Catheter-associated Urinary Tract Infection Rates Research Articles

2112. Assessing the Accuracy of Catheter-Associated Urinary Tract Infections (CAUTI) Identification Using Urinalysis Results

BackgroundCatheter-associated urinary tract infections (CAUTI) negatively impact patient morbidity, mortality and insurance reimbursement rates in acute care hospitals. Since CAUTIs are solely defined by the National Health and Safety Network (NHSN), not by clinical definition or urinalysis (UA) result, eliminating unnecessary urine cultures will improve the accuracy of reportable CAUTI rates. Negative UA can accurately detect false-positive (FP) CAUTIs in patients with 100% negative predictive value.MethodsWe conducted a retrospective analysis of 2017 CAUTIs reported from two acute care hospitals (A and B) to determine the effectiveness of a UA screening protocol and the distribution of FPs. Hospital B implemented a UA screening protocol requiring a UA prior to urine culture. Hospital A relied solely on microbiology cultures. FPs were identified by a negative UA result, the absence of bacteria, performed on the same or prior day to the urine culture that resulted in a CAUTI.ResultsOur analysis showed that 13 (34%) of the 38 reported CAUTIs with an associated UA result at hospital A were FPs. Patients with a UC line duration >7 days had a CAUTI FP rate of 62% compared with 27% of those with a line duration between 3 and 7 days (Figure 1) (OR 4.6, CI: 0.9, 23.7, P = 0.09). Hospital A (no screening protocol) was 37.4 times more likely to have a FP CAUTI compared with hospital B (UA screening protocol) (CI: 2.1, 660.6; P < 0.0004).ConclusionA positive culture with a negative UA is indicative of asymptomatic colonization, not true infection. Preventing FP CAUTIs would result in a 34% reduction in CAUTI rates at hospital A, placing the hospital in a better reimbursement benchmark (Figure 2). Interventions include: (1) A best practice alert in the patient’s electronic medical record that can be used to notify the providers to re-evaluate patients with UCs in place ≥ 5 days, (2) A screening protocol that requires a UA order prior to/during specimen collection and prevents processing of urine cultures with a negative UA. In patients with UCs, a protocol should be implemented to reduce FP CAUTIs to better understand the true epidemiology of CAUTIs in hospitals and increase reporting accuracy. Disclosures All authors: No reported disclosures.

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.

Association of Thoracic Epidural Pain Management with Urinary Retention after Complex Abdominal Wall Reconstruction

The association of thoracic epidural analgesia and urinary retention after complex abdominal wall reconstruction (CAWR) is unknown. The purpose of this study was to investigate the association between the presence of a thoracic epidural, timing of Foley catheter removal, and the rates of urinary retention and catheter-associated urinary tract infections (CAUTIs) in patients undergoing CAWR. All patients undergoing CAWR, who had an epidural catheter for postoperative pain management at our institution from September 2015 through April 2016, were prospectively followed. Patients were divided into two groups. Group 1 had their Foley catheters removed on postoperative day one, whereas Group 2 had their Foley catheters removed after epidural removal. The incidence of urinary retention and CAUTI were compared between the two groups. A total of 67 patients met inclusion criteria; 27 (40.3%) patients were in Group 1. Patients in Group 1 were significantly more likely to experience urinary retention requiring Foley catheter replacement (P = 0.02). There was no statistically significant difference in the rate of CAUTI between the two groups (P = 0.51). Patients undergoing CAWR with thoracic epidural pain management are at risk of experiencing postoperative urinary retention. Foley catheter removal after epidural removal does not place the patient at an increased risk for CAUTI and therefore should be strongly considered in this patient population.

Decreasing Catheter-Associated Urinary Tract Infections in Urologic Oncology Patients Discharged With an Indwelling Urinary Catheter: A Quality Improvement Project

Few strategies exist regarding decreasing catheter-associated urinary tract infections (CAUTIs) in the outpatient urologic oncologypopulation discharged with an indwelling urinary catheter (IUC). A quality improvement methodology using a premeasurement-postmeasurement structure was used to study the impact of process interventions on reducing CAUTIs. Creation of IUC outpatient materials, an "IUC Removal Form," and bundling IUC supplies were translated to an outpatient and perioperative setting to reduce CAUTIs. The CAUTI rate in urologic surgical patients requiring an IUC at discharge decreased from 12.5% to 8%. Preoperative IUC education increased from 0% to 100%. The average number of days the IUC was present was unchanged. The average postanesthesia care unit length of stay decreased from 1.98 to 1.32hours, saving the organization $11,880.00. IUC removal appointments at discharge increased from 4% to 33% (P=.0146). Implementation of consistent patient education and improved process for IUC removal reduced CAUTIs in this population.

