Catheter-associated Urinary Tract Infection Bundle Research Articles

Analysis of CAUTIs and Projected Effect of Increasing Pyuria Threshold in Urinalysis with Reflex to Culture

Background: Catheter-Associated Urinary Tract Infections (CAUTI) are preventable hospital acquired infections that contributes to patient morbidity, prolonged hospital stays and increased healthcare costs. Complete compliance to the CAUTI bundle is critical for preventing infection—not only reducing catheter days, but also ensuring appropriate indications are present for urine culture collection. Methods: This retrospective study included 145 patients diagnosed with CAUTI per NHSN definitions from July 1, 2020 to June 30, 2023. Data collected included laboratory data, catheter duration, catheter indication, urinalysis/culture indication and if foley was appropriately removed/changed prior to specimen collection. A urinary catheter indication order was implemented in February 2021 requiring providers to select specific criteria for catheter placement/maintenance. In July 2023, the threshold for urinalysis to reflex to culture was increased to ≥10 WBCs and this criteria was applied to these cases to estimate the effect on diagnosis of CAUTI. Results: The most common indications for urinary catheters were input and output monitoring 76 (52%) and urinary retention/obstruction 34 (23%). No indication was entered on 22 (15%) patients. No difference was seen in the number of catheters without an indication before or after the 2021 order update. Mean catheter duration was 11.5 days with a median of 7 days. The most common indications for obtaining a urine specimen were leukocytosis/fever/sepsis 91 (63%), urinary symptoms/abdominal/flank pain 13 (9%), urine appearance 6 (4%), and altered mental status 4 (3%). In 31 (21%) patients, no indication was identified. A urinalysis with reflex to culture was completed in 105 (72%) and the catheter was removed prior to culture collection in 68 (47%). Of the 127 patients with a urinalysis and culture, 11 had 0-5 WBCs, 16 had 6-9 WBCs, 15 had 10-20 WBCs and 85 had >20 WBCs. Using the new pyuria criteria for urinalysis to reflex to culture, 27 (19%) CAUTIs could have been avoided. Conclusion: Review of CAUTI cases identified opportunities for improving documentation and education of appropriate indications for urinary catheters and evaluation of urinary tract infection. The majority of urine cultures were obtained due to non-specific symptoms and less than 10% had specific urinary symptoms indicating need for continued education and diagnostic stewardship. Increasing the pyuria threshold needed to reflex to culture has the potential to significantly reduce CAUTIs but additional education is needed to ensure catheters are changed prior culture collection and specimens are only sent when signs and symptoms of urinary tract infection are present.

Effectiveness of catheter-associated urinary tract infections bundle approach to reduce urinary catheter associated infection rate among children admitted in Paediatric unit

Background: CAUTI bundle care aims to reduce catheter associated urinary tract infection, enhance quality of life and promote comfort. The present study aimed to assess the effect of CAUTI bundle approach on urinary catheter associated infection rate among children admitted in paediatric unit of KGMU. Methods: Quantitative research approach was done on 46 children who were admitted in paediatric unit, KGMU, Lucknow. Purposive sampling technique was used. Socio demographic was obtained by socio demographic Performa, CAUTI was assessed by urine culture test and symptomatic assessment of UTI. Results: The result revealed that on the basis of urine culture results, in exposed group majority of the children that is 18 (78.26%) was sterile and rest 5 (21.73%) was infected and in unexposed group 13 (56.52%) children was sterile and remain 10 (43.47%) was infected. And on the basis of symptomatic assessment for CAUTI, in exposed group majority of the children that is 17 (73.91%) are less symptomatic and remain 6 (26.08%) was more symptomatic for CAUTI and in unexposed group most of the children that is 14 (60.86%) was less symptomatic for CAUTI and rest 9 (39.13%) was more symptomatic for CAUTI. Conclusions: CAUTI bundles approach provides evidence-based prevention practices and strategies to reduce CAUTI. The present study found that CAUTI bundle care was effective in reducing CAUTI in children.

