Catheter Necessity Research Articles

P-237. The CLABSI (Central Line Audit by Staff Investigators) Intervention: Reducing Central Line Use in a Medical ICU using Physician-Led Prospective Audit and Feedback of Catheter Necessity

Abstract Background Prompt removal of unnecessary central lines has been associated with reduction in central line associated bloodstream infections (CLABSI). Following the COVID-19 pandemic, sustained increases in central line utilization and CLABSI were seen at our medical ICU (MICU). Here we present a quality improvement intervention of a weekly physician-led audit and feedback to reduce central line utilization. Methods The intervention was conducted in the MICU at a single tertiary-care hospital from June 2023 to February 2024. Once weekly, 2 physicians did an electronic medical record audit of all central lines. Line necessity was defined as requiring one or more of the following: irritant medication use, renal replacement therapy, hemodynamic monitoring, total parenteral nutrition, or inability to obtain peripheral access. Lines for renal replacement therapy (HD lines) were excluded from evaluation as they were medically necessary by definition. Once an unnecessary line was identified, the primary ICU fellow and attending were sent a text message prior to morning rounds to recommend removal. Central line removal rates and patient demographic data were collected from June 2023 to February 2024. Data on central line utilization and CLABSI rates were collected from July 2023 to December 2023 and compared to data from January 2022 to June 2023. Results 365 patients and 447 central lines were reviewed. 49 (11%) central lines were deemed unnecessary and removal recommended, of which 26 (53%) were removed within 24 hours. The central line device utilization ratio (DUR) in line days per patient days decreased by 20%, from 0.48 to 0.38 [p = < 0.0001]. When HD lines were included, we observed a reduction in DUR by 8%, from 0.61 to 0.56 [p = < 0.0001]. The CLABSI National Healthcare Safety Network Standardized Infection Ratio (SIR) pre-implementation was 2.84 and post-implementation was 2.83 [p = 1.00]. Conclusion A physician-led, once weekly prospective audit and feedback of central line necessity led to a substantial decline in central line utilization rates in our medical ICU. There was no observed reduction in CLABSI SIR, however this may be due to the short intervention period and low incidence rate of CLABSI; over time it would be expected that a reduction in central line days would lead to a reduction in CLABSI. Disclosures All Authors: No reported disclosures

Contributing Factors to Central Line-associated Bloodstream Infections and Catheter-associated Urinary Tract Infections

Background: Central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) are key healthcare-associated infection (HAI) quality metrics. In this qualitative analysis, we aimed to identify common issues contributing to CLABSIs and CAUTIs occurring during the COVID-19 pandemic. Methods: In an academic healthcare network in Atlanta, GA, four hospitals perform real-time, apparent cause analyses (ACAs) for all CLABSIs and CAUTIs. Contributing factors are entered as free text into an electronic database. We analyzed data from 8/2020–8/2022. We first performed a qualitative open card sort of all reported contributing factors to CLABSI and created a novel framework based on mutually defined critical tasks (e.g., line insertion) and cross-cutting issues (e.g., communication breakdown). Contributing factors could describe ≥1 critical task and/or ≥1 cross-cutting issue. After establishing interrater reliability, a multidisciplinary group applied this framework to classify each contributing factor. For CAUTI, we used the same set of cross-cutting issues but identified new critical tasks via open card sorting. We then used the framework to classify each CAUTI contributing factor. We used descriptive statistics to identify frequent critical tasks and cross-cutting issues. Results: We reviewed 350 CLABSI ACAs with 602 contributing factors and 240 CAUTI ACAs with 405 contributing factors (Figure 1). Our classification framework comprised 11 cross-cutting issues and 9 critical tasks for CLABSI and 7 critical tasks for CAUTI (Figure 2). CLABSI: The critical tasks most often reported were bathing (19%), central line dressing maintenance (15%), and assessing central line indication (8%; Figure 3). Within these tasks, the most frequent issues described for bathing were the task not being performed (20%) and unclear documentation (18%); for dressing maintenance, the task was not performed (15%), not documented (15%), or poorly performed due to lack of competency (15%); and for assessing line indication, there was frequent communication breakdown (33%). CAUTI: The critical tasks most often reported were urinary catheter care (26%) and assessing the indication for urinary catheter (22%; Figure 4). Within these tasks, urinary catheter care was frequently not documented (38%) or not performed (16%); assessing urinary catheter necessity was often not documented (29%) or involved breakdown of communication (19%). Conclusion: We created a novel framework to evaluate common causes of HAIs in an academic healthcare network. This framework can be used to identify and track gaps over time and to develop quality improvement initiatives targeting key tasks and associated factors, such as communication difficulties when assessing device indications.Disclosure: Colleen Kraft: Consultant - REbiotix/Ferring; Scientific Advisory Board - Seres, LLC

