperative urinary tract infections (UTIs) are associated with increased lengths of stay, inpatient costs, and mortality. Review of institutional data from the American College of Surgeons (ACS) NSQIP revealed opportunities to improve practices with respect to urinary catheter (Foley) insertion, catheter care, adherence to diagnosis and prevention protocols, and ACS NSQIP reporting. STUDY DESIGN A multidisciplinary quality improvement team convened and implemented interventions based on a literature review and analysis of institutional drivers of postoperative UTI. The team educated the ACS NSQIP surgical clinical reviewers and clinical teams about UTI diagnostic criteria and prevention, trained staff in proper catheterization technique, and provided performance feedback. The team also developed kits with supplies and instructions for patients who were discharged home with catheters, along with an instructional video. The investigators evaluated project effectiveness by comparing pre- and postintervention process measures and rates of postoperative UTI. RESULTS After interventions, compliance rates improved for hand hygiene (62% to 83%, p = 0.04), precleansing of the periurethral area (66% to 97%, p = 0.001), and catheter positioning (41% to 93%, p < 0.001), and the composite performance (10% to 73%, p < 0.001). Surgery residents' scores on a UTI knowledge assessment improved from 71% to 81% (p = 0.005). The majority of residents and staff strongly agreed that the training sessions would change their practice (57% and 69%, respectively). The unadjusted rate of postoperative UTIs at our institution decreased from 1.55% to 0.69% (p = 0.016), corresponding to an improvement in the ACS NSQIP odds ratio from 1.51 to 0.86. CONCLUSIONS A series of interventions, including provider training, patient education, and audits of practice with performance feedback, are associated with improvements in both practice and the incidence of postoperative UTI.
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Brady B, Li W, Farooque N, Ehrhardt C, Meyerhoff ME, Wang X. S-Nitrosothiol-Impregnated Silicone Catheter for Colorimetric Sensing of Indole and E. coli: Toward On-Body Detection of Urinary Tract Infections. ACS Sens 2022; 7:1712-1719. [PMID: 35604028 DOI: 10.1021/acssensors.2c00439] [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] [Indexed: 01/10/2023]
Abstract
Although there are many techniques to detect pathogenic bacteria, most of them are only suited for in vitro diagnostics. We report a urinary catheter-based colorimetric sensor for potential on-body detection of E. coli, the most prevalent bacterial species in urinary tract infections associated with the use of urinary catheters. In urine, indole is secreted by E. coli and reacts with a nitrosating agent incorporated in a silicone catheter. A red dimeric product, indoxyl red, is generated within silicone rubber to allow for color-based indole sensing with high sensitivity, linearity, and specificity. This reaction is initiated by the nitrosation reaction of indole at its C-3 position via reagents like sodium nitrite or S-nitroso-N-acetyl-penicillamine under aerobic conditions. The generated 3-nitrosoindole undergoes tautomerization, dimerization, and deoximation to form indoxyl red with high absorbance at 537 nm. In contrast to other indole sensors, the presented method can be applied in real catheters to detect indole and E. coli in biofluids such as urine. The is because (1) S-nitroso-N-acetyl-penicillamine, the nitrosating agent, can be impregnated into silicone elastomers, (2) indole from urine is extracted into silicone due to its hydrophobicity, and (3) the high acidity and oxygen solubility of silicone facilitates the sensing reaction within the silicone matrix. This silicone-based colorimetric sensor clearly differentiates E. coli below and above 105 CFU/mL, which is the threshold concentration of bacteriuria. We expect that early diagnosis of urinary tract infections using the naked eye is possible by functionalizing an exposed section of urinary catheters with the proposed molecular probe.
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Affiliation(s)
- Brock Brady
- Department of Chemistry, Virginia Commonwealth University, 1001 West Main Street, Richmond, Virginia 23284, United States
| | - Wuwei Li
- Department of Chemistry, Virginia Commonwealth University, 1001 West Main Street, Richmond, Virginia 23284, United States
| | - Nashwan Farooque
- Department of Chemistry, Virginia Commonwealth University, 1001 West Main Street, Richmond, Virginia 23284, United States
| | - Christopher Ehrhardt
- Department of Forensic Science, Virginia Commonwealth University, 1015 Floyd Avenue, Richmond, Virginia 23284, United States
| | - Mark E. Meyerhoff
- Department of Chemistry, University of Michigan, 930 North University, Ann Arbor, Michigan 48109, United States
| | - Xuewei Wang
- Department of Chemistry, Virginia Commonwealth University, 1001 West Main Street, Richmond, Virginia 23284, United States
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5
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Zhao T, Du G, Zhou X. Inappropriate urinary catheterisation: a review of the prevalence, risk factors and measures to reduce incidence. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S4-S13. [PMID: 35559693 DOI: 10.12968/bjon.2022.31.9.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Urinary tract infections (UTIs) comprise the second most common type of healthcare-associated infections, with up to 80% of UTIs caused by indwelling urinary catheters. Current research suggests that the best way to prevent catheter-associated UTIs (CAUTIs) is to reduce unnecessary catheterisation. Few reviews have focused on the prevalence, risk factors and preventive measures for inappropriate catheterisation. This article, consequently, sought to evaluate the current evidence on the prevalence, risk factors and measures that can be taken to prevent inappropriate urinary catheterisation.
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Affiliation(s)
- Tao Zhao
- Department of Hospital Infection Management, The First People's Hospital of Guiyang, Guiyang City, Guizhou Province, China
| | - Guiqin Du
- Department of Hospital Infection Management, The First People's Hospital of Guiyang, Guiyang City, Guizhou Province, China
| | - Xuan Zhou
- Department of Science and Education, The First People's Hospital of Guiyang, Guiyang City, Guizhou Province, China
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6
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Siméon H, Rouget B, Bladou F, Bernhard JC, Alezra E, Delleci C, Petit L, Vital JM, Robert G, Capon G. [Urinary drainage of spinal cord injured patients in the acute phase of trauma: A descriptive, retrospective study]. Prog Urol 2021; 32:6-13. [PMID: 34863636 DOI: 10.1016/j.purol.2021.09.005] [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: 03/22/2021] [Revised: 08/10/2021] [Accepted: 09/10/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Urinary retention in the acute phase of a spinal cord injury (SCI) requires bladder drainage (BD). International scientific societies recommend early implementation of intermittent catheterisation (IC) to prevent lower urological complications, preserve fertility, the urological future of the patient and improve its quality of life. The aim of our study was to analyze the mode of BD in the acute phase of a trauma in patients with SCI. MATERIALS AND METHODS We retrospectively analyzed the mode of BD of patients with SCI in the acute phase of trauma at the Bordeaux University Hospital from 2013 to 2018. RESULTS The care pathways of 81 patients were analyzed; patients were hospitalized in intensive care unit (ICU) (42%, n=34), in orthopaedic ward (19.8%, n=16) or in ICU and orthopaedic ward (38.2%, n=31). All of them had an indwelling catheter (IUD) inserted before IC was introduced in 56 of them (69%). On hospital discharge, IC was the BD for only 37% of patients, with differences according to the care pathway: 65% of patients leaving ICU were on IC, compared with 11% leaving orthopaedic ward. 80% of patients who had IC in ICU had an IUD installed in orthopaedic ward. CONCLUSION In this study, during the acute phase of a trauma in the majority of SCI patient, IC was introduced only in a minority of patients and the promotion was different within the hospital care pathways. Those results enhanced the need for IC awareness in different hospital units to standardize the best patient care. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- H Siméon
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France.