Implementation of a multi-modal intervention adopting new technologies, clinical services, and feedback improves catheter-associated urinary tract infections

ABSTRACT Objectives Catheter-associated urinary tract infections (CAUTI) are a significant cause of morbidity and financial burden to healthcare systems. The aim of this study was to develop and implement a program designed to reduce Foley catheter use days and associated CAUTI rates. Methods A retrospective evaluation of a multi-modal program aimed toward reducing Foley catheter use days and associated CAUTI rates across the Indiana University Health (IUH) system was conducted. IUH is comprised of 16 hospitals and 2,703 available beds. The program included the adoption of new technologies with evidence-based clinical training materials based on change management and feedback from clinicians. National Healthcare Safety Network Standardized Infection Ratio (SIR), Standardized Utilization Ratio (SUR), and Incidence Density Ratio (IDR) rates were assessed. Results Implementation of the multi-modal program resulted in a significant reduction in SIR, SUR, and IDR in the post-implementation compared to the baseline periods. Conclusions Through CAUTI bundle workflow assessments, education, and interventions designed to standardize practice variation, the program was successfully implemented and resulted in a significant decrease in Foley Catheter use days, and associated CAUTI rates.

When the Catheter-Associated Urinary Tract Infection Bundle Is Not Enough.

Patients with cancer who are immunocompromised are at risk for catheter-associated urinary tract infections (CAUTIs). Many recommendations are available for healthcare organizations to use to reduce CAUTIs. Implementing vario.

MP34-18 ONGOING EFFORTS AT MAINTAINING CATHETER-ASSOCIATED URINARY TRACT INFECTION BUNDLE PROVE TO BE EFFECTIVE: AN EIGHT YEAR EXPERIENCE

You have accessJournal of UrologyCME1 Apr 2023MP34-18 ONGOING EFFORTS AT MAINTAINING CATHETER-ASSOCIATED URINARY TRACT INFECTION BUNDLE PROVE TO BE EFFECTIVE: AN EIGHT YEAR EXPERIENCE Joshua Altschuler, Olena Dzenkevych, Angela Gabasan, Barbara Smith, Nicholas Sells, Krystina Woods, and Jay A. Motola Joshua AltschulerJoshua Altschuler More articles by this author , Olena DzenkevychOlena Dzenkevych More articles by this author , Angela GabasanAngela Gabasan More articles by this author , Barbara SmithBarbara Smith More articles by this author , Nicholas SellsNicholas Sells More articles by this author , Krystina WoodsKrystina Woods More articles by this author , and Jay A. MotolaJay A. Motola More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003268.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Catheter-associated urinary tract infections (CAUTIs) account for a large proportion of urinary tract infections and account for a major healthcare expenditure nationwide. The risk of CAUTI increases 5% with each day (d) of catheterization. For over a decade, we have implemented an evidence-based, joint commission and Centers for Disease Control approved CAUTI Bundle (CB). We seek to prove if after achieving low CAUTI rates in prior years if the manpower needed to do this is worthwhile. METHODS: We collected data from hospitals 1 and 2 (H1 and H2) in an urban healthcare system. Daily catheter (C) use and maintenance are monitored by a multidisciplinary hospital team. Compliance is determined by several factors: maintaining integrity of tamper-evident seal, keeping C bag below to gravity below bladder and off of floor, C secured to leg (no tape), labeled drainage bag, daily perineal care and daily C order renewal. We recorded device days (dd), utilization rates (dd/patient d) and standardized infection ratios (SIR). Non-compliance for C orders and C in > than 4 d in ICUs or >2 d in non-ICU were promptly addressed by hospital administration. RESULTS: Over the last 8 years, CAUTI rates have remained relatively stable. C utilization steadily increased between 2017 and 2021, plateauing this calendar year. SIR increased at H2 (Table 1), attributable to a busy cardiac surgery service that routinely uses C, in addition to an ever-growing population of nursing home patients with indwelling C. Figure 1 shows overall CB and C order compliance rates. Figure 2 shows compliance rates broken down by parameters of CB for H 1 & 2. CONCLUSIONS: As utilization rates have plateaued this calendar year, we have consistently sustained SIR<1 using our CB compliance model (CBCM) across multiple institutions with different cultures and practitioners. Efforts to further improve CAUTI incidence are ongoing with hospital-wide education programs teaching proper catheterization technique, device management and specimen collection. This study clearly demonstrates the benefits of maintaining the CAUTI bundle, and suggests that the resources required to maintain low infection rates may offset the non-reimbursable costs associated with CAUTI. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e466 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joshua Altschuler More articles by this author Olena Dzenkevych More articles by this author Angela Gabasan More articles by this author Barbara Smith More articles by this author Nicholas Sells More articles by this author Krystina Woods More articles by this author Jay A. Motola More articles by this author Expand All Advertisement PDF downloadLoading ...