Impact of Foley Catheter Placement by Medical Students on Rates of Postoperative Urinary Tract Infection

The aim of this study was to evaluate the impact of medical student placement of Foley catheters on rates of postoperative catheter-associated urinary tract infection (CAUTI). We included adult surgical patients in our institutional National Surgical Quality Improvement Program (NSQIP) database, and defined CAUTI according to NSQIP criteria. A multivariable model risk-adjusting for patient and operative variables associated with CAUTI in univariate analysis (exploratory p < 0.20) evaluated the independent effect of medical student placement of Foley catheters on the odds of CAUTI. There were 891 patients who had a Foley catheter placed by a surgical resident (61%; n= 547), operating room nurse (25%; n= 227), or medical student (13%; n= 117). After risk-adjustment, patients with Foleys placed by medical students were at a more than 4-fold increased risk of CAUTI (odds ratio [OR] 4.09, p= 0.02) compared with patients with catheters placed by nurses. Patients with catheters placed by residents did not have an increased risk-adjusted odds of CAUTI (OR 2.16, p= 0.15). Other significant predictors of postoperative CAUTI included female sex (OR 2.61, p= 0.01), partial/total functional dependence (OR 4.81, p= 0.008), blood transfusion (OR 34.7, p= 0.02), and increased length of Foley stay (OR 1.06, p < 0.001). Surgical patients with Foley catheters placed by medical students are at increased risk-adjusted odds of postoperative CAUTI. More intense supervision of medical students during urinary catheter insertion in the operating room and improved education regarding sterile technique may be important factors in reducing rates of postoperative CAUTI in academic institutions.

Implementing a Nurse-Driven Protocol to Reduce Catheter-Associated Urinary Tract Infections in a Long-Term Acute Care Hospital.

Catheter-associated urinary tract infections (CAUTIs) are the second most common health care-associated infection. CAUTIs represent a serious threat to chronic critically ill patients in long-term acute care hospitals (LTACHs). Evidence-based guidelines have been shown to reduce the risk of infection in acute care settings but are not well documented in LTACHs. An evidence-based urinary catheter protocol was developed and implemented across three units in a large LTACH. RNs were oriented to the new protocol through online educational modules. During the evaluation period, 120 patients were admitted with a urinary catheter who qualified for chart review for CAUTI incidence. Overall catheter-days and CAUTI rates were compared, and changes in practice were noted. After the education intervention, overall urinary catheter-days decreased by 10.1%, and CAUTI incidence decreased by 74% (4.82 CAUTI per 1,000 patient-days to 1.24). The absolute risk reduction was 3.58 infections per 1,000 catheter-days. The findings were statistically significant (z = 1.00, p < .03). Significant reductions were noted in total catheter-days, and CAUTI rates improved after implementation of an education program and an evidence-based urinary catheter protocol in an LTACH. J Contin Educ Nurs. 2018;49(8):372-377.

Indwelling urethral versus suprapubic catheters in nursing home residents: determining the safest option for long-term use

The incidence of infectious complications has not been previously compared for two types of common urinary catheters used in the long-term care setting: indwelling urethral catheters and suprapubic catheters. To compare catheter-associated urinary tract infection (CAUTI) rates and multidrug-resistant organism (MDRO) colonization between nursing home residents with indwelling urethral and suprapubic catheters. Participants included 418 nursing home residents with an indwelling device enrolled in a previously published prospective targeted infection prevention study conducted between 2010 and 2013. Resident age, gender, function, comorbidities, and information on infections, antibiotic use, and recent hospitalizations were obtained at study enrolment, day 14, and every 30 days thereafter for up to one year. Microbiological samples were obtained from several anatomic sites at each visit. Cox proportional hazard models were adjusted for facility-level clustering and other covariates. In all, 208 study participants had an indwelling urinary catheter, contributing 21,700 device-days; 173 (83%) with a urethral catheter, 35 (17%) with a suprapubic catheter. After covariate adjustment, the suprapubic group had a lower incidence of CAUTI (6.6 vs 8.8 per 1000 device-days; P= 0.05), were half as likely to be hospitalized (hazard ratio (HR) = 0.46; P < 0.01) and were 23% less likely to have had antibiotics in the past 30 days (HR = 0.77; P= 0.02). Among residents catheterized ≥90 days, the mean number of MDROs isolated in the suprapubic group was significantly higher than in the urethral group (0.57 vs 0.44; P= 0.01). Ciprofloxacin-resistant Gram-negative bacilli were frequent in both groups. Residents with a suprapubic catheter may have fewer CAUTIs, less hospitalization and less antibiotic use, but are more likely colonized with MDROs.

Interventions to prevent urinary catheter–associated infections in children and neonates: a systematic review

Few data are available to inform strategies for the prevention of catheter-associated urinary tract infection (CAUTI) in children and neonates. Many recommendations are derived from studies in adults and cannot be applied to the paediatric population. This study was aimed to identify all studies that measured the efficacy of an intervention for the prevention of CAUTI in children and neonates. A systematic review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) was conducted. Eligible studies published between January 1st, 1995 and December 31st, 2017, were identified in PubMed, the Cochrane Database of Systematic Reviews, LILACS, SciELO and DOAJif applying an intervention with the aim of CAUTI prevention in inpatient children, infants or neonates. The following study designs were included: controlled and non-controlled before-and-after studies, (controlled) interrupted time series analyses and randomized controlled trials. Quantitative or qualitative studies on interventions in both adults and children were eligible if data on children could be extracted. Reviews, case series, letters, notes, conference abstractsand opinion articles were excluded. Of 99 articles identified, six were included in the final analysis, after consensus from three independent investigators. Four studies used a multimodal strategy (using at least four or more different components at the same time) as follows: aseptic rules during catheter insertion and removal; cleaning the urethral meatus with sterile water; use of a new silicone catheter per insertion with a closed sterile drainage system by a sterile technique; daily evaluation of catheter requirement; placement of indwelling urinary catheters only for approved indications; reducing of urinary catheter days and positioning of the patient and collection device to assist in urine drainage. One study tested periurethral cleaning intervention to reduce CAUTI. One study described the association of the presence of a physician safety champion with urinary catheter device utilization ratios. Catheter-associated UTI reduction rates were reported in four studies; three achieved statistically significant decreases in CAUTI rates. Positive results were achieved only when a multimodal strategy was used with at least four or more components. This strategy could be adopted for paediatric healthcare institutions to reduce CAUTI rates in children and neonates. Evidence exists to support the use of a multimodal strategy for CAUTI reduction in hospitalized children and neonates.

The effect of daily change of sterile urinary bag on bacteriuria and catheter–associated urinary tract infections

Introduction: One of the major healthcare measures in hospitals, is reducing the risk of infections. Since catheter-associated urinary tract infections (CA-UTIs) occur in 80% of cases, the prevention of these infections plays an important role in reducing infections related to the treatment care. Objectives: The present study aims to determine the effect of daily change of sterile urinary bag on the incidence of bacteriuria and CA-UTIs. Patients and Methods: This quasi-experimental study include all patients referred to the neurology, urology and surgery wards, as well as the ICU and CCU of Hajar and Kashani hospitals, Shahrekord, Iran. A total of 200 patients aged 18-75 years that required insertion of the urinary Foley catheter were divided into two groups: catheterization with the usual method (control group) and catheterization with daily change of sterile urinary bag (case group). In each of the two groups, immediately after insertion and during the removal of urethral catheter, the urine sample was collected using sterile method and was sent to the laboratory to conduct examinations for bacteriuria. The demographic information was prepared and collected using the researcher made questionnaire. Results: In this study, the average age of the patients was 49.81±15.11. The rate of CA-UTI was more in the control group than the case group (29% as compared with 16%) (P=0.04). The average age of patients with infection due to urethral catheterization was found to be higher (55.4±14.52 versus 48.4±14.92) (P<0.001). Conclusion: While a preference for closed drainage system existed, however in the present study, it was found that with daily change of sterile urinary bag even with opening of system, the rate of CA-UTI was reduced

Impact of a Multidisciplinary Infection Prevention Initiative on Central Line and Urinary Catheter Utilization in a Long-term Acute Care Hospital.