| | - B Rouget
- Service de chirurgie urologique, hôpital Robert-Boulin Libourne, Libourne, France
| | - F Bladou
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France
| | - J-C Bernhard
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France
| | - E Alezra
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France
| | - C Delleci
- Service de médecine physique et réadaptation, CHU de Bordeaux, Bordeaux, France
| | - L Petit
- Service de réanimation chirurgicale, CHU de Bordeaux, Bordeaux, France
| | - J-M Vital
- Service de chirurgie orthopédique et de traumatologie, CHU de Bordeaux, Bordeaux, France
| | - G Robert
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France
| | - G Capon
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France
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Wang A, Weldrick PJ, Madden LA, Paunov VN. Enhanced clearing of Candida biofilms on a 3D urothelial cell in vitro model using lysozyme-functionalized fluconazole-loaded shellac nanoparticles. Biomater Sci 2021; 9:6927-6939. [PMID: 34528638 DOI: 10.1039/d1bm01035b] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Candida urinary tract biofilms are increasingly witnessed in nosocomial infections due to reduced immunity of patients and the hospital ecosystem. The indwelling devices utilized to support patients with urethral diseases that connect the unsterilized external environment with the internal environment of the patient are another significant source of urinary tract biofilm infections. Recently, nanoparticle (NP)-associated therapeutics have gained traction in a number of areas, including fighting antibiotic-resistant bacterial biofilm infection. However, most studies on nanotherapeutic delivery have only been carried out in laboratory settings rather than in clinical trials due to the lack of precise in vitro and in vivo models for testing their efficiency. Here we develop a novel biofilm-infected 3D human urothelial cell culture model to test the efficiency of nanoparticle (NP)-based antifungal therapeutics. The NPs were designed based on shellac cores, loaded with fluconazole and coated with the cationic enzyme lysozyme. Our formulation of 0.2 wt% lysozyme-coated 0.02 wt% fluconazole-loaded 0.2 wt% shellac NPs, sterically stabilised by 0.25 wt% poloxamer 407, showed an enhanced efficiency in removing Candida albicans biofilms formed on 3D layer of urothelial cell clusteroids. The NP formulation exhibited low toxicity to urothelial cells. This study provides a reliable in vitro model for Candida urinary tract biofilm infections, which could potentially replace animal models in the testing of such antifungal nanotechnologies. The reproducibility and availability of a well-defined biofilm-infected 3D urothelial cell culture model give valuable insights into the formation and clearing of fungal biofilms and could accelerate the clinical use of antifungal nanotherapeutics.
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Affiliation(s)
- Anheng Wang
- Department of Chemistry, University of Hull, Cottingham Road, Hull, HU67RX, UK
| | - Paul J Weldrick
- Department of Chemistry, University of Hull, Cottingham Road, Hull, HU67RX, UK
| | - Leigh A Madden
- Department of Biomedical Sciences, University of Hull, Hull, HU67RX, UK
| | - Vesselin N Paunov
- Department of Chemistry, Nazarbayev University, 53 Kabanbay Batyr Avenue, Nursultan city, 010000, Kazakhstan.
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Chuang L, Tambyah PA. Catheter-associated urinary tract infection. J Infect Chemother 2021; 27:1400-1406. [PMID: 34362659 DOI: 10.1016/j.jiac.2021.07.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
This guideline contains updated recommendations on the management and prevention of CAUTIs by the Urological Association of Asia and the Asian Association of Urinary Tract Infection and Sexually Transmitted Infection.
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Affiliation(s)
- Leyland Chuang
- Raffles Internal Medicine Centre, Raffles Hospital, Singapore
| | - Paul Anantharajah Tambyah
- University Medicine Cluster, National University Health System, Singapore; Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Page S, Hazen D, Kelley K, Singh R, Rodgers RB, Brewer B, Sadowski J, Desai A, Beeler C, Webb D, Azar J, Dbeibo L. Changing the culture of urine culturing: Utilizing Agile Implementation to improve diagnostic stewardship in the ICU. Am J Infect Control 2020; 48:1375-1380. [PMID: 33097138 DOI: 10.1016/j.ajic.2020.01.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/28/2020] [Accepted: 01/28/2020] [Indexed: 01/22/2023]
Abstract
Over diagnosis of catheter-associated urinary tract infection (CAUTI) contributes to unnecessary and excessive antibiotic use, selection for resistant organisms, increased risk for Clostridiodes difficile infections, as well as a false elevation in CAUTI rates. Utilizing agile implementation to implement a urine culture algorithm achieved statistically significant reduction in CAUTI rates in a critical care unit resulting in sustainment and spread throughout the system.
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Schallom M, Prentice D, Sona C, Vyers K, Arroyo C, Wessman B, Ablordeppey E. Accuracy of Measuring Bladder Volumes With Ultrasound and Bladder Scanning. Am J Crit Care 2020; 29:458-467. [PMID: 33130866 DOI: 10.4037/ajcc2020741] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Removal of urinary catheters depends on accurate noninvasive measurements of bladder volume. Patients with acute kidney injury often have low bladder volumes/ascites, possibly causing measurement inaccuracy. OBJECTIVE To evaluate the accuracy of bladder volumes measured with bladder scanning and 2-dimensional ultrasound (US) compared with urinary catheterization among different types of clinicians. METHODS Prospective correlational descriptive study of 73 adult critical care patients with low urine output receiving hemodialysis or unable to void. Bladder volumes were independently measured by (1) a physician and an advanced practice registered nurse using US, (2) an advanced practice registered nurse and a bedside nurse using bladder scanning, and (3) urinary catheterization (cath). Bland-Altman and χ2 analyses were conducted. RESULTS Mean (SD) cath volume was 171.7 (269.7) mL (range, 0-1100 mL). Abdominal fluid was observed in 28% of patients. Bias was -1.3 mL for US vs cath and 3.3 mL for bladder scanning vs cath. For patients with abdominal fluid and cath volume less than 150 mL, decisions to not catheterize patients were accurate more often when based on US measurements (97%-100%) than when based on bladder scanning measurements (86%-89%; P = .02). In patients with cath volume of 300 mL or more, decisions to catheterize patients were accurate more often when based on bladder scanning measurements (94%-100%) than when based on horizontal US measurements (50%-56%; P = .001). CONCLUSIONS Bladder volume can be measured accurately with bladder scanning or US, but abdominal fluid remains a confounding factor limiting accuracy of bladder scanning.