Abstract TP85: A Collaborative Approach In The Reduction Of Hospital Acquired Infections In A Neuroscience ICU

Intro: HAIs such as catheter associated urinary tract infections (CAUTIs) and central line associated bloodstream infections (CLABSIs) increase morbidity, mortality, healthcare cost, and account for a significant burden of patient harm. We describe efforts between nursing, Infection Prevention (IP), and clinicians in the reduction of HAI-CAUTIs and HAI-CLABSIs on a neuroscience intensive care unit (NeuroICU) in an academic acute care hospital. Methods: Using the Centers for Disease Control and Prevention’s (CDC) Targeted Assessment for Prevention (TAP) framework [Target, Assess, Prevent], IP identified the Neuro-ICU as having an excess burden of HAI-CAUTIs and HAI-CLABSIs and facilitated interdisciplinary engagement. In partnership, nursing, IP, and Neuro-ICU clinicians, developed action plans focused on foley catheter (FC) and central line (CL) utilization, FC bundle compliance, FC maintenance competency validation, and training on central line maintenance. Monthly meetings to discuss progress and identify barriers were performed. Neuro-ICU clinicians and nurse managers performed device rounds twice a day to discuss device necessity utilizing a nurse-driven protocol, and verified FC and CL removal. This project used the CDC’s National Healthcare Safety Network (NHSN) healthcare-associated infection (HAI) tracking system to compute standardized infection ratios, HAI events, FC utilization, and CL utilization. CLABSI and CAUTI bundle compliance were evaluated using an electronic audit tool. Staff competency validation and education attendance were tracked. The project period was from September 2020-July 2021 for CAUTI and January 2021-July 2021 for CLABSI. Results: HAI-CAUTI events decreased from 6 to 1, the standardized infection ratio (SIR) reduced from 3.003 to 0.593, and the FC utilization ratio decreased from 0.36 to 0.31 from October 2019- August 2020 to September 2020-July 2021. HAI-CLABSI events decreased from 1 to 0, CL utilization ratio decreased from 3.31 to 2.81 from June 2020- December 2020 to January 2021- July 2021. Conclusions: These results suggest that an interdisciplinary approach and robust IP practices may be an effective approach to improving patient safety and reducing patient harm.

The Compliance of Hospital Nurse in the Prevention of Urinary Tract Infection in Surabaya, Indonesia

Background: Catheter-Associated Urinary Tract Infection (CAUTI) is one of the most common infections in the hospital. In order to prevent and control CAUTI incidence, nurses are required to implement bundles of prevention. However, the lack of nurses’ compliance behavior in implementing the CAUTI bundle prevention was found. Objective: This study analyzes the nurse’s compliance behavior in implementing CAUTI prevention using the Theory of Planned Behavior (TPB) approach. Methods: This study was an analytical descriptive study with a cross-sectional design. Nurses who work in ICU, ICCU, HCU, and in-patient unit of the hospital were set as study population and taken as samples using simple random sampling. Background factors (age, education, knowledge, employment duration, career levels), attitudes, subjective norms, Perceived Behavior Control (PBC), and intention were determined as independent variables. In contrast, nurses’ compliance behavior in CAUTI prevention bundle implementation was determined as the dependent variable. Data were collected using a questionnaire and analyzed using logistic regression with a significance level of α &lt; 0.05. Results: Among 111 nurses, most of them are in the age of 26-45 years (80.1%), has worked as a nurse for 8-13 years (29.7%), reach career level at Clinical Nurse 3 (51.4%), and have good knowledge about CAUTI prevention bundle (83.8%). The employment duration and career levels are background factors that correlate the most to the TPB factors. The nurses’ compliance behavior is influenced by attitude, subjective norm, PBC, and intention (P Value= 0.000). Multivariate analysis shows that intention is associated with nurses’ compliance behavior and increases nurses’ commitment to implement CAUTI prevention bundle (P Value= 0.033, OR= 6.46). Conclusion: The intention simultaneously influences the nurses’ compliance behavior.