BackgroundProlonged central line (CL) and urinary catheter (UC) use can increase risk of central line–associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI).MethodsThis interventional study conducted in a 76-bed long-term acute care hospital (LTACH) in Southeast Michigan was divided into 3 periods: pre-intervention (January 2015–June 2015), intervention (July–November 2015), and postintervention (December 2015–March 2017). During the intervention period, a multidisciplinary infection prevention team (MIPT) made weekly recommendations to remove unnecessary CL/UC or switch to alternate urinary/intravenous access. Device utilization ratios (DURs) and infection rates were compared between the study periods. Interrupted time series (ITS) and 0-inflated poisson (ZIP) regression were used to analyze DUR and CLABSI/CAUTI data, respectively.ResultsUC-DUR was 31% in the pre- and postintervention periods and 21% in the intervention period. CL-DUR decreased from 46% (pre-intervention) to 39% (intervention) to 37% (postintervention). The results of ITS analysis indicated nonsignificant decrease and increase in level/trend in DURs coinciding with our intervention. The CAUTI rate per catheter-days did not decrease during intervention (4.36) compared with pre- (2.49) and postintervention (1.93). The CLABSI rate per catheter-days decreased by 73% during intervention (0.39) compared with pre-intervention (1.45). Rates again quadrupled postintervention (1.58). ZIP analysis indicated a beneficial effect of intervention on infection rates without reaching statistical significance.ConclusionsWe demonstrated that a workable MIPT initiative focusing on removal of unnecessary CL and UC can be easily implemented in an LTACH requiring minimal time and resources. A rebound increase in UC-DURs to pre-intervention levels after intervention end indicates that continued vigilance is required to maintain performance.

Reducing indwelling urinary catheter use through staged introduction of electronic clinical decision support in a multicenter hospital system.

To integrate electronic clinical decision support tools into clinical practice and to evaluate the impact on indwelling urinary catheter (IUC) use and catheter-associated urinary tract infections (CAUTIs).Design, Setting, and ParticipantsThis 4-phase observational study included all inpatients at a multicampus, academic medical center between 2011 and 2015.InterventionsPhase 1 comprised best practices training and standardization of electronic documentation. Phase 2 comprised real-time electronic tracking of IUC duration. In phase 3, a triggered alert reminded clinicians of IUC duration. In phase 4, a new IUC order (1) introduced automated order expiration and (2) required consideration of alternatives and selection of an appropriate indication. Overall, 2,121 CAUTIs, 179,070 new catheters, 643,055 catheter days, and 2,186 reinsertions occurred in 3·85 million hospitalized patient days during the study period. The CAUTI rate per 10,000 patient days decreased incrementally in each phase from 9·06 in phase 1 to 1·65 in phase 4 (relative risk [RR], 0·182; 95% confidence interval [CI], 0·153-0·216; P<·001). New catheters per 1,000 patient days declined from 53·4 in phase 1 to 39·5 in phase 4 (RR, 0·740; 95% CI, 0·730; P<·001), and catheter days per 1,000 patient days decreased from 194·5 in phase 1 to 140·7 in phase 4 (RR, 0·723; 95% CI, 0·719-0·728; P<·001). The reinsertion rate declined from 3·66% in phase 1 to 3·25% in phase 4 (RR, 0·894; 95% CI, 0·834-0·959; P=·0017). The phased introduction of decision support tools was associated with progressive declines in new catheters, total catheter days, and CAUTIs. Clinical decision support tools offer a viable and scalable intervention to target hospital-wide IUC use and hold promise for other quality improvement initiatives.

Implementation of a Nurse-Driven Protocol for Catheter Removal to Decrease Catheter-Associated Urinary Tract Infection Rate in a Surgical Trauma ICU.