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Affiliation(s)
- Marilyn Schallom
- Marilyn Schallom is director of research, Donna Prentice is a research scientist, Kara Vyers is a research coordinator, and Cassandra Arroyo is a statistician in the Department of Research and Carrie Sona is a clinical nurse specialist in the Department of Surgical Services, Barnes-Jewish Hospital, St Louis, Missouri
| | - Donna Prentice
- Marilyn Schallom is director of research, Donna Prentice is a research scientist, Kara Vyers is a research coordinator, and Cassandra Arroyo is a statistician in the Department of Research and Carrie Sona is a clinical nurse specialist in the Department of Surgical Services, Barnes-Jewish Hospital, St Louis, Missouri
| | - Carrie Sona
- Marilyn Schallom is director of research, Donna Prentice is a research scientist, Kara Vyers is a research coordinator, and Cassandra Arroyo is a statistician in the Department of Research and Carrie Sona is a clinical nurse specialist in the Department of Surgical Services, Barnes-Jewish Hospital, St Louis, Missouri
| | - Kara Vyers
- Marilyn Schallom is director of research, Donna Prentice is a research scientist, Kara Vyers is a research coordinator, and Cassandra Arroyo is a statistician in the Department of Research and Carrie Sona is a clinical nurse specialist in the Department of Surgical Services, Barnes-Jewish Hospital, St Louis, Missouri
| | - Cassandra Arroyo
- Marilyn Schallom is director of research, Donna Prentice is a research scientist, Kara Vyers is a research coordinator, and Cassandra Arroyo is a statistician in the Department of Research and Carrie Sona is a clinical nurse specialist in the Department of Surgical Services, Barnes-Jewish Hospital, St Louis, Missouri
| | - Brian Wessman
- Brian Wessman and Enyo Ablordeppey are associate professors in the Department of Anesthesiology and Division of Emergency Medicine, School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Enyo Ablordeppey
- Brian Wessman and Enyo Ablordeppey are associate professors in the Department of Anesthesiology and Division of Emergency Medicine, School of Medicine, Washington University in St Louis, St Louis, Missouri
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11
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Meddings J, Manojlovich M, Fowler KE, Ameling JM, Greene L, Collier S, Bhatt J, Saint S. A Tiered Approach for Preventing Catheter-Associated Urinary Tract Infection. Ann Intern Med 2019; 171:S30-S37. [PMID: 31569226 DOI: 10.7326/m18-3471] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jennifer Meddings
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (J.M., S.S.)
| | | | - Karen E Fowler
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (K.E.F.)
| | | | - Linda Greene
- University of Rochester Highland Hospital, Rochester, New York (L.G.)
| | - Sue Collier
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois (S.C., J.B.)
| | - Jay Bhatt
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois (S.C., J.B.)
| | - Sanjay Saint
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (J.M., S.S.)
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12
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Karadag Arli S, Berivan Bakan A. Development of the Catheter-Associated Urinary Tract Infections Control Precautions Scale. J Contin Educ Nurs 2018; 49:507-513. [DOI: 10.3928/00220124-20181017-07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/31/2018] [Indexed: 11/20/2022]
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Abstract
BACKGROUND: Strategies to decrease use of female indwelling urinary catheters and catheter-associated urinary tract infections are challenging due to the limited availability of proper fitting external collection devices. Female urinary incontinence predisposes the skin to potential pain, itching, burning, infection, or pressure injuries. CASE STUDIES: This article discusses 3 patients' trajectory of care with use of an external female urinary collection device. All of these females were incontinent of urine after the indwelling urinary catheter was removed and managed with an external female urinary collection device. CONCLUSIONS: The use of an external female urinary collection device is a feasible alternative to an indwelling urinary catheter as well as managing urinary incontinence.
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14
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Siegel BI, Figueroa J, Stockwell JA. Impact of a Daily PICU Rounding Checklist on Urinary Catheter Utilization and Infection. Pediatr Qual Saf 2018; 3:e078. [PMID: 30229190 PMCID: PMC6132817 DOI: 10.1097/pq9.0000000000000078] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 03/27/2018] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION In critically ill children, inappropriate urinary catheter (UC) utilization is associated with increased morbidity, including catheter-associated urinary tract infections (CAUTIs). Checklists are effective for reducing medical errors, but there is little data on their impact on device utilization in pediatric critical care. In this study, we evaluated UC utilization trends and CAUTI rate after implementing a daily rounding checklist. METHODS A retrospective review of our checklist database from 2006 through 2016 was performed. The study setting was a 36-bed pediatric intensive care unit in a quaternary-care pediatric hospital. Interventions included the "Daily QI Checklist" in 2006, ongoing education regarding device necessity, and a CAUTI prevention bundle in 2013. UC utilization and duration were assessed via auto-correlated time series models and Cochran-Armitage tests for trend. Changes in CAUTI rate were assessed via Poisson regression. RESULTS UC utilization decreased from 30% of patient-days in 2006 to 18% in 2016 (P < 0.0001, Cochran-Armitage trend test), while duration of UC use (median, 2.0 days; interquartile range, 1-4) did not change over time (P = 0.18). CAUTI rate declined from 9.49/1,000 UC-days in 2009 to 1.04 in 2016 (P = 0.0047). CONCLUSIONS Implementation of the checklist coincided with a sustained 40% reduction in UC utilization. The trend may be explained by a combination of more appropriate selection of patients for catheterization and improved timeliness of UC discontinuation. We also observed an 89% decline in CAUTI rate that occurred after stabilization of UC utilization. These findings underscore the potential impact of a checklist on incorporating best practices into daily care of critically ill children.
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Affiliation(s)
- Benjamin I Siegel
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga
| | - Janet Figueroa
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga
| | - Jana A Stockwell
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga
- Division of Critical Care Medicine, Children's Healthcare of Atlanta at Egleston, Atlanta, Ga
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15
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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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Patel PK, Gupta A, Vaughn VM, Mann JD, Ameling JM, Meddings J. Review of Strategies to Reduce Central Line-Associated Bloodstream Infection (CLABSI) and Catheter-Associated Urinary Tract Infection (CAUTI) in Adult ICUs. J Hosp Med 2018; 13:105-116. [PMID: 29154382 DOI: 10.12788/jhm.2856] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) are costly and morbid. Despite evidence-based guidelines, Some intensive care units (ICUs) continue to have elevated infection rates. In October 2015, we performed a systematic search of the peer-reviewed literature within the PubMed and Cochrane databases for interventions to reduce CLABSI and/or CAUTI in adult ICUs and synthesized findings using a narrative review process. The interventions were categorized using a conceptual model, with stages applicable to both CAUTI and CLABSI prevention: (stage 0) avoid catheter if possible, (stage 1) ensure aseptic placement, (stage 2) maintain awareness and proper care of catheters in place, and (stage 3) promptly remove unnecessary catheters. We also looked for effective components that the 5 most successful (by reduction in infection rates) studies of each infection shared. Interventions that addressed multiple stages within the conceptual model were common in these successful studies. Assuring compliance with infection prevention efforts via auditing and timely feedback were also common. Hospitalists with patient safety interests may find this review informative for formulating quality improvement interventions to reduce these infections.
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Affiliation(s)
- Payal K Patel
- Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan, USA.
- Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Ashwin Gupta
- Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Valerie M Vaughn
- Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jason D Mann
- Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jessica M Ameling
- Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jennifer Meddings
- Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Department of Pediatrics and Communicable Diseases, Division of General Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Veterans Affairs Center for Clinical Management Research, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan, USA
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Catheter-associated urinary tract infections: challenges and opportunities for the application of systems engineering. Health Syst (Basingstoke) 2017. [DOI: 10.1057/s41306-016-0017-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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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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Kim B, Pai H, Choi WS, Kim Y, Kweon KT, Kim HA, Ryu SY, Wie SH, Kim J. Current status of indwelling urinary catheter utilization and catheter-associated urinary tract infection throughout hospital wards in Korea: A multicenter prospective observational study. PLoS One 2017; 12:e0185369. [PMID: 28991927 PMCID: PMC5633151 DOI: 10.1371/journal.pone.0185369] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 09/12/2017] [Indexed: 11/30/2022] Open
Abstract
To evaluate the frequency and appropriateness of indwelling urinary catheters (IUC) use and the incidence of catheter-associated urinary tract infections (CA-UTI), and explore the risk factors for CA-UTI in hospitals as a whole, we conducted a study. This study was divided into two parts; a point-prevalence study on Dec 12th 2012 and a prospective cohort study from Dec 13th 2012 to Jan 9th 2013 were performed in six hospitals in Korea. All hospitalized patients with newly-placed IUCs were enrolled and monitored weekly for 28 days after IUC placement. In the point-prevalence study, the IUCs were present in median 14.9/100 hospitalized patients (1Q 14, 3Q 16) across the six hospitals. In the prospective cohort study, the median IUC-days per patient was 5 (1Q 3, 3Q 10) and the median CA-UTI prevalence per 1,000 catheter days was 1.9 (1Q 0.7, 3Q 3.8) with significant inter-hospital variation. The proportion of patients with inappropriate IUC maintenance increased with number of IUC-days (8.5% on day 7, 9.4% on day 14, 16.3% on day 21, and 23.1% on day 28). Urinary output monitoring (23/36, 63.9%) was the most common indication for inappropriate use after 1 week of ICU placement. In multivariate analysis, IUC-days was significantly associated with the development of CA-UTI (odds ratio 1.122, 95% confidence interval 1.074–1.173, P< 0.001). IUC-days and CA-UTI rates vary between hospitals. IUC-days is a risk factor for CA-UTI, and is correlated with inappropriate use.
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Affiliation(s)
- Bongyoung Kim
- Department of Internal Medicine, Eulji University College of Medicine, Daejeon, Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Won Suk Choi
- Department of Internal Medicine, Korea University College of Medicine, Ansan, Korea
| | - Yeonjae Kim
- Department of Infectious Disease, National Medical Center, Seoul, Korea
| | - Ki Tae Kweon
- Department of Infectious Disease, Patima Hospital, Daegu, Korea
| | - Hyun Ah Kim
- Department of Internal Medicine, Gyemyeong University College of Medicine, Daegu, Korea
| | - Seong Yeol Ryu
- Department of Internal Medicine, Gyemyeong University College of Medicine, Daegu, Korea
| | - Seong-heon Wie
- Department of Internal Medicine, St. Vincent Hospital, Suwon, Korea
| | - Jieun Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
- * E-mail:
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Short HL, Parakati I, Heiss KF, Wulkan ML, Sweeney JF, Raval MV. Challenge of balancing duration of stay and readmissions in children's operation. Surgery 2017; 162:950-957. [PMID: 28709646 DOI: 10.1016/j.surg.2017.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/08/2017] [Accepted: 06/08/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgeons balance competing interests of minimizing duration of stay with readmissions. Complications that occur early after discharge often result in readmissions. This study examines the relationship between duration of stay, timing of complications, and readmission risk. METHODS Cases from the 2012-2014 National Surgical Quality Improvement Project-Pediatric were organized into 30 procedural groups. Procedures where duration of stay approximated the median day of complication were identified. A theoretical model was applied to minimize readmissions by extending duration of stay. RESULTS From 30 procedure groups, 3 were identified where duration of stay approximated median day of compilations: complicated appendectomy, antireflux operation, and abdominal operation without bowel resection. The complicated appendectomy readmission rate drops from 12.2% to 8.2%, increasing duration of stay from 3 to 8 days at the cost of 16,428 additional hospital days among 4,740 patients (3.5 days/patient). Readmission optimization tapers after duration of stay of 8 days. Similar findings were observed for antireflux operation and abdominal operation without bowel resection with readmission optimization at duration of stay of 5 days (2.6 days/patient) and 7 days (5.3 days/patient), respectively. CONCLUSION Our theoretical model aimed at balancing readmissions by extending duration of stay to capture early complications results in a substantial increase in hospital days illustrating the conflict between competing quality metrics and limited resources.
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Affiliation(s)
- Heather L Short
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Isaac Parakati
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Kurt F Heiss
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Mark L Wulkan
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - John F Sweeney
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA.
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Hughes P, Chandra L, Lunawat R, Cartledge J. ‘Tubeless’ nephrectomy: Routine omission of indwelling catheters and abdominal drains and impact on patient outcomes. JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415816656736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Continued refinements to the enhanced recovery after surgery (ERAS) protocols can help improve patient care. This study details the experience and outcomes of a single surgeon’s practice over a two-year period for all laparoscopic renal surgery where omitting abdominal drains and indwelling catheters, ‘tubeless nephrectomy’, was the default. Methodology: A total of 178 consecutive unselected patients underwent laparoscopic renal surgery during a 22-month period. This included laparoscopic radical, partial, live donor and benign nephrectomy cases. Demographic details and data on length of stay, complications and the need for catheterisation post-operatively and use of abdominal drains were collected prospectively. Results: Of the patient group, 142 (80%) underwent entirely ‘tubeless’ procedures. Catheterisation (indwelling catheter (IDC) or clean intermittent catheterisation (CIC)) was required in 23 (13%) patients, 11 (6%) had a drain placed at operation and two had both. The median length of stay for tubeless procedures was one day (interquartile range (IQR) 1–2, range 1–22 days). This compared to a median length of stay of three days (IQR 1–6) for those with a catheter and two days (IQR 1.5–4.5) for those with a drain post-operatively. The difference between the median length of stay for tubeless and non-tubeless procedures was statistically significant ( p=0.001). The difference in frequency of complications between the tubeless group and those who received a drain or catheter was also significant ( p=0.003). Conclusions: This change in clinical practice is safe, effective and easy to implement. When incorporated into laparoscopic nephrectomy ERAS protocols, ‘tubeless’ surgery can have a significant benefit on length of stay and patient outcomes, without a detrimental impact on complication rates.
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Affiliation(s)
- Paul Hughes
- Urology Department, Mid Yorkshire Hospitals NHS Trust, UK
| | - Lizzie Chandra
- Urology Department, Leeds Teaching Hospitals NHS Trust, UK
| | - Rahul Lunawat
- Urology Department, King George Hospital, Barking, Havering & Redbridge University Hospitals NHS Trust, UK
| | - Jon Cartledge
- Urology Department, Leeds Teaching Hospitals NHS Trust, UK
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Galiczewski JM, Shurpin KM. An intervention to improve the catheter associated urinary tract infection rate in a medical intensive care unit: Direct observation of catheter insertion procedure. Intensive Crit Care Nurs 2017; 40:26-34. [PMID: 28237090 DOI: 10.1016/j.iccn.2016.12.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 12/06/2016] [Accepted: 12/10/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Healthcare associated infections from indwelling urinary catheters lead to increased patient morbidity and mortality. AIM The purpose of this study was to determine if direct observation of the urinary catheter insertion procedure, as compared to the standard process, decreased catheter utilization and urinary tract infection rates. METHODS This case control study was conducted in a medical intensive care unit. During phase I, a retrospective data review was conducted on utilsiation and urinary catheter infection rates when practitioners followed the institution's standard insertion algorithm. During phase II, an intervention of direct observation was added to the standard insertion procedure. RESULTS The results demonstrated no change in utilization rates, however, CAUTI rates decreased from 2.24 to 0 per 1000 catheter days. CONCLUSION The findings from this study may promote changes in clinical practice guidelines leading to a reduction in urinary catheter utilization and infection rates and improved patient outcomes.
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Affiliation(s)
- Janet M Galiczewski
- Stony Brook University School of Nursing, United States; Long Island Jewish Medical Center, United States.