Prevention of catheter associated urinary tract infections: Assessment of knowledge and practices among nurses in a tertiary care centre in Nigeria

Background: Catheter-associated urinary tract infections (CAUTI) are responsible for up to 80% of healthcare associated infections. Recommended strategies to prevent CAUTI are based on implementation of a ‘care bundle’. Nurses are responsible for catheter care, yet few studies have been conducted in developing countries to assess their understanding of CAUTI and the care bundle. The study aimed to assess the knowledge and practices toward prevention of CAUTI among nurses. Methods and materials: A cross-sectional study was carried out in a tertiary hospital in Edo state, Nigeria between January and July 2019 among 200 consenting nurses recruited through a systematic sampling process. Data was collected using pretested questionnaires. A checklist was used for observation of patients with an indwelling catheter to assess compliance with CAUTI maintenance bundle. Analysis was done using the Statistical package for social sciences. Ethical approval was obtained. Results: One hundred and eighty nurses completed the study giving a response rate of 90%. Majority, 138 (76.7%) had fair knowledge of CAUTI and its prevention, 42 (23.3%) had poor knowledge. Gaps in knowledge were observed in the areas of appropriate indications for urinary catheterization, catheter care including removal, and risk factors for CAUTI. One hundred and forty-nine (82,8%) respondents had positive attitude although slightly above half erroneously believed that catheter removal should be at the convenience of nurses. Neither knowledge nor attitude was associated with any demographic characteristic. One hundred and three (71.0%) respondents had good practice and 42 (29.0%) poor practice of the CAUTI bundle. Practice was not associated with any demographic variable, but significantly associated with knowledge (χ2 8.62, df = 1, p < 0.001). One hundred and fifty-eight (87.8%) respondents had received training on catheter care as part of their nursing education, however there was no association between previous training and knowledge or practice of CAUTI prevention. Findings from the check list showed meatal hygiene not performed daily (23.8%) and urine bag and tubing on the floor (38.1%). Conclusion: There is an urgent need for education intervention to improve the knowledge and practices of CAUTI prevention bundle among nurses in the study area.

Resident Distraction as a Strategy to Improve Perineal Care and Reduce Catheter Associated Urinary Tract Infections in Long-Term Care

<h3>Background</h3> Catheter Associated Urinary Tract Infections (CAUTIs) can lead to sepsis and death in the elderly. Despite good compliance with the CAUTI bundle, the CAUTI rates in the 116 bed long-term care facility were stagnant. Safety huddles are utilized by patient safety after an event and was trialed by Infection Prevention and Control to explore its effectiveness after an infection event. Combativeness in residents surfaced as the root cause. Our objective was to reduce CAUTI incidence by taking a team approach where one member would distract combative residents during perineal care. <h3>Methods</h3> Baseline period was January 2016 to March 2017. A tool was developed for the huddle process which included practices related to CAUTI (catheter insertion and maintenance including irrigation, perineal care and catheter care). The tool was reviewed with front line nurses and nursing assistants caring for each resident within a week of identifying the CAUTI. These huddles revealed good knowledge of the CAUTI bundle, catheter care and maintenance. Three huddles were conducted between January and April 2017 and a common barrier of combativeness in residents during peri-care was identified. Intervention period (distracting the resident to reduce combativeness) was from April 2017 to September 2018. <h3>Results</h3> During the study period CAUTIs were reduced by 73% from a baseline CAUTI rate of 1.86 per 1000 urinary catheter days (with 12 CAUTI and 6,440 catheter days in a 15-month period) to 0.51 per 1000 urinary catheter days during the intervention period (4 CAUTI and 7,909 catheter days in an 18-month period) (p-value 0.02). <h3>Conclusions</h3> The event huddle revealed resident combativeness as the root cause for inability to perform excellent perineal care. Providing distraction through a team approach during perineal care has resulted in dramatic reduction in CAUTI incidence at this long-term care facility.

Preventing Catheter-Associated Urinary Tract Infections in the Pediatric Intensive Care Unit.