Impact of Indwelling Urinary Catheter Necessity Review on Urinary Catheter Utilization and Catheter-Associated Urinary Tract Infections

Impact of Indwelling Urinary Catheter Necessity Review on Urinary Catheter Utilization and Catheter-Associated Urinary Tract Infections

IMPACT OF RESIDENT & NURSING EDUCATION TOWARDS HAND HYGIENE TO REDUCE THE INCIDENCE OF CATHETER ASSOCIATED URINARY TRACT INFECTION

Background: Catheter associated urinary tract infections(CAUTIs) are the most common health care acquired infection and leading cause of morbidity. The aim of this study is to determine the incidence of CAUTI and impact of resident and nursing education towards hand hygiene to reduce CAUTI. Methods: The study was conducted in Chirayu medical college, Bhopal after approval from institutional Research Committee for a period of 3 months. Admitted patients are enrolled in our study, according to given inclusion and exclusion criteria with their written informed consent. 7 Days nursing education will be done with informative illustrative charts 30 minutes daily for 7 days following which the Intensive Care Unit will be observed for reduction in incidence of CAUTI rates for a period of 3 months. Results And Conclusion: In our stuty. the incidence of CAUTI preintervention was 35.6% and decreases to 9.2% post intervention which suggests that aseptic insertion of indwelling catheters and evidence-based care bundle utilization are not only important in the reduction of CAUTIs also the nursing autonomy with patients and situational awareness promoted through catheter necessity discussions are keys in delivering timely care reduces CAUTIS and length of catheter days.

Early Mobility in Patients With Femoral Catheters

Early Mobility in Patients With Femoral Catheters

116: DE-ESCALATING URINARY CATHETER OUTPUT MEASUREMENT REPORTING IN THE ICU: A QUALITATIVE SURVEY

Introduction: Indwelling urinary catheter utilization and catheter-associated urinary tract infection rates remain high among intensive care unit (ICU) patients despite targeted, best practice de-implementation efforts. ICU de-escalation protocols to decrease urinary catheter output measurement reporting could lead to increased urinary catheter removal. As part of our multimodal strategies to advance early urinary catheter removal in select patients, we evaluate attitudes and perceptions of urinary catheter necessity and hourly urine output measurement in the ICU. Methods: We conducted brief qualitative survey at an urban, academic medical center among surgical ICU nurses (RN’s), Advance practice providers (APP), and physicians (MD). Participants selection was random and based on if the patient had a urinary catheter in place. We assessed self-reported perceptions of hourly urine output need as well as perceived barriers toward de-escalation of urinary output measurement reporting (from hourly to q2 or q4hrs) and urinary catheter removal. Results: 51 survey responses were collected in the beginning of the academic calendar. Survey participants were 74.5 percent RN, 7.8 percent APP, and 15.7 percent MD. Most were aware of their ICU urinary catheter removal protocol (52.9%). Participants felt that for a given patient, 74.5% needed hourly urine output monitoring. The most cited indication of hourly urinary catheter measurements was “using urine measure as a marker of perfusion”, