Incidence Of Catheter-associated Urinary Tract Infections Research Articles

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 ...

SG-APSIC1149: Continuous quality improvement project: Changing from sterile to clean perineal care sets at Maharaj Nakorn Chiang Mai Hospital

Objectives: The central sterile supply department (CSSD) provides sterile perineal care sets (SPC sets) for use with patients. However, the SPC sets exceed the standard, and the sterilization process incurs high cost. Therefore, a CSSD nursing team set out to find ways to save costs by providing clean perineal care sets (CPC sets) instead of sterile sets. We examined the rate of catheter-associated urinary tract infection (CAUTI) after using CPC sets, measured the satisfaction of the nursing staff who use the CPC sets, evaluated the decrease in the cost to the hospital. Methods: The CSSD nursing team presented some evidence of the benefits of using the CPC sets to the infection control subcommittee and asked for their approval to use CPC sets instead of SPC sets. After approval by the subcommittee, the CSSD nursing staff began to use CPC sets for patients. The incidence of CAUTI was monitored, and a satisfaction survey of the nurses who used the CPC sets was performed. We compared the costs between the SPC set and the CPC set to determine the cost savings. Results: The CAUTI rate did not change after using CPC sets. The nurses who used the CPC sets indicated no difference in satisfaction between the SPC and CPC sets, and the cost of the CPC set was cheaper than the SPC set (27 Baht per set). Conclusions: In a quality improvement effort, using the CPC set was safe for patients. The users were satisfied with the CPC set and trusted the safety of the instruments. Moreover, using the less expensive CPC sets saved the hospital &gt;700,000 Baht per year.

Unintended impact of COVID-19 pandemic on the rate of catheter related nosocomial infections and incidence of multiple drug resistance pathogens in three intensive care units not allocated to COVID-19 patients in a large teaching hospital

BackgroundThe prevalence of resistant hospital infections in the intensive care unit (ICU) increases mortality and antibiotic resistance. COVID-19 pandemic may have unintended impact on nosocomial infections (NI) and the prevalence of resistant microorganism.MethodologyThe present non-interventional study was performed by a pre and a post survey each lasting 8 months before (March–October 2019) and after (March–October 2020) the onset of COVID-19 pandemic in three ICU’s, not allocated to COVID-19 patients, in Nemazee Hospital, Shiraz, Iran. The rates of the following nosocomial infections were compared at pre- and post-pandemic period: ventilator associated pneumonia (VAP), central line associated blood stream infection (CLABSI), catheter-associated urinary tract infections (CAUTI) and incidence of multiple drug resistance (MDR) pathogens.ResultsPre-pandemic and pandemic incidence of VAP was 23.5 and 17.2 cases per 1000 device-days, respectively; an absolute decrease of 27%. The main reason for the decrease in the rate of VAP during the pandemic was a significant decrease in the rate of VAP caused by Acinetobacter baumannii; from 39 to 17% in total VAP episodes. The rate of VAP associated with other microorganisms remained relatively unchanged from 14.2 cases in pre-pandemic period to 14.3 cases per 1000 MV-days during the pandemic (P = 0.801). Pre-pandemic incidence of CLABSI was 7.3 cases and, in pandemic period, was 6.5 cases per 1000 device-days (IRR = 0.88, 95% CI 0.43–1.73, P = 0.703). Pre-pandemic incidence of CAUTI was 2 and in pandemic period, was 1.4 cases per 1000 device-days (IRR = 0.70, 95% CI 0.22–1.98, P = 0.469).ConclusionThe results of the present study showed a decrease in the incidence of VAP in critically ill non-COVID-19 patients during the pandemic compared to before the pandemic, especially regarding Acinetobacter baumannii.

Evaluating the Potential of a New Low-Profile Urinary Catheter in Preventing Catheter-Associated Urinary Tract Infections: A Prospective Randomized Blinded Clinical Trial