Catheter-associated urinary tract infections are common health care-associated infections and have been associated with increased mortality, morbidity, length of stay, and cost. Prevention strategies are grouped into bundles focused on reducing unnecessary catheter use and promptly removing urinary catheters. Before intervention in the study institution, no urinary catheters were unnecessarily used and compliance with the catheter-associated urinary tract infection bundle was 84%. To increase bundle compliance by using targeted rounds specifically focused on eliminating dependent loops in drainage tubing and ensuring appropriate catheter use to reduce the incidence of catheter-associated urinary tract infections. A multidisciplinary team was formed to identify misperceptions, highlight best practices, and eliminate barriers to success over 1 year in a single pediatric intensive care unit. The team completed a quality improvement project of daily targeted rounding for patients with an indwelling urinary catheter. The goals were to assess appropriateness of catheterization, increase bundle compliance, and decrease catheter-associated urinary tract infection risk. Targeted rounds were conducted in addition to the medical team rounds. Bundle compliance supported by targeted rounding increased from 84% to 93% and helped reduce the overall catheter-associated urinary tract infection rate from 2.7 infections per 1000 catheter-days at baseline to 0. This change was sustained for 1 year. Targeted rounding for pediatric patients with an indwelling urinary catheter is an effective and sustainable strategy to reduce catheter-associated urinary tract infections. The ease of implementation for this intervention lends itself to generalizability to other patient populations.

Auditing CAUTI Best Practices Bundle Adherence in a 24-bed Neurovascular/Cardiovascular/Intensive Care Unit

BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are the most common healthcare-associated infection (HAI) in the United States. The Centers for Disease Control and Prevention (CDC) recommends monitoring, and documentation of auditing catheter care practices. To reduce CAUTI rates in the Neurovascular/Cardiovascular/Intensive Care Unit (ICU), a Minnesota hospital conducted audits of CAUTI bundle compliance between March 1st and October 30th, 2018 and measured the correlation between bundle compliance and incidence of CAUTI. METHODS Three audits on patients with indwelling catheters were conducted weekly in the ICU using the Joint Commission's CAUTI tracer tool. Staff on the unit floor were given verbal feedback in real time. Compliance was reported to hospital leadership weekly. ?Incidence of CAUTI was tracked monthly and reported to the National Healthcare Safety Network (NHSN) and hospital leadership. Using SAS version 9.4 a Poisson regression analysis was ?conducted to determine correlation between individual elements of the tracer and ICU infection rates. Adherence to the entire bundle was also examined. RESULTS No statistically significant correlation was found between compliance with elements of the tracer and CAUTI rates. Correlation between adherence to the full bundle and CAUTI rates was found to be approaching significance (p=0.06). The most common noncompliant elements of the tracer were missing indications for catheter placement in the order, dependent loops, and missing tamper evidence seals. CAUTI rates in the ICU increased during this time period while audit compliance remained constant. CONCLUSIONS Auditing CAUTI bundle compliance did not reduce CAUTI rates in this ICU. We were able to determine areas to focus on when educating staff on best practices to prevent CAUTI. Adhering to a CAUTI bundle is best practice, but auditing bundle compliance does not have an appreciable effect on CAUTI rates. Facilities should focus more on initial education around best practices to prevent CAUTI than on maintenance auditing.

Targeting Catheter-Associated Urinary Tract Infections in a Trauma Population: A 5-S Bundle Preventive Approach.

Complications from catheter-associated urinary tract infections (CAUTIs) can cause morbidity and mortality. Our institution's Trauma Quality and Improvement Program analysis identified CAUTIs as an outlier complication in our trauma population. This study aimed to determine whether implemented measures would reduce CAUTI rates in trauma population. A 5-S CAUTI bundle was implemented. Its effects were measured on a prospectively collected dataset of adult trauma patients using our Trauma Registry during the 4-year study period. Implemented measures included (1) staff education, (2) bladder catheter stabilization, (3) patient and caregiver education, (4) keeping the collection bag below the bladder and above the floor, and (5) daily evaluations for discontinuation. Chi-squared and t-test analyses were used with significance defined as p < .05. Twelve thousand nine hundred and sixty-two trauma patients were admitted to trauma service during the 4-year study period. Of these, 94 developed CAUTIs, with an average age of 67 years and 56% were females. The average injury severity score was 16 in patients with CAUTIs compared with 9 in non-CAUTI patients (p < .0002). In the index year, CAUTIs occurred in 41 out of 3,054 (1.34%), the following year there were 34 out of 3,455 (0.98%), in 2016 there were 11 out of 3,246 (0.33%), and 8 out of 3,207 (0.25%) in 2017 (p < .001). Results demonstrated an 80% reduction in CAUTI rate. Execution of the 5-S CAUTI bundle resulted in a significant 80% reduction in CAUTI rate in our trauma population.