Early removal of urinary catheters is an effective strategy for catheter-associated urinary tract infection (CAUTI) prevention. We hypothesized that a nurse-directed catheter removal protocol would result in decreased catheter utilization and CAUTI rates in a surgical trauma intensive care unit (STICU). We performed a retrospective, cohort study following implementation of a multimodal CAUTI prevention bundle in the STICU of a large tertiary care center. Data from a 19-month historical control were compared to data from a 15-month intervention period. Pre- and postintervention indwelling catheter utilization and CAUTI rates were compared. Catheter utilization decreased significantly with implementation of the nurse-driven protocol from 0.78 in the preintervention period to 0.70 in the postintervention period (P < .05). As a result of the bundle, the CAUTI rate declined significantly, from 5.1 to 2.0 infections per 1000 catheter-days in the pre- vs postimplementation period (Incident Rate Ratio [IRR]: 0.38, 95% confidence interval: 0.21-0.65). Implementation of a nurse-driven protocol for early urinary catheter removal as part of a multimodal CAUTI intervention strategy can result in measurable decreases in both catheter utilization and CAUTI rates.

Multicenter Study of Device-Associated Infection Rates, Bacterial Resistance, Length of Stay, and Mortality in Intensive Care Units of 2 Cities of Vietnam: International Nosocomial Infection Control Consortium Findings.

The aim of the study was to report the results of the International Nosocomial Infection Control Consortium (INICC) study conducted from May 2008 to March 2015. A device-associated healthcare-acquired infection surveillance study in three adult intensive care units (ICUs) and 1 neonatal ICU from 4 hospitals in Vietnam using U.S. the Centers for Disease Control and Prevention's National Healthcare Safety Network (CDC/NHSN) definitions and criteria as well as INICC methods. We followed 1592 adult ICU patients for 12,580 bed-days and 845 neonatal ICU patients for 4907 bed-days. Central line-associated bloodstream infection (CLABSI) per 1000 central line-days rate was 9.8 in medical/surgical UCIs and 1.5 in the medical ICU. Ventilator-associated pneumonia (VAP) rate per 1000 mechanical ventilator-days was 13.4 in medical/surgical ICUs and 23.7 in the medical ICU. Catheter-associated urinary tract infection (CAUTI) rate per 1000 urinary catheter-days was 0.0 in medical/surgical ICUs and 5.3 in the medical ICU. While most device-associated healthcare-acquired infection rates were similar to INICC international rates (4.9 [CLABSI]; 16.5 [VAP]; 5.3 [CAUTI]), they were higher than CDC/NHSN rates (0.8 [CLABSI], 1.1 [VAP], and 1.3 [CAUTI]) for medical/surgical ICUs, with the exception of CAUTI rate for medical/surgical ICU and CLABSI rate for the medical ICU. Because of limited resources of our Vietnamese ICUs, cultures could not be taken as required by the CDC/NHSN criteria, and therefore, there was underreporting of CLABSI and CAUTI, influencing their rates. Most device utilization ratios and bacterial resistance percentages were higher than INICC and CDC/NHSN rates. Device-associated healthcare-acquired infection rates found in the ICUs of our study were higher than CDC/NHSN US rates, but similar to INICC international rates. It is necessary to build more capacity to conduct surveillance and prevention strategies.

A Technology Intervention for Nurses Engaged in Preventing Catheter-Associated Urinary Tract Infections.

Catheter-associated urinary tract infections account for 40% of healthcare-acquired infections. This study explored the addition of cloud-based software technology to an established nursing quality improvement program to reduce catheter-associated urinary tract infections. Unit-based nurse champions evaluated peers' evidence-based catheter-associated urinary tract infection prevention practices using manual, paper-based feedback. That process achieved reduced rates of catheter-associated urinary tract infection over 18 months. However, it was resource intensive. Cloud-based software technology was introduced to replace the paper. Nurse champions' satisfaction, catheter-associated urinary tract infection and indwelling urinary catheter utilization, and prevention practices were compared before and after the technology intervention. Compliance with the provision of a chlorhexidine bath demonstrated improvement (P = .003), while other practice measures did not significantly change. The indwelling urinary catheter utilization ratio was lower (P = .01), yet the intervention yielded no change in catheter-associated urinary tract infection rates. The short time interval of the intervention was potentially a contributing factor in no significant rate change. Nurse champions (N = 14) were more satisfied with the cloud-based technology (P = .004), the clarity of improvement targets (P = .004), and the speed of sharing data (P = .001). Their time to share data decreased from 4 days or more to 1 hour or less. Nurse champions readily adopted the cloud-based technology. These findings suggest additional research on technology innovations for nursing quality improvement is needed.