Aim To investigate the efficacy of a new low-profile catheter on incidence of the catheter-associated urinary tract infections (CAUTI) in comatose patients admitted to the intensive care unit. Background Catheter-induced urothelial injury is a key component in the development of urinary tract infections in catheterized patients. Methods In this prospective randomized blinded clinical trial, 80 patients requiring indwelling urinary catheterization were equally randomized to either the standard Foley catheter (control) or the low-profile catheter (experimental) group. The signs of urinary tract infection for comatose patients were considered (ie, ≥105 of colony-forming unit/milliliter of urine, hematuria, serum leukocytes, and body temperature) and recorded at baseline and on days 3 and 5 after catheterization. The analysis of covariance was applied by the SPSS-20 software at a 95% confidence level. Results An increasing proportion of patients with elevated urinary colony counts were seen in the Foley catheter group compared with the low-profile catheter group (12.5% vs 5%). However, there were no between-group differences in the urinary colony counts and body temperature after controlling for antibiotic doses and fluid intake. Patients in the low-profile catheter group had significantly lower rates of hematuria and serum leukocytes than those in the Foley catheter group. Conclusion A newly designed low-profile urinary catheter has demonstrated a trend toward reducing the incidence of CAUTI in patients with indwelling urinary catheters. Further studies with larger sample sizes and follow-up are needed to confirm the benefits.

2028. Reduction in Health Care Facility Onset Catheter-Associated Urinary Tract Infections: A Resident-Led Quality Improvement Initiative

Abstract Background Hospital-acquired catheter-associated urinary tract infection (CAUTI) was estimated to cause 19,700 cases in 2020 across the United States per the Centers for Disease Control and Prevention (CDC). While this is a 25% decrease in reported incidence rates since 2015, ad-hoc changes in care practices and limitations of surveillance definitions brought on by the giant burden of COVID-19 on the healthcare system possibly resulted in underreporting of CAUTIs. In a 290-bed tertiary, community hospital in the Detroit metropolitan area, there was a 200% increase CAUTIs from 2020 (5 CAUTIs) to 2021(16 CAUTIs). A multidisciplinary, resident-led team was assembled to reduce hospital-acquired CAUTIs. Methods A multi-pronged quality improvement initiative was conducted from January 1, 2021, through March 31, 2022. CAUTIs were identified and reviewed via electronic health records using predefined criteria related to CDC surveillance definitions, urinary catheter insertion indications, laboratory data, and antibiotic use. Plan-Do-Study-Act (PDSA) Cycle model was used to guide the initiative. Thus far one PDSA cycle has been completed. The initial intervention bundle was designed by the multidisciplinary team and led by internal medicine and transitional year residents. The intervention bundle included 1. Provider (including physician and RN) education, 2. Design and implementation of an appropriate urinary catheter practice algorithm, and 3. Expert review of positive urine cultures and CAUTI cases. Results Baseline data collected from January to December 2021 showed 16 CAUTIs. Post-implementation of the intervention bundle from January to March 2022 resulted in a 75% reduction in CAUTI incidence (1 CAUTI flagged). Conclusion A targeted intervention bundle improved CAUTI incidence by reducing inappropriate urinary catheter insertion and prolonged removal. Ongoing local initiatives focused on hospital-acquired infections, such as this one, are paramount to the persistent optimization of infection prevention despite national trends. Disclosures All Authors: No reported disclosures.

Factors Associated With Catheter-Associated Urinary Tract Infection in Patients in the Intensive Care Unit

Catheter-associated urinary tract infection (CAUTI) commonly occurs in intensive care units (ICU) and is associated with longer hospital stays and higher healthcare costs, morbidity, and mortality. The purpose of this study was to examine the factors associated with CAUTI in ICU patients. This study was a secondary analysis of data from a study on the usage of indwelling catheters in adult internal and surgical ICU patients at a teaching hospital in southern Taiwan conducted between January 1 and December 31, 2017. Descriptive analysis, the independent t test, chi-square test, and logistic regression were used to examine the factors associated with CAUTI. Of the 1,120 patients with an indwelling urinary catheter in the ICU, 330 revealed a positive urine culture result, indicating a 29.5% prevalence of CAUTI. The average duration of indwelling urinary catheter usage was 6.55 (SD = 4.89) days. The participants averaged 69.93 years old (SD = 15.19 years), and 627 (56.0%) were men and 493 (44.0%) were women. Being female, having diabetes, having a large indwelling urinary catheter, having a longer duration of indwelling urinary catheter usage, and being unable to remove the indwelling urinary catheter during the ICU stay were found to be associated with a significantly higher risk of CAUTI. Women and patients with diabetes are particularly vulnerable to CAUTI. Thus, urinary catheters should be used with caution. Using smaller-sized urinary catheters and reducing the duration of urinary catheter use are suggested. The results of this study may be used to guide clinical practice to help reduce the incidence of CAUTI and enhance overall healthcare service quality.