Achieving balance between implementing effective infection prevention and control practices and maintaining a home-like setting in U.S. Department of Veterans Affairs nursing homes

Nursing homes present a unique challenge for implementing infection prevention and control practices while striving to maintain a home-like environment. Medical devices such as urinary catheters and central venous catheters have become a part of nursing home care but can predispose residents to associated infections. Because evidence-based prevention bundles were implemented, catheter-associated urinary tract infections (CAUTIs) and central line-associated bloodstream infections (CLABSIs) were monitored in all U.S. Department of Veterans Affairs (VA) nursing homes, and outcomes were evaluated. Bundle components for CLABSIs focused on insertion technique, site selection, and routine assessment of central line necessity, while the CAUTI bundle focused on insertion technique, appropriate indication, and routine assessment of urinary catheter necessity. From October 2010 through September 2016, VA nursing homes reported nationwide reductions of CAUTIs (51.2%; P < .0001) and CLABSIs (25.0%; P = .0009).

Implementation of a national bundle care program to reduce catheter-associated urinary tract infection in high-risk units of hospitals in Taiwan.

This study was intended to investigate the impact of implementation of catheter-associated urinary tract infection (CA-UTI) bundle care on the incidence of CA-UTI in high-risk units. Thirteen high-risk units, including medical (n=5), surgical (n=3), cardiac intensive care units (n=2), respiratory care centers (n=2), and respiratory care ward (n=1) were included in this quality-improvement project. This study was divided into pre-intervention phase (from January 1 to July 31) and post-intervention phase (from August 1 to October 31) in 2013. The incidence of CA-UTI decreased by 22.7%, from 3.86 to 2.98 per 1000 catheter-days (95% confidence interval, 0.65-0.82; p<0.0001) before and after the introduction of the CA-UTI bundle. Among 66 episodes of culture-proven CA-UTIs, Candida spp. were the most common pathogens (n=17, 25.8%), followed by Escherichia coli (n=10, 15.2%). For the seven elements of the insertion bundle, the compliance was the lowest for cleaning of the perineum, followed by hand hygiene. The overall compliance rates of the insertion bundle were 93.4%, 99.5%, and 96.3% in medical centers, regional hospitals, and district hospital, respectively. For the six elements of the maintenance bundle, the compliance was the lowest for daily review of the need of a Foley catheter. The overall compliance rates of the maintenance bundle were 95.7%, 99.9%, and 99.9% in medical centers, regional hospitals, and district hospital, respectively. The implementation of CA-UTI bundle care successfully reduced CA-UTI in Taiwanese high-risk units. A process surveillance checklist can be helpful for understanding which parts of the bundle care require improvements.

Using Data to Drive and Sustain Practice Changes in Conquering Catheter-Associated Urinary Tract Infections

BACKGROUND: A 1,541 bed academic hospital had 65 catheter-associated urinary tract infections (CAUTIs) throughout 8 adult and pediatric intensive care units (ICUs) in 2015. The standardized infection ratio (SIR) 0.53 placed the institution at a “lower than expected” SIR in the National Healthcare Safety Network (NHSN) system. This was a decrease in CAUTI events of 108 in 2014 and a SIR of 1.48 resulting in a “higher than expected” NHSN benchmark for the institution. A CAUTI bundle education was provided to nursing and medical staff who insert catheters from January- September 2015. An interdisciplinary CAUTI Prevention Charter utilized a Plan-Do-Study-Act (PDSA) method to reduce and sustain CAUTIs below expected benchmark levels.

Virtual Breakthrough Series, Part 1: Preventing Catheter-Associated Urinary Tract Infection and Hospital-Acquired Pressure Ulcers in the Veterans Health Administration