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Stoleru E, Munteanu BS, Darie-Niţă RN, Pricope GM, Lungu M, Irimia A, Râpă M, Lipşa RD, Vasile C. Complex poly(lactic acid)-based biomaterial for urinary catheters: II. Biocompatibility. BIOINSPIRED BIOMIMETIC AND NANOBIOMATERIALS 2016. [DOI: 10.1680/jbibn.15.00012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The present paper is focused on the surface and bulk characterization of poly(lactic acid) (PLA)-based composites that contain hydrolyzed collagen as a biological polymer, silver nanoparticles and vitamin E and epoxidized soybean oil as a plasticizer. The bionanocomposites were obtained by melt processing and evaluated for structural and surface characteristics, biocompatibility, functional properties such as antimicrobial and antioxidant activity and hydrolytic degradation behavior. It has been established that the optimal composition to impart functional properties to the PLA matrix is a formulation containing 15% epoxidized soybean oil, 15% hydrolyzed collagen, 5% Pluronic, 5% vitamin E and 0·3% silver nanoparticles. This bionanocomposite inhibits the growth of both Gram-positive bacteria, Escherichia coli and Salmonella typhimurium, and Gram-negative bacteria, Listeria monocytogenes, and reaches 100% radical-scavenging activity. The PLA-based biomaterials obtained in this study are stable in biological media in the short and medium terms and therefore are recommended as multifunctional biomaterials for the manufacture of medical devices, such as urinary catheters.
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Affiliation(s)
- Elena Stoleru
- ‘Petru Poni’ Institute of Macromolecular Chemistry, Iași, Romania
| | | | | | - Gina M. Pricope
- Veterinary and the Food Safety Laboratory, Food Safety Department, Iași, Romania
| | - Maria Lungu
- National Institute for Biological Sciences, Bucharest, Romania
| | - Anamaria Irimia
- ‘Petru Poni’ Institute of Macromolecular Chemistry, Iași, Romania
| | - Maria Râpă
- S.C. ICPE BISTRITA S.A., Bistrița, Romania
| | - Rodica D. Lipşa
- ‘Petru Poni’ Institute of Macromolecular Chemistry, Iași, Romania
| | - Cornelia Vasile
- Petru Poni Institute of Macromolecular Chemistry, Iași, Romania
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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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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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Andrade VLF, Fernandes FAV. Prevention of catheter-associated urinary tract infection: implementation strategies of international guidelines. Rev Lat Am Enfermagem 2016; 24:e2678. [PMID: 27027676 PMCID: PMC4809180 DOI: 10.1590/1518-8345.0963.2678] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 07/11/2015] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE to describe strategies used by health professionals on the implementation of the Centers for Disease Control and Prevention guidelines for the prevention of urinary infection related to catheterism. METHOD systematic review on literature based on data from CINAHL(r), Nursing & Allied Health Collection, Cochrane Plus Collection, MedicLatina, MEDLINE(r), Academic Search Complete, ACS - American Chemical Society, Health Reference Center Academic, Nursing Reference Center, ScienceDirect Journals and Wiley Online Library. A sample of 13 articles was selected. RESULTS studies have highlighted the decrease of urinary tract infection related to catheterism through reminder systems to decrease of people submitted to urinary catheterism, audits about nursing professionals practice and bundles expansion. CONCLUSION the present review systemizes the knowledge of used strategies by health professionals on introduction to international recommendations, describing a rate decrease of such infection in clinical practice.
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Interventions for the prevention of catheter associated urinary tract infections in intensive care units: An integrative review. Intensive Crit Care Nurs 2016; 32:1-11. [DOI: 10.1016/j.iccn.2015.08.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 08/24/2015] [Accepted: 08/31/2015] [Indexed: 11/20/2022]
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Cai W, Chen Z, Wen L, Jiang X, Liu X. Bipolar plasma vaporization using plasma-cutting and plasma-loop electrodes versus cold-knife transurethral incision for the treatment of posterior urethral stricture: a prospective, randomized study. Clinics (Sao Paulo) 2016; 71:1-4. [PMID: 26872076 PMCID: PMC4732386 DOI: 10.6061/clinics/2016(01)01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 10/22/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Evaluate the efficiency and safety of bipolar plasma vaporization using plasma-cutting and plasma-loop electrodes for the treatment of posterior urethral stricture. Compare the outcomes following bipolar plasma vaporization with conventional cold-knife urethrotomy. METHODS A randomized trial was performed to compare patient outcomes from the bipolar and cold-knife groups. All patients were assessed at 6 and 12 months postoperatively via urethrography and uroflowmetry. At the end of the first postoperative year, ureteroscopy was performed to evaluate the efficacy of the procedure. The mean follow-up time was 13.9 months (range: 12 to 21 months). If re-stenosis was not identified by both urethrography and ureteroscopy, the procedure was considered "successful". RESULTS Fifty-three male patients with posterior urethral strictures were selected and randomly divided into two groups: bipolar group (n=27) or cold-knife group (n=26). Patients in the bipolar group experienced a shorter operative time compared to the cold-knife group (23.45±7.64 hours vs 33.45±5.45 hours, respectively). The 12-month postoperative Qmax was faster in the bipolar group than in the cold-knife group (15.54±2.78 ml/sec vs 18.25±2.12 ml/sec, respectively). In the bipolar group, the recurrence-free rate was 81.5% at a mean follow-up time of 13.9 months. In the cold-knife group, the recurrence-free rate was 53.8%. CONCLUSIONS The application of bipolar plasma-cutting and plasma-loop electrodes for the management of urethral stricture disease is a safe and reliable method that minimizes the morbidity of urethral stricture resection. The advantages include a lower recurrence rate and shorter operative time compared to the cold-knife technique.
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Affiliation(s)
- Wansong Cai
- Renmin Hospital of Wuhan University, Department of Urology, Wuhan, Hubei, China
| | - Zhiyuan Chen
- Renmin Hospital of Wuhan University, Department of Urology, Wuhan, Hubei, China
| | - Liping Wen
- Renmin Hospital of Fuyang, Department of Urology, Hangzhou, Zhejiang, China
| | - Xiangxin Jiang
- Renmin Hospital of Fuyang, Department of Urology, Hangzhou, Zhejiang, China
| | - Xiuheng Liu
- Renmin Hospital of Wuhan University, Department of Urology, Wuhan, Hubei, China
- corresponding authors E-mail:
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Ma XY, Tian LX, Liang HP. Early prevention of trauma-related infection/sepsis. Mil Med Res 2016; 3:33. [PMID: 27833759 PMCID: PMC5101695 DOI: 10.1186/s40779-016-0104-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 10/20/2016] [Indexed: 01/09/2023] Open
Abstract
Trauma still represents one of the major causes of death worldwide. Despite the reduction of post-traumatic sepsis over the past two decades, the mortality of septic trauma inpatients is still high (19.5-23 %). Early prevention of sepsis development can aid in the subsequent treatment of patients and help improve their outcomes. To date, the prevention of trauma-related infection/sepsis has mainly included infection prevention (e.g., surgical management, prophylactic antibiotics, tetanus vaccination, immunomodulatory interventions) and organ dysfunction prevention (e.g., pharmaceuticals, temporary intravascular shunts, lung-protective strategies, enteral immunonutrition, acupuncture). Overall, more efficient ways should be developed to prevent trauma-related infection/sepsis.