Catheter-Associated Urinary Tract Infections, Bacteremia, and Infection Control Interventions in a Hospital: A Six-Year Time-Series Study.

Catheter-associated urinary tract infections (CAUTIs) are among the most common healthcare-associated infections. Urine catheters are often reservoirs of multidrug-resistant (MDR) bacteria and sources of pathogens transmission to other patients. The current study was conducted to investigate the correlation between CAUTIs, MDR bacteremia, and infection control interventions, in a tertiary-care hospital in Athens, from 2013 to 2018. The following data were analyzed per month: 1. CAUTI incidence; 2. consumption of hand hygiene disinfectants; 3. incidence of isolation of MDR carrier patients, and 4.incidence of bacteremia/1000 patient-days [total resistant a.Gram-negative: carbapenem-resistant Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae; b.Gram-positive: vancomycin-resistant Enterococci and methicillin-resistant Staphylococcus aureus]. The use of scrub disinfectant solutions was associated with decreased CAUTI rate in Total Hospital Clinics (OR: 0.97, 95% CI: 0.96–0.98, p-value: <0.001) and in Adults ICU (OR: 0.79, 95% CI: 0.65–0.96, p-value:0.018) while no correlation was found with isolation rate of MDR-carrier pathogens. Interestingly, an increase in total bacteremia (OR: 0.81, 95% CI: 0.75–0.87, p-value:<0.001) or carbapenem-resistant bacteremia correlated with decreased incidence of CAUTIs (OR: 0.96, 95% CI: 0.94–0.99, p-value: 0.008). Hand hygiene measures had a robust and constant effect on infection control, reducing the incidence of CAUTIs.

Catheter-Associated Urinary Tract Infection in Intensive Care Unit Patients at a Tertiary Care Hospital, Hail, Kingdom of Saudi Arabia.

Catheter-associated urinary tract infections (CAUTIs) are some of the most common hospital-acquired infections (HAIs). Prolonged hospitalization, invasive devices such as catheters, and irrational use of antimicrobial agents are believed to be the major causes of high rates of HAIs. Infections such as pyelonephritis, urethritis, cystitis, and prostatitis are the main concerns in catheterized ICU patients. In these cases, Gram-negative bacteria are the most common bacteria. The present study was undertaken to determine the frequency, antibiograms, disease pattern, and risk factors involved in providing an advocacy recommendation to prevent CAUTI. A total of 1078 patients were admitted to the hospital ICU, out of which healthcare-associated infection was reported in 316 patients. CAUTI was reported only in 70 patients. Klebsiella pneumoniae (20%) was the predominant isolate, with Serratia (3%) and Providencia (3%) species being the least common isolates in this study. The present study provides CAUTI incidence rates in a tertiary care hospital in Hail, Saudi Arabia. Furthermore, information on the risk factors of common associated CAUTI causative organisms and their antibiogram patterns are also presented. This study provides vital information that can be used to formulate an effective antibiotic stewardship program that can be implemented throughout the kingdom.

Implementation of Evidence-based Maintenance Bundles to Reduce Central Line-Associated Bloodstream Infection (CLABSI) and Catheter-Associated Urinary Tract Infection (CAUTI) Rates