In 2014 the Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA) implemented a Virtual Breakthrough Series (VBTS) collaborative to help VHA facilities prevent hospital-acquired conditions: catheter-associated urinary tract infection (CAUTI) and hospital-acquired pressure ulcers (HAPUs). During the prework phase, participating facilities assembled a multidisciplinary team, assessed their current system for CAUTI or HAPU prevention, and examined baseline data to set improvement aims. The action phase consisted of educational conference calls, coaching, and monthly team reports. Learning was conducted via phone, web-based options, and e-mail. The CAUTI bundle focused on four key principles: (1) avoidance of indwelling urinary catheters, (2) proper insertion technique, (3) proper catheter maintenance, and (4) timely removal of the indwelling catheter. The HAPU bundle focused on assessment and inspection, pressure-relieving surfaces, turning and repositioning, incontinence management, and nutrition/hydration assessment and intervention. For the 18 participating units, the mean aggregated CAUTI rate decreased from 2.37 during the prework phase to 1.06 per 1,000 catheter-days during the action (implementation) phase (p < 0.001); the rate did not change for CAUTI nonparticipating sites. HAPU data were available only for 21 of the 31 participating units, whose mean aggregated HAPU rate decreased from 1.80 to 0.99 from prework to continuous improvement (p < 0.001). Staff education and documentation improvement were the most frequently implemented changes. This project helped improve CAUTI and HAPU rates in the VHA and presents a promising model for implementing a virtual model for improvement.

Evaluation of the Utilization of Catheter Associated Urinary Tract Infection Bundle Among Critical Care Nurses - Kenyatta National Hospital

Majority if not all patients admitted to the Critical Care Units (CCUs) have indwelling urinary catheters predisposing them to Catheter Associated Urinary Tract Infections (CAUTI). CAUTI bundle was introduced to reduce the infections whose prevalence had been high. Utilization of this bundle is considered standard gold and should be utilized completely by nurses while providing care to the patients. The aim of this study was to determine the utilization of the CAUTI bundle among critical care nurses at Kenyatta National Hospital’s (KNH’s). The study applied a cross-sectional descriptive design with cluster sampling and simple random sampling for each cluster. Ninety five critical care nurses were selected from a total of 136 nurses using Cochran’s formulae. A structured questionnaire and an observation checklist were used to collect data which was analyzed using the Statistical Package for Social Sciences (SPSS) version 21.0. Descriptive statistics was used to summarize the data and inferential statistics (Chi-square test, odds ratio and Pearsons’ correlation) was used to establish relationships between variables. Nurses working at KNH’s CCUs utilized and adhered (49.5%; P >0.005) to the bundle. There was a weak correlation between the observed and reported bundle utilization [r = 0.043; 95% CI 0.16 – 0.24; P = 0.678].

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Introduction: The prevention of hospital-related infections continues to be a major concern for Accountable Care Organizations (ACOs) who are interested in optimal patient outcomes. The prevalence of hospital acquired catheter-associated urinary tract infections (CAUTI) remains a subject that requires ongoing research in the implementation of standardized protocols for improved patient outcomes. Methods: A multidisciplinary team implemented an evidence-based quality improvement practice change to examine the use of a CAUTI bundle in both a Surgical/Trauma (SICU) and a Medical Intensive Care Unit (MICU). Historical data of CAUTI incidence was used for comparison. Phase 1 included staff education followed by daily audits and data collection of bundle compliance over a 3 month period. Interim analysis of the data suggested further optimization of the maintenance catheter bundle. Key changes included implementation of routine foley catheter changes every 7 days and twice a day pericare. Data collection is ongoing. Results: The initial maintenance bundle compliance was 80% for the SICU and 71% for the MICU with both units increasing to 100% at the end of 3 months. CAUTI incidence rate for 2012 was 22 cases for SICU and 40 cases for MICU. During the first phase there were 102 catheter insertions equally divided between AM and PM shifts. Compliance with the insertion bundle after initial education was 97% increasing to 100% at the end of 3 months. Post-initiation of the bundle did result in a reduction overall in the first quarter of 2013 cases with 11 MICU cases and 7 SICU cases reported. Subsequently, the implementation of routine catheter change and pericare resulted in a 55% MICU and 86% SICU reduction in CAUTIs the 3rd quarter of 2013. Barriers to reduction included the following; compliance with ongoing maintenance cares, not changing foley catheters, and the presence of staff awareness. Conclusions: Implementation of CAUTI bundles may result in reduction of catheter associated infections; however population specific interventions may be needed to achieve sustained reduction in CAUTIs.

Implementation of a Catheter-Associated Urinary Tract Infection Bundle in an Academic Medical Center

Implementation of a Catheter-Associated Urinary Tract Infection Bundle in an Academic Medical Center

A Catheter-Associated Urinary Tract Infection Bundle

A Catheter-Associated Urinary Tract Infection Bundle