Knowing IS the Battle: Evidence-Based Infection Prevention Practices & Outcome Metrics in Nursing Homes

Abstract

<h3>Background</h3> A robust infection prevention and control (IPC) program is critical for a safe nursing home (NH) resident environment. Data sharing, auditing with feedback on performance, and implementation of evidence-based practices are cornerstones of an effective IPC program. The purpose of this study was to identify outcome and process measures data that are collected and shared in NHs, and specific IPC strategies used to prevent both non-catheter and catheter-associated urinary tract infections (UTIs and CAUTIs). <h3>Methods</h3> Over a two-year period, 50 NHs participated in a 12-month program to reduce healthcare-associated infections by enhancing relationships between NHs and hospitals. A 36-question survey on IPC facility characteristics was distributed; 11 surveys were administered between January-March 2018 and another 39 administered January-February 2019. Missing responses for individual questions were omitted from analyses. Surveys were completed by infection preventionists, directors of nursing, or NH administrators. <h3>Results</h3> All 50 NHs (100%) completed the survey. 92% of responding NHs were aware of their facility's UTI/CAUTI rates. When asked about process measures, 48% knew their facility's hand hygiene rates and 44% their glove/gown use rates. While all 100% indicated they share infection data with NH leadership, only 72% share infection data with bedside nursing staff and 32% with residents and families. UTI/CAUTI prevention strategies implemented by NHs included hydration practices (83%); nurse-initiated indwelling urinary catheter (IUC) discontinuation (65%); stop orders for IUCs (46%); multidisciplinary rounds examining indwelling devices (33%); and electronic alerts/reminders of IUC need (25%). Despite evidence to the contrary, 56% reported cranberry juice/tablet use to prevent UTI/CAUTI. Two NHs (0.04%) reported having no UTI/CAUTI prevention strategies. <h3>Conclusions</h3> While awareness of UTI and CAUTI rates is high, process measures like facility hand hygiene rates are not evaluated consistently. Additionally, data are not routinely shared with stakeholders. NHs have made significant progress operationalizing many evidence-based infection prevention practices but gaps exist.