Background In 2021, an increase in central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) rates was observed at an academic medical center. CLABSI and CAUTI have a significant impact on patient outcomes including mortality, length of stay, and healthcare costs. Reduction of CLABSI and CAUTI incidence can be achieved through implementation of standardized, evidence-based maintenance bundles for central lines and foley catheters. Methods A multidisciplinary team began meeting weekly in July 2021 to review CLABSI and CAUTI rates, insertion and maintenance practices, product utilization, and education initiatives. Standardized central line and foley catheter maintenance bundles were developed based on current infection prevention evidence-based guidelines. In August 2021, the maintenance bundles were implemented on every unit and education was provided to nursing unit leaders and staff by the infection prevention department. The maintenance bundles are maintained through daily audits by nursing unit leaders and weekly validation audits by the infection prevention department. Observations from the weekly validation audits are documented and reviewed on a weekly basis by the multidisciplinary team and influence ongoing education topics. Results Between August and November 2021, a 4% reduction in CLABSI rate (2.2 per 1,000 device days) and a 19% reduction in CAUTI rate (2.9 per 1,000 device days) was observed compared to the baseline period. The central line maintenance bundle compliance increased by 21% from August to November with a maximum monthly compliance of 84%. The foley catheter maintenance bundle compliance increased by 23% with a maximum monthly compliance of 79% during the same time period. Conclusions A standardized, evidence-based maintenance bundle for central lines and foley catheters contributes to the reduction of CLABSI and CAUTI rates. Continuous monitoring and validation of the maintenance bundles provides guidance, accountability, and feedback for staff and highlights issues and trends that can be addressed through education. In 2021, an increase in central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) rates was observed at an academic medical center. CLABSI and CAUTI have a significant impact on patient outcomes including mortality, length of stay, and healthcare costs. Reduction of CLABSI and CAUTI incidence can be achieved through implementation of standardized, evidence-based maintenance bundles for central lines and foley catheters. A multidisciplinary team began meeting weekly in July 2021 to review CLABSI and CAUTI rates, insertion and maintenance practices, product utilization, and education initiatives. Standardized central line and foley catheter maintenance bundles were developed based on current infection prevention evidence-based guidelines. In August 2021, the maintenance bundles were implemented on every unit and education was provided to nursing unit leaders and staff by the infection prevention department. The maintenance bundles are maintained through daily audits by nursing unit leaders and weekly validation audits by the infection prevention department. Observations from the weekly validation audits are documented and reviewed on a weekly basis by the multidisciplinary team and influence ongoing education topics. Between August and November 2021, a 4% reduction in CLABSI rate (2.2 per 1,000 device days) and a 19% reduction in CAUTI rate (2.9 per 1,000 device days) was observed compared to the baseline period. The central line maintenance bundle compliance increased by 21% from August to November with a maximum monthly compliance of 84%. The foley catheter maintenance bundle compliance increased by 23% with a maximum monthly compliance of 79% during the same time period. A standardized, evidence-based maintenance bundle for central lines and foley catheters contributes to the reduction of CLABSI and CAUTI rates. Continuous monitoring and validation of the maintenance bundles provides guidance, accountability, and feedback for staff and highlights issues and trends that can be addressed through education.

Implementation of Standardized Catheter Cleansing Cloths at an Inpatient Rehab Facility

<h3>Background</h3> A higher than expected number of catheter-associated urinary tract infections (CAUTIs) was occurring at an inpatient rehab facility (IRF). Patients at IRFs often have indwelling urinary catheters (IUCs) for medical conditions like neurogenic bladder or urinary retention conditions. It is essential to provide consistent care and maintenance of IUCs for patients with long-term or chronic urinary catheters to prevent infection. Variability exists in the frequency, procedure, and availability of products for catheter care. <h3>Methods</h3> The quality improvement project, using lean methodology, took place over a six-month period at a 38 bed IRF to include patients with an IUC. The catheter cleansing cloths were used daily and as needed on patients with an IUC. The improvement project assessed if the daily use of the catheter cleansing cloths reduced the incidence of CAUTI at an IRF. A daily tracking tool was developed to monitor catheter device utilization and record daily documentation of urinary catheter care with the designated cleansing cloths. <h3>Results</h3> In the 12 months prior to the implementation of the catheter cleansing cloths, the IRF had seven CAUTIs. In the six months since the start of using the cloths, the IRF had zero CAUTIs. The Standardized Utilization Ratio (SUR) for the IRF in the six months prior to implementing daily device monitoring was 1.458. In the first six months of daily device monitoring, the SUR was 1.014. <h3>Conclusions</h3> The quality improvement project revealed a standardized process for daily catheter care is associated with a reduction in CAUTI. This project also notes an association between the daily monitoring of IUC devices and a reduction in catheter device utilization. Using catheter cleansing cloths for daily catheter care may be a great resource to provide consistent and predicable care for patients with IUCs.

Can we really make catheter-associated urinary tract infections a never event? A level 1 trauma center's experience with prophylactic antibiotic bladder irrigation.