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Affiliation(s)
- Xiao-Yuan Ma
- State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, 400042 China
| | - Li-Xing Tian
- State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, 400042 China
| | - Hua-Ping Liang
- State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, 400042 China
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Taleschian-Tabrizi N, Farhadi F, Madani N, Mokhtarkhani M, Kolahdouzan K, Hajebrahimi S. Compliance With Guideline Statements for Urethral Catheterization in an Iranian Teaching Hospital. Int J Health Policy Manag 2015; 4:805-11. [PMID: 26673464 DOI: 10.15171/ijhpm.2015.128] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 07/09/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND It is believed that healthcare staff play an important role in minimizing complications related to urethral catheterization. The purpose of this study was to determine whether or not healthcare staff complied with the standards for urethral catheterization. METHODS This study was conducted in Imam Reza teaching hospital, Tabriz, Iran, from July to September 2013. A total of 109 catheterized patients were selected randomly from surgical and medical wards and intensive care units (ICUs). A questionnaire was completed by healthcare staff for each patient to assess quality of care provided for catheter insertion, while catheter in situ, draining and changing catheter bags. Items of the questionnaire were obtained from guidelines for the prevention of infection. Data analysis was performed with SPSS 16. RESULTS The mean age of the patients was 50.54±22.13. Of the 109 patients, 56.88% were admitted to ICUs. The mean duration of catheter use was 15.86 days. Among the 25 patients who had a urinalysis test documented in their hospital records, 11 were positive for urinary tract infection (UTI). The lowest rate of hand-washing was reported before bag drainage (49.52%). The closed drainage catheter system was not available at all. Among the cases who had a daily genital area cleansing, in 27.63% cases, the patients or their family members performed the washing. In 66.35% of cases, multiple-use lubricant gel was applied; single-use gel was not available. The rate of documentation for bag change was 79%. CONCLUSION The majority of the guideline statements was adhered to; however, some essential issues, such as hand hygiene were neglected. And some patients were catheterized routinely without proper indication. Limiting catheter use to mandatory situations and encouraging compliance with guidelines are recommended.
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Affiliation(s)
- Negar Taleschian-Tabrizi
- Students' Research Committee, Iranian Evidence-Based Medicine Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fereshteh Farhadi
- Students' Research Committee, Iranian Evidence-Based Medicine Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Neda Madani
- Students' Research Committee, Iranian Evidence-Based Medicine Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohaddeseh Mokhtarkhani
- Students' Research Committee, Iranian Evidence-Based Medicine Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kasra Kolahdouzan
- Students' Research Committee, Iranian Evidence-Based Medicine Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sakineh Hajebrahimi
- Iranian Evidence-Based Medicine Center of Excellence, Department of Urology, Tabriz University of Medical Sciences, Tabriz, Iran
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Meddings J, Saint S, Fowler KE, Gaies E, Hickner A, Krein SL, Bernstein SJ. The Ann Arbor Criteria for Appropriate Urinary Catheter Use in Hospitalized Medical Patients: Results Obtained by Using the RAND/UCLA Appropriateness Method. Ann Intern Med 2015; 162:S1-34. [PMID: 25938928 DOI: 10.7326/m14-1304] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Interventions to reduce urinary catheter use involve lists of "appropriate" indications developed from limited evidence without substantial multidisciplinary input. Implementing these lists, however, is challenging given broad interpretation of indications, such as "critical illness." To refine criteria for appropriate catheter use-defined as use in which benefits outweigh risks-the RAND/UCLA Appropriateness Method was applied. After reviewing the literature, a 15-member multidisciplinary panel of physicians, nurses, and specialists in infection prevention rated scenarios for catheter use as appropriate, inappropriate, or of uncertain appropriateness by using a standardized, multiround rating process. The appropriateness of Foley catheters, intermittent straight catheters (ISCs), and external condom catheters for hospitalized adults on medical services was assessed in 299 scenarios, including urinary retention, incontinence, wounds, urine volume measurement, urine sample collection, and comfort. The scenarios included patient-specific issues, such as difficulty turning and catheter placement challenges. The panel rated 105 Foley scenarios (43 appropriate, 48 inappropriate, 14 uncertain), 97 ISC scenarios (15 appropriate, 66 inappropriate, 16 uncertain), and 97 external catheter scenarios (30 appropriate, 51 inappropriate, 16 uncertain). The refined criteria clarify that Foley catheters are appropriate for measuring and collecting urine only when fluid status or urine cannot be assessed by other means; specify that patients in the intensive care unit (ICU) need specific medical indications for catheters because ICU location alone is not an appropriate indication; and recognize that Foley and external catheters may be pragmatically appropriate to manage urinary incontinence in select patients. These new appropriateness criteria can inform large-scale collaborative and bedside efforts to reduce inappropriate urinary catheter use.
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Affiliation(s)
- Jennifer Meddings
- From the University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, and Cushing/Whitney Medical Library, Yale University, New Haven, Connecticut
| | - Sanjay Saint
- From the University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, and Cushing/Whitney Medical Library, Yale University, New Haven, Connecticut
| | - Karen E. Fowler
- From the University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, and Cushing/Whitney Medical Library, Yale University, New Haven, Connecticut
| | - Elissa Gaies
- From the University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, and Cushing/Whitney Medical Library, Yale University, New Haven, Connecticut
| | - Andrew Hickner
- From the University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, and Cushing/Whitney Medical Library, Yale University, New Haven, Connecticut
| | - Sarah L. Krein
- From the University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, and Cushing/Whitney Medical Library, Yale University, New Haven, Connecticut
| | - Steven J. Bernstein
- From the University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, and Cushing/Whitney Medical Library, Yale University, New Haven, Connecticut
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Jain M, Dogra V, Mishra B, Thakur A, Loomba PS. Knowledge and attitude of doctors and nurses regarding indication for catheterization and prevention of catheter-associated urinary tract infection in a tertiary care hospital. Indian J Crit Care Med 2015; 19:76-81. [PMID: 25722548 PMCID: PMC4339908 DOI: 10.4103/0972-5229.151014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background and Aims: Catheter-associated urinary tract infection (CAUTI) is one of the most common health care acquired infection encountered in clinical practice. The present study was planned to assess the knowledge and attitude of health care providers regarding the indications for catheterization and methods of preventing CAUTI. Methods: A prospective questionnaire-based survey was done from March 2011 to August 2011. A structured questionnaire comprising of 41 items related to demographic details of the respondents, their knowledge regarding indications for catheterization and methods of preventing CAUTI was given to 54 doctors and 105 nurses. The response was evaluated for statistical correlation using a computer software. Results: The mean years of experience of the respondents in the health care setup was 6.8 years. Only 57% of the respondents could identify all the measures for prevention of CAUTI. The knowledge regarding the indication for catheterization though suboptimal was significantly better amongst the doctors as compared to nurses. Conclusion: The knowledge regarding indication and preventive measures was suboptimal in our study group. There is a tremendous scope of improvement in catheterization practices in our hospital and education induced intervention would be the most appropriate effort toward reducing the incidence of CAUTI.
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Affiliation(s)
- Manisha Jain
- Department of Microbiology, ESIC Hospital and Dental College, Sector-15, New Delhi, India
| | - Vinita Dogra
- Department of Microbiology, G.B Pant Hospital, New Delhi, India
| | | | - Archana Thakur
- Department of Microbiology, G.B Pant Hospital, New Delhi, India
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Abstract
Evidence based care (EBP) is imperative to the promotion of best practices. EBP forms the foundation for safe, efficient, and cost-effective patient management. It gives nurses the ability to implement care activities with proved outcomes and validate interventions from a database of sources. EBP not only has an impact on nursing practice but also affects theoretic models and care frameworks. It forms a foundation for professional care activities that use grounded protocols and guidelines and nursing education. This article includes resources to promote continued use of research evidence to guide in patient care areas.