EC-99 - CAUTI Reduction Observed During Development of Nurse Driven Protocol for Foley Catheter Removal

Background: Catheter Associated Urinary Tract Infections (CAUTI) are the most frequent device associated hospital infection. In 2014 our CAUTI rate was 4.4/1000 device days. CAUTI reduction initiatives included compliance with a catheter insertion bundle, custom insertion kits, and alternatives to indwelling catheters. Efforts resulted in a 46% rate reduction over a two year period. CAUTI rate in 2016 was 2.37. In 2017 an 83% reduction was observed during the planning and pilot of a nurse driven protocol for urinary management and Foley removal.

EPOP-122 - One Year CAUTI Free: A Multi-Disciplinary Team Approach to Reducing CAUTI in a Pediatric Intensive Care Unit

Background: Our pediatric catheter associated urinary tract infection (CAUTI) prevention team was formed in August 2015 to address a patient safety need. Our CAUTI rate, specifically in our pediatric intensive care unit (PICU), was consistently above national benchmarks, resulting in unnecessary harm for our patients.

Assessing a National Collaborative Program To Prevent Catheter-Associated Urinary Tract Infection in a Veterans Health Administration Nursing Home Cohort.

OBJECTIVECollaborative programs have helped reduce catheter-associated urinary tract infection (CAUTI) rates in community-based nursing homes. We assessed whether collaborative participation produced similar benefits among Veterans Health Administration (VHA) nursing homes, which are part of an integrated system.SETTINGThis study included 63 VHA nursing homes enrolled in the "AHRQ Safety Program for Long-Term Care," which focused on practices to reduce CAUTI.METHODSChanges in CAUTI rates, catheter utilization, and urine culture orders were assessed from June 2015 through May 2016. Multilevel mixed-effects negative binomial regression was used to derive incidence rate ratios (IRRs) representing changes over the 12-month program period.RESULTSThere was no significant change in CAUTI among VHA sites, with a CAUTI rate of 2.26 per 1,000 catheter days at month 1 and a rate of 3.19 at month 12 (incidence rate ratio [IRR], 0.99; 95% confidence interval [CI], 0.67-1.44). Results were similar for catheter utilization rates, which were 11.02% at month 1 and 11.30% at month 12 (IRR, 1.02; 95% CI, 0.95-1.09). The numbers of urine cultures per 1,000 residents were 5.27 in month 1 and 5.31 in month 12 (IRR, 0.93; 95% CI, 0.82-1.05).CONCLUSIONSNo changes in CAUTI rates, catheter use, or urine culture orders were found during the program period. One potential reason was the relatively low baseline CAUTI rate, as compared with a cohort of community-based nursing homes. This low baseline rate is likely related to the VHA's prior CAUTI prevention efforts. While broad-scale collaborative approaches may be effective in some settings, targeting higher-prevalence safety issues may be warranted at sites already engaged in extensive infection prevention efforts.Infect Control Hosp Epidemiol 2018;820-825.

Reducing Serious Safety Events and Priority Hospital-Acquired Conditions in a Pediatric Hospital with the Implementation of a Patient Safety Program

A freestanding children's hospital evaluated the impact of a patient safety program on serious safety events (SSEs) and hospital-acquired conditions (HACs). The No Harm Patient Safety Program was developed throughout the organization using a multifaceted approach that included safety moments, leadership rounding, cause analysis changes, event reporting enhancements, error prevention training, leadership training, identifying priority HACs, Eye on Safety Campaign, and safety coaches. The organization set strategic goals for improvement of SSEs and priority HACs. The rate of SSEs decreased from 0.19 in 2014 to 0.09 in 2015. The rate significantly declined from 2015 to 2016 to a rate of 0.00, for a rate difference of -0.00009 (95% confidence interval [CI]: -0.00016, -0.00002; p = 0.012). The organization reached two years without an SSE in July 2017. The central line-associated bloodstream infection rate significantly declined from 2.8 per 1,000 line-days in 2015 to 1.6 in 2016, for a difference of -0.00118 (95% CI: -0.002270, -0.00008; p = 0.036). Surgical site infection rates declined from a 2015 rate of 3.8 infections per 100 procedures to a 2016 rate of 2.6 (p = 0.2962), and catheter-associated urinary tract infection rates declined from a 2015 rate of 2.7 per 1,000 catheter-days to a 2016 rate of 1.4 (p = 0.2770). The No Harm Patient Safety Program was interwoven into the organization's strategic mission and values, and key messaging was used to purposefully tie the many interventions being implemented back to it. These interventions were associated with improvements in patient safety outcomes.