Hospital-acquired catheter-associated urinary tract infections (CAUTIs) are considered "never events" and are reportable to Centers for Medicare and Medicaid Services as a quality indicator. Despite protocols to determine appropriate removal of urinary catheters as soon as possible, severely injured trauma patients often require prolonged catheterization during ongoing resuscitation or develop retention requiring catheter replacement, exposing them to risk for CAUTI. We evaluated whether prophylactic antibiotic bladder irrigation reduces the incidence of CAUTI in critically ill trauma patients. As a quality initiative, gentamicin bladder catheter irrigation (GBCI) was performed on a level 1 trauma center's patients at risk for CAUTI in 2021, defined by indwelling Foley catheterization for a minimum of 3 days. We then conducted a retrospective study using a comparison cohort of 2020 admissions as the control group. Catheter-associated urinary tract infection rates per 1,000 catheterized days were compared between these two groups. Patients with traumatic bladder injuries were excluded. Our cohort included 342 patients with a median hospitalization of 11 (7-17) days, Injury Severity Score of 17 (10-26), and 6 (4-11) days of catheterization. Eighty-six patients, catheterized for 939 at-risk days, received twice-daily GBCI compared with 256, catheterized for 2,114 at-risk days, who did not. Zero patients in the GBCI group versus nine patients in the control group developed CAUTI. The incidence of CAUTI in the GBCI group was significantly less than in the control group (0/1,000 vs. 4.3/1,000 catheterized days, p = 0.018). Prophylactic antibiotic bladder irrigation was associated with a zero incidence of CAUTI among trauma patients at risk for CAUTI. This practice holds promise as effective infection prophylaxis for such patients. The optimal duration and frequency of irrigation remain to be determined. Therapeutic/care management, Level III.

Assessment of persistent antimicrobial and anti-biofilm activity of p-HEMA hydrogel loaded with rifampicin and cefixime

Catheter-associated urinary tract infections (CAUTIs) are nosocomial infections causing more than one million hospital cases annually. The progress of CAUTIs leads to severe health complications. Infections result in blockage of the medical device due to biofilm formation, which necessitates the replacement of the device. The objective of this study is to improve urological biomaterials to minimize microbial growth and reduce the incidence of CAUTIs. Challenges from mixed biofilm are crucial and need to be addressed in the development of new coating materials. Herein, an investigation highlighted the reduction of mixed biofilm overgrowth and attachment tendency on poly-2-hydroxyethyl methacrylate (p-HEMA) surface by loading the hydrogel with rifampicin (RIF), cefixime trihydrate (CFX), and combined ratios of RIF and CFX. Mixed biofilm-formation ability in (3:1) RIF: CFX-loading p-HEMA (F6) surface showed best tendency to resist form biofilm. Persistent antimicrobial activity increased in p-HEMA loaded with combined ratios of RIF and CFX surface compared to p-HEMA alone, antimicrobial activity lasted for 8 days. All fabricated films exhibited %cell viability higher than 75% on HEK 293 cells. The addition of RIF and CFX may improve the duration of urological device employment before replacement.

Prevalence and appropriateness of indwelling urinary catheters in Japanese hospital wards: a multicenter point prevalence study

BackgroundIndwelling urinary catheters are commonly used in hospitalized patients, which can lead to the development of urinary catheter complications, including catheter-associated urinary tract infection (CAUTI). Limited reports on the appropriateness of urinary catheter use exist in Japan. This study investigated the prevalence and appropriateness of indwelling urinary catheters, and the incidence of CAUTI in non-intensive care unit (non-ICU) wards in Japanese hospitals.MethodsThis prospective observational study was conducted in 7 non-ICU wards from 6 hospitals in Japan from October 2017 to June 2018. At each hospital the study teams evaluated urinary catheter prevalence through in-person bedside evaluation for at least 5 days of each week for 3 months. Catheter associated urinary tract infection (CAUTI) incidence and appropriateness of catheter use was collected via chart review.ResultsWe assessed 710 catheter-days over 5528 patient-days. The mean prevalence of indwelling urinary catheter use in participating wards was 13% (range: 5% to 19%), while the mean incidence of CAUTI was 9.86 per 1000 catheter-days (range: 0 to 33.90). Approximately 66% of the urinary catheter days assessed had an appropriate indication for use (range: 17% to 81%). A physician's order for catheter placement was present in only 10% of catheterized patients.ConclusionThis multicenter study provides epidemiological information about the appropriate use of urinary catheters in Japanese non-ICU wards. A multimodal intervention may help improve the appropriate use of urinary catheters.

Effect of Cluster Nursing Based on Risk Management Strategy on Urinary Tract Infection in Patients With Severe Craniocerebral Injury.