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Affiliation(s)
- Maria A Revell
- Division of Nursing, Tennessee State University, 214 Jon Paul Court, Murfreesboro, TN 37128, USA.
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Weber DJ, Kang J, Brown VM, Sickbert-Bennett EE, Rutala WA. Preventing Catheter-Associated Urinary Tract Infections: Hospital Location of Catheter Insertion. Infect Control Hosp Epidemiol 2015; 33:1057-8. [DOI: 10.1086/667771] [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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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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Halm MA, O’Connor N. Do system-based interventions affect catheter-associated urinary tract infection? Am J Crit Care 2014; 23:505-9. [PMID: 25362675 DOI: 10.4037/ajcc2014689] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Margo A. Halm
- Margo A. Halm is the director of nursing research, professional practice, and Magnet at Salem Hospital in Salem, Oregon. Nancy O’Connor is the infection prevention and employee health manager at Salem Hospital
| | - Nancy O’Connor
- Margo A. Halm is the director of nursing research, professional practice, and Magnet at Salem Hospital in Salem, Oregon. Nancy O’Connor is the infection prevention and employee health manager at Salem Hospital
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Temkin E, Adler A, Lerner A, Carmeli Y. Carbapenem-resistant Enterobacteriaceae: biology, epidemiology, and management. Ann N Y Acad Sci 2014; 1323:22-42. [PMID: 25195939 DOI: 10.1111/nyas.12537] [Citation(s) in RCA: 160] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Introduced in the 1980s, carbapenem antibiotics have served as the last line of defense against multidrug-resistant Gram-negative organisms. Over the last decade, carbapenem-resistant Enterobacteriaceae (CRE) have emerged as a significant public health threat. This review summarizes the molecular genetics, natural history, and epidemiology of CRE and discusses approaches to prevention and treatment.
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Affiliation(s)
- Elizabeth Temkin
- Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Israel
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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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Zielinski MD, Thomsen KM, Polites SF, Khasawneh MA, Jenkins DH, Habermann EB. Is the Centers for Medicare and Medicaid Service's lack of reimbursement for postoperative urinary tract infections in elderly emergency surgery patients justified? Surgery 2014; 156:1009-15. [PMID: 25239361 DOI: 10.1016/j.surg.2014.06.073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 06/27/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Urinary tract infections, a risk factor for readmission, have been deemed a potentially preventable problem and, therefore, not reimbursable by the Centers for Medicare and Medicaid Services since 2008. Defining the risk factors for development of urinary tract infection in the postoperative period will provide risk stratification for development of urinary tract infection in these challenging patients. METHODS Pre-, intra-, and postoperative characteristics were collected for patients ≥65 years who underwent an emergency abdominal operation from the 2005 to 2012 National Surgical Quality Improvement Program Participant User File, a database of 374 participating hospitals. In-hospital urinary tract infections occurring within 30 days of the operation were identified. Multivariable logistic regression analysis was conducted to identify risk factors of urinary tract infection. RESULTS In total, 53,879 patients were included, 1,881 (3.5%) of whom were diagnosed with a postoperative urinary tract infection before discharge. In-hospital urinary tract infection was associated with a longer hospital stay (27 vs 13 days, P < .001) and greater 30-day mortality rates (18% vs 16%, P = .003). The rate of urinary tract infection decreased from 4.5% before the Centers for Medicare and Medicaid Services decree to 3.2% thereafter (P < .001). Multivariable logistic regression demonstrated advanced age, female sex, insulin-dependent diabetes mellitus, dependent functional status, open wound, hypoalbuminemia, increased American Society of Anesthesiologists class, operative approach, and prolonged operative time were independent risk factors for development of postoperative urinary tract infection. CONCLUSION Although postoperative rates of urinary tract infection decreased after the Centers for Medicare and Medicaid Services decree, the lack of reimbursement is not justified, as few modifiable risk factors to further improve postoperative urinary tract infection rates in elderly emergency surgical patients were identified. Although targeted interventions may be developed, this complication is not easily preventable and will continue to plague acute care surgeons taking care of this challenging patient population.
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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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Vincitorio D, Barbadoro P, Pennacchietti L, Pellegrini I, David S, Ponzio E, Prospero E. Risk factors for catheter-associated urinary tract infection in Italian elderly. Am J Infect Control 2014; 42:898-901. [PMID: 25087142 DOI: 10.1016/j.ajic.2014.05.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 05/08/2014] [Accepted: 05/08/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are the most common cause of hospital-acquired infections, especially in elderly patients. Data on CAUTIs in older persons in acute care settings are lacking, however. This study aimed to describe the epidemiology of CAUTIs and related outcomes (ie, length of stay and mortality), in patients admitted to an acute geriatric care hospital in central Italy. METHODS A CAUTI surveillance program was implemented from October 2011 to April 2012, according to the Centers for Disease Control and Prevention's National Healthcare Safety Network methodology. RESULTS A total of 2773 patients aged ≥65 years were included in the study, and 483 catheterized patients were monitored for the risk of CAUTI. The catheterization rate was 16.7% (95% confidence interval [CI], 15.3%-18.2%), and the overall CAUTI incidence rate was 14.7/1000 device-days (95% CI, 11.7-18.3/1000). Mortality was significantly higher in catheterized patients with a CAUTI compared with noncatheterized patients (19.2% vs 10.5%; P < .05). Female sex (odds ratio [OR], 1.31; 95% CI, 1.06-1.67), increasing age (≥90 years: OR, 2.76; 95% CI, 2.00-3.83), and longer hospital stay before catheter insertion (≥15 days: OR, 2.90; 95% CI, 2.20-3.83) were independent risk factors for catheterization; increasing age (>90 years: OR, 2.75; 95% CI, 1.03-7.35), and duration of hospital stay before catheter insertion (OR, 2.41; 95% CI, 1.12-5.51) were associated with CAUTIs. CONCLUSIONS These results underscore the importance of the proper choice of patients for catheterization, particularly in individuals aged >90 years.
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Affiliation(s)
- Daniela Vincitorio
- Medical Direction Department, National Institute for Health and Science on Ageing, Istituto Nazionale di Ricovero e Cura per Anziani-Istituto di Ricovero e Cura a Carattere Scientifico, Ancona, Italy
| | - Pamela Barbadoro
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy.