Impact of a Daily PICU Rounding Checklist on Urinary Catheter Utilization and Infection.

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.

MP23-09 COMPARISON OF POSTOPERATIVE CATHETER-ASSOCIATED URINARY TRACT INFECTION (CAUTI) RATES IN THE UROLOGIC PATIENT WITH A SUPRAPUBIC CATHETER VERSUS TRANSURETHRAL CATHETER

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder II1 Apr 2018MP23-09 COMPARISON OF POSTOPERATIVE CATHETER-ASSOCIATED URINARY TRACT INFECTION (CAUTI) RATES IN THE UROLOGIC PATIENT WITH A SUPRAPUBIC CATHETER VERSUS TRANSURETHRAL CATHETER Jason Warncke, Brittan Sutphin, John Hohenmeyer, E. David Crawford, and Brian Flynn Jason WarnckeJason Warncke More articles by this author , Brittan SutphinBrittan Sutphin More articles by this author , John HohenmeyerJohn Hohenmeyer More articles by this author , E. David CrawfordE. David Crawford More articles by this author , and Brian FlynnBrian Flynn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.741AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urinary tract infections (UTIs) are the most common type of healthcare-associated infection. Among UTIs acquired in the hospital, 75% are catheter-associated urinary tract infections (CAUTI). CAUTI has gained much attention, as in 2008 Medicare regulations ceased reimbursement for costs related to nosocomial CAUTIs. Traditional teaching has been that suprapubic catheters (SPC) are associated with less risk of CAUTI than transurethral catheters (TUC). However, studies directly comparing the CAUTI rate in patients with SPC versus TUC are lacking, particularly in the postoperative Urologic patient. Thus, in this study we aim to compare the CAUTI rate with SPC versus TUC in the postoperative Urologic patient. METHODS We retrospectively reviewed and compared the medical records of 354 patients over a 5-yr period that underwent Urologic surgery. The SPC group consisted of patients that underwent SPC placement at the time of concomitant autologous rectus fascia pubovaginal sling (PVS) by a single surgeon (BJF). SPC placement was accomplished using the T-Spec device from Swan Valley Medical. The TUC group consisted of patients that underwent TUC placement using an 18 Fr Foley at the time of open radical prostatectomy (RP) by a single surgeon (EDC). Patients without a SPC or TUC and patients with both were excluded from the study. The primary outcome of comparison was the CAUTI rate (defined by the 2017 CDC guidelines) between the SPC and TUC cohorts. A Fisher’s exact test was performed to determine if the difference in CAUTI rate between the two cohorts was statistically significant (p<0.05). RESULTS 252 patients were included, including 145 (57.6%) in the SPC group and 107 (42.5%) in the TUC group, mean age 54.5 and 61.5 yrs, respectively. The mean catheter duration at the time of CAUTI for the SPC and TUC groups were 21.3 and 16.0 days, respectively (p=0.79). The mean catheter duration for the TUC group with and without CAUTI was 25.4 and 14.7 days, respectively (p=0.14). The overall CAUTI rate when catheter duration was less than 15 days compared to greater than 15 days was 3.3% and 5.0%, respectively (p=0.39). The CAUTI rate for the SPC group was 2.1% versus the TUC group 7.5% (p=0.039; OR 3.82). CONCLUSIONS In this study of postoperative Urologic patients, SPC was found to have a statistically significant lower rate of CAUTI when compared to TUC. This information may help guide providers when choosing the appropriate bladder drainage modality for their patients, particularly in the postoperative Urologic setting. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e284 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Jason Warncke More articles by this author Brittan Sutphin More articles by this author John Hohenmeyer More articles by this author E. David Crawford More articles by this author Brian Flynn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...