ObjectiveTo observe the effect of cluster nursing based on risk management strategy in the management of urinary tract infection in patients with severe craniocerebral injury.MethodsA total of 116 patients with severe craniocerebral injury who were admitted to our hospital from March 2019 to March 2021 were included. They were divided into the control group (58 patients) and the observation group (58 patients). The control group received routine nursing care and the observation group received cluster nursing based on risk management strategy. The incidence of catheter-associated urinary tract infection (CAUTI), the results of bacterial culture on the surface of the urinary catheter, the incidence of nursing risk events, the duration of placing the urinary catheter, the length of hospital stay, and hospital costs as well as the patient satisfaction score were compared between the two groups. The knowledge, attitude, and practice scale for prevention of catheter infection and the competence evaluation scale of nurses were used to evaluate the sense-control ability and core competence of the interveners.ResultsThe total incidence of CAUTI in the observation group was (6.90%) lower than that in the control group (20.69%) (p < 0.05). The bacterial culture results on the catheter surface of patients in the observation group before and after 6 and 12 h of catheter cleaning were better than those of patients in the control group (p < 0.05). The duration of indwelling urinary catheter, hospitalization time, and hospitalization expenses of patients in the observation group were lower than those of patients in the control group (p < 0.05). The incidence rate of nursing risk events in the observation group was (1.72%) lower than that in the control group (11.86%) (p < 0.05). The overall satisfaction score of patients and the control and core ability scores of nursing staff in the observation group were higher than those in the control group (p < 0.05).ConclusionCluster nursing based on risk management strategy can effectively reduce the incidence of nursing risk events and the probability of UTI in patients with severe craniocerebral injury, shorten the duration of indwelling urinary catheter and hospitalization.

Poor Sensorium at the Time of Intubation Predicts Polymicrobial Ventilator Associated Pneumonia.

BackgroundVentilator-associated pneumonia (VAP) is the most common nosocomial infection in the intensive care unit and is associated with a high mortality rate.AimThe study was conducted to estimate the frequency, outcomes, and predictors of polymicrobial VAP.MethodsA prospective observational study was conducted in mechanically ventilated adult patients in the medical intensive care unit in a tertiary care hospital in India from July 2016 to July 2018 with a 30-day follow-up period. The patients were grouped into monomicrobial and polymicrobial VAP. We compared the 30-day outcome parameters such as discharge from hospital, in-hospital stay, death, and complications such as catheter associated urinary tract infection (CAUTI), central line associated blood stream infection (CRBSI), bacteremia and collapse of lung. The predictors of polymicrobial VAP were identified by multiple logistic regression.ResultsOut of 301 patients clinically diagnosed with VAP, 151 patients were excluded, and the remaining 150 developed 186 episodes of VAP during the study period. The incidence of polymicrobial VAP was 62.9%. Out of 150 patients, 51 patients had monomicrobial VAP, and 99 had polymicrobial VAP. On univariate analysis, diabetes mellitus and poor sensorium (Glasgow Coma Scale [GCS] score <8) during endotracheal intubation; 30-day outcome, mean days of mechanical ventilation after VAP diagnosis and days in ICU; and CAUTI were significantly associated with polymicrobial VAP. On multivariable logistic regression, poor sensorium (GCS score <8) at the time of endotracheal intubation was an independent predictor of polymicrobial VAP.ConclusionThe incidence of polymicrobial VAP is high in the medical ICU and is associated with increased duration of mechanical ventilation, hospital stay, and incidence of CAUTI. Poor GCS score was the single independent predictor of polymicrobial VAP.

Association between hospital and ICU structural factors and patient outcomes in China: a secondary analysis of the National Clinical Improvement System Data in 2019