| | - Lucia Pennacchietti
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Ilaria Pellegrini
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Serenella David
- Medical Direction Department, National Institute for Health and Science on Ageing, Istituto Nazionale di Ricovero e Cura per Anziani-Istituto di Ricovero e Cura a Carattere Scientifico, Ancona, Italy
| | - Elisa Ponzio
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Emilia Prospero
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy
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Cheng HWB, Sham MK, Chan KY, Li CW, Au HY, Yip T. Combination therapy with low-dose metolazone and furosemide: a “needleless” approach in managing refractory fluid overload in elderly renal failure patients under palliative care. Int Urol Nephrol 2014; 46:1809-13. [PMID: 24824145 DOI: 10.1007/s11255-014-0724-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 04/21/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Hon Wai Benjamin Cheng
- Palliative Medical Unit, Grantham Hospital, 125 Wong Chuk Hang Road, Aberdeen, Hong Kong, China,
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Meddings J, Rogers MAM, Krein SL, Fakih MG, Olmsted RN, Saint S. Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review. BMJ Qual Saf 2014; 23:277-89. [PMID: 24077850 PMCID: PMC3960353 DOI: 10.1136/bmjqs-2012-001774] [Citation(s) in RCA: 238] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 05/16/2013] [Accepted: 07/26/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Catheter-associated urinary tract infections (CAUTI) are costly, common and often preventable by reducing unnecessary urinary catheter (UC) use. METHODS To summarise interventions to reduce UC use and CAUTIs, we updated a prior systematic review (through October 2012), and a meta-analysis regarding interventions prompting UC removal by reminders or stop orders. A narrative review summarises other CAUTI prevention strategies including aseptic insertion, catheter maintenance, antimicrobial UCs, and bladder bundle implementation. RESULTS 30 studies were identified and summarised with interventions to prompt removal of UCs, with potential for inclusion in the meta-analyses. By meta-analysis (11 studies), the rate of CAUTI (episodes per 1000 catheter-days) was reduced by 53% (rate ratio 0.47; 95% CI 0.30 to 0.64, p<0.001) using a reminder or stop order, with five studies also including interventions to decrease initial UC placement. The pooled (nine studies) standardised mean difference (SMD) in catheterisation duration (days) was -1.06 overall (p=0.065) including a statistically significant decrease in stop-order studies (SMD -0.37; p<0.001) but not in reminder studies (SMD, -1.54; p=0.071). No significant harm from catheter removal strategies is supported. Limited research is available regarding the impact of UC insertion and maintenance technique. A recent randomised controlled trial indicates antimicrobial catheters provide no significant benefit in preventing symptomatic CAUTIs. CONCLUSIONS UC reminders and stop orders appear to reduce CAUTI rates and should be used to improve patient safety. Several evidence-based guidelines have evaluated CAUTI preventive strategies as well as emerging evidence regarding intervention bundles. Implementation strategies are important because reducing UC use involves changing well-established habits.
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Affiliation(s)
- Jennifer Meddings
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Mary A M Rogers
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Sarah L Krein
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Mohamad G Fakih
- Department of Internal Medicine, St. John Hospital and Medical Center, Detroit, Michigan, USA
| | | | - Sanjay Saint
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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Wynne R, Patel M, Pascual N, Mendoza M, Ho P, Qian D, Thangavel D, Law L, Richards M, Hobbs L. A single centre point prevalence survey to determine prevalence of indwelling urinary catheter use and nurse-sensitive indicators for the prevention of infection. ACTA ACUST UNITED AC 2014. [DOI: 10.1071/hi13031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kwok CS, Pal A, Sargen K. Cystogram use and outcomes in colorectal surgery involving bladder repair: a clinical audit. ANZ J Surg 2013; 85:774-6. [PMID: 24224778 DOI: 10.1111/ans.12440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND The role of routine cystograms after bladder repair during colorectal surgery is unclear so we aimed to evaluate this in our department. METHODS We conducted a retrospective audit of colorectal surgical patients who had an operation and subsequent cystogram between 2006 and 2011 at the Norfolk and Norwich University Hospital. Data on patient characteristics, operative procedures and findings, and cystogram results were collected from electronic discharge summaries, operative notes and radiological records. RESULTS A total of 59 operations were included and 92% had documented bladder involvement. The most common indications for surgery were diverticular disease (49%) and neoplastic disease (39%). Operations evaluated included high anterior resection, anterior resection, Hartmann's procedures and sigmoid colectomy. Although all patients had at least one post-operative cystogram, only 46% of cases had instructions documented in the operative note for a cystogram to be arranged. Out of the 59 operations, 4 (7%) had cystograms that showed a leak. Repeat cystography in these cases showed no leak or smaller leak and no additional procedures were required. Two of the leaks occurred in cases that had extensive bladder involvement or bladder wall sepsis, and two occurred in cases where the operative findings revealed less major bladder pathology. CONCLUSIONS Our results suggest that majority of cystograms are negative. More studies are needed to evaluate if selective use of cystogram should be performed to reduce unnecessary the risks associated with radiation exposure and contrast exposure.
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Affiliation(s)
- Chun Shing Kwok
- Department of General Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - Atanu Pal
- Department of General Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - Kevin Sargen
- Department of General Surgery, Norfolk and Norwich University Hospital, Norwich, UK
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Meddings J. Interventions to reduce urinary catheter use: it worked for them, but will it work for us? BMJ Qual Saf 2013; 22:967-71. [PMID: 24050982 DOI: 10.1136/bmjqs-2013-002331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Preventing catheter-associated urinary tract infections in acute care: the bundle approach. J Nurs Care Qual 2012; 27:209-17. [PMID: 22327333 DOI: 10.1097/ncq.0b013e318248b0b1] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Catheter-associated urinary tract infections account for 40% of all nosocomial infections. A multidisciplinary team implemented evidence-based guidelines and a urinary catheter bundle, focusing on optimizing the use of urinary catheters through continual assessment and prompt catheter removal. Data were obtained on catheter device days, compliance with urinary catheter orders, and computer documentation of continued catheter indications. Results included an overall reduction of 71% in catheter device days and a 56% reduction in catheter use.
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Active training and surveillance: 2 good friends to reduce urinary catheterization rate. Am J Infect Control 2012; 40:692-5. [PMID: 22632823 DOI: 10.1016/j.ajic.2012.01.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 01/16/2012] [Accepted: 01/17/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Because catheter-associated urinary tract infections (CAUTI) represent the most frequent health care-associated infection (HAI), we implemented an educational intervention on urinary catheter use to reduce the CAUTI rate. METHODS The intervention was focused on correct management of catheterized patients. To assess the participants' knowledge, pre- and post-tests were performed. An active CAUTI surveillance program took place in a 900-bed teaching hospital in central Italy before and after the educational intervention. CAUTI definition, catheterization rate, and CAUTI rate were expressed according to the Centers for Disease and Prevention/National Healthcare Safety Network definitions. The level of significance was set at P ≤ .05. RESULTS Two hundred ninety-six health care workers attended the educational intervention; the analysis of the pre- and post-tests highlighted a statistically significant improvement (P < .05). Before the intervention, mean catheterization rate was 18.5% (95% confidence interval [CI]:18.1-18.9); 46 cases of CAUTI were detected, with an incidence rate of 6.6/1,000 catheter-days (95% CI: 4.8-8.8). After the intervention, mean catheterization rate was 9.2% (95% CI: 8.9-9.5); 19 cases of CAUTI were detected, with an incidence rate of 5.8/1,000 catheter-days (95% CI: 3.5-9.0). CONCLUSION Through an active educational update and thanks to the implementation of a surveillance system, a successful reduction of catheterization rate was achieved. More efforts are needed to preserve this goal and to improve the CAUTI rate also.
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Laurent M, Bories PN, Le Thuaut A, Liuu E, Ledudal K, Bastuji-Garin S, Paillaud E. Impact of Comorbidities on Hospital-Acquired Infections in a Geriatric Rehabilitation Unit: Prospective Study of 252 Patients. J Am Med Dir Assoc 2012; 13:760.e7-12. [DOI: 10.1016/j.jamda.2012.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Revised: 07/01/2012] [Accepted: 07/02/2012] [Indexed: 11/29/2022]
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