BackgroundHospital and ICU structural factors are key factors affecting the quality of care as well as ICU patient outcomes. However, the data from China are scarce. This study was designed to investigate how differences in patient outcomes are associated with differences in hospital and ICU structure variables in China throughout 2019.MethodsThis was a multicenter observational study. Data from a total of 2820 hospitals were collected using the National Clinical Improvement System Data that reports ICU information in China. Data collection consisted of a) information on the hospital and ICU structural factors, including the hospital type, number of beds, staffing, among others, and b) ICU patient outcomes, including the mortality rate as well as the incidence of ventilator-associated pneumonia (VAP), catheter-related bloodstream infections (CRBSIs), and catheter-associated urinary tract infections (CAUTIs). Generalized linear mixed models were used to analyse the association between hospital and ICU structural factors and patient outcomes.ResultsThe median ICU patient mortality was 8.02% (3.78%, 14.35%), and the incidences of VAP, CRBSI, and CAUTI were 5.58 (1.55, 11.67) per 1000 ventilator days, 0.63 (0, 2.01) per 1000 catheter days, and 1.42 (0.37, 3.40) per 1000 catheter days, respectively. Mortality was significantly lower in public hospitals (β = − 0.018 (− 0.031, − 0.005), p = 0.006), hospitals with an ICU-to-hospital bed percentage of more than 2% (β = − 0.027 (− 0.034, -0.019), p < 0.001) and higher in hospitals with a bed-to-nurse ratio of more than 0.5:1 (β = 0.009 (0.001, 0.017), p = 0.027). The incidence of VAP was lower in public hospitals (β = − 0.036 (− 0.054, − 0.018), p < 0.001). The incidence of CRBSIs was lower in public hospitals (β = − 0.008 (− 0.014, − 0.002), p = 0.011) and higher in secondary hospitals (β = 0.005 (0.001, 0.009), p = 0.010), while the incidence of CAUTIs was higher in secondary hospitals (β = 0.010 (0.002, 0.018), p = 0.015).ConclusionThis study highlights the association between specific ICU structural factors and patient outcomes. Modifying structural factors is a potential opportunity that could improve patient outcomes in ICUs.

Catheter-associated urinary tract infections in patients who have undergone radical cystectomy for bladder cancer: A prospective randomized clinical study of two silicone catheters (clinical benefit of antibiotic silicone material).

PurposeThe prevalence of catheter-associated urinary tract infections (CAUTIs) varies from 5% to 8.2%, and the risk of infection increases by 5% to 7% per day of primary indwelling. We investigated whether a novel biofilm inhibitory mechanism using an inhibitory silicone urethral catheter (a coated Foley catheter) can reduce CAUTIs compared to conventional non-coated Foley catheters.Materials and MethodsThis study prospectively analyzed the difference in the incidence of CAUTIs in patients who underwent radical cystectomy with an orthotopic neobladder for bladder cancer and received a coated or conventional non-coated catheter. Additionally, differences in bacterial colonization between the groups were analyzed using a catheter-tip bacterial culture test.ResultsEighty-five patients were randomized into the “coated Foley catheter” group (abbreviated as “case” group; 41 patients) and a control group (44 patients). The two groups were identical except for their surgical history. The incidence of CAUTIs 2 weeks after radical cystectomy was 21.95% (case) and 27.27% (control), with no significant difference between the two groups. However, when the catheter was removed 2 weeks after surgery, the catheter tip culture test revealed significant bacterial colonies in 25 (60.98%) and 38 (86.36%) patients in the case and control group, respectively. No catheter-related postoperative side effects were observed in either group.ConclusionsThe incidence of CAUTIs in the two groups did not differ according to the catheter material. However, the catheter bacterial culture test showed that bacterial colonization was significantly suppressed on the Bi-Fi Free technology catheter, which comparatively inhibited biofilm formation.

Chlorhexidine gluconate bathing of adult patients in intensive care units in São Paulo, Brazil: Impact on the incidence of healthcare-associated infection

BackgroundThere is an increasing use of daily chlorhexidine gluconate (CHG) bathing to decrease healthcare associated infections (HAI). Daily bathing of patients with CHG has been successfully used to prevent multidrug-resistant organisms (MDROs) HAI in intensive care units (ICU). MethodsThis was a 12-month, single-center, open, cluster randomized trial, conducted at four ICUs of the University Hospital of Universidade Federal de São Paulo, Unifesp, Brazil. ICUs were randomized to either perform daily bathing of the patients with pH neutral soap and water – control units, or daily bathing with 2% CHG detergent solution – intervention units. We evaluated the incidence density rate of central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP), catheter associated urinary tract infection (CAUTI), Klebsiella pneumoniae carbapenemase (KPC)-producing enterobacteria HAI, and death in the intervention and control units. ResultsA total of 1,640 admissions of 1,487 patients occurred during the study period (41.2% control group, and 58.8% intervention group). Incidence density rates of KPC-producing enterobacteria HAI were 5.01 and 2.25 infections/1000 patient-days in the control units and in the intervention units (p = 0.013) and mortality rates were 28.7% and 18.7% in the control units and in the intervention units (p<0.001), respectively. No difference between groups was observed in CLABSI incidence (p = 0.125), VAP incidence (p = 0.247) and CAUTI incidence (p = 0.435). No serious skin reactions were noted in either study group.Daily 2% CHG detergent solution bathing is a feasible, low cost option for HAI prevention in ICU.

Infections Acquired During Venoarterial Extracorporeal Membrane Oxygenation Postcardiac Surgery in Children: A Retrospective Observational Study

Abstract Introduction Extracorporeal membrane oxygenation (ECMO) is increasingly being used in refractory cardiac and pulmonary dysfunction as a rescue modality. The common indications for establishing venoarterial ECMO (VA-ECMO) support in children postcardiac surgery are failure to wean from cardiopulmonary bypass (CPB), postcardiotomy cardiogenic shock (PCCS), refractory pulmonary arterial hypertension, and as a bridge to recovery or transplant. The survival rate of children on VA-ECMO support is 45%. The most frequently encountered complications during VA-ECMO are bleeding, thrombosis, acute kidney injury, and infections. Among those, infections acquired during VA-ECMO lead to high morbidity and mortality. Hence, this study aimed to determine infection rates, causal microorganisms, and mortality risk factors in children developing an infection during VA-ECMO therapy. Methods This retrospective observational study was conducted on 106 children under 14 years of age who underwent elective or emergent cardiac surgery (between 2016 and 2020) and required VA-ECMO support. Medical records were reviewed to collect the targeted variables and analyzed. Results Out of 106 children, 49 (46.23%) acquired infections representing a prevalence of 46.23% and an infection rate of 186.4 episodes per 1,000 ECMO days. Prevalence and acquired infection rate/1,000 ECMO days were higher in the nonsurvivor group than in the survivor group (26.42 vs.19.81%) and (215.07 vs. 157.49), respectively. The bloodstream infection (BSI) and catheter-associated urinary tract infection (CAUTI) episodes were 53.04 and 68.19 per 1,000 ECMO days, and the ventilator-associated pneumonia (VAP) rate was 44.50 per 1,000 ventilator days. The mean preoperative admission duration, aortic cross-clamping duration, CPB duration (minutes), and vasoactive-inotropic score were higher in the nonsurviving children (p &lt; 0.001). Similarly, prolonged mean ECMO duration was also found in the nonsurvivor group compared with the survivor group (p = 0.03). Conclusion In our study, the prevalence of acquired infection during VA-ECMO was 46.23%. The incidence of BSI, CAUTI, and VAP per 1,000 ECMO days was higher in the nonsurvivor group than in survivors. Acinetobacter baumannii was the most common cultured gram-negative organism in VAP and BSI, with 67.65% Acinetobacter spp. resistant to carbapenems. CAUTI was predominately due to Candida species during VA-ECMO.

To Assess the Incidence of Catheter Associated Urinary Tract Infection and Evaluate the Effectiveness of Evidence based Practice Protocol for Prevention of Catheter-associated Urinary Tract Infections (CAUTI) in Adult Critical Care Patients

Background: UTIs are the most common type of healthcare-associated infection. Among UTIs acquired in the hospital, approximately 75% are associated with a urinary catheter, which is a tube inserted into the bladder through the urethra to drain urine. The most important risk factor for developing a CAUTI is prolonged use of the urinary catheter. Therefore, catheters should only be used for appropriate indications and should be removed as soon as they are no longer needed. Aim: The aim of the study is to prevent CAUTIs in adult critical care patients, by using evidence based practice protocol. Materials and Methods: A Quasi Experimental one group pretest posttest research design was used. 200 staff nurses were selected from hospitals by using purposive sampling technique. Biophysical measures like signs and symptoms of CAUTI and urine culture was done to assess the incidence of CAUTIs in adult critical care patients before administration of evidence based practice protocol. Result: The overall incidence rate of CAUTI in adult critical care patients was 11.1%. A Comparison of Pre and Post test level of Knowledge of Staff Nurse’s regarding CAUTIs shows that 46(23.0%) had poor knowledge before intervention and it was reduced 2(1.0%) after intervention. None of the staff nurse had excellent knowledge before intervention and was increased 12(6.0%) after intervention, 23(11.5%) had pre test good knowledge and was increased to 122(61.0%) in post test. Pre test mean knowledge of staff nurse regarding CAUTIs was 13.68 whereas post test knowledge score was 16.5 and was statistically significant with p-value &lt;0.0001. Conclusion: This approach shows for reduction of CAUTIs in critical care settings. The same type of protocol or education programme might be adopted for the other health care associated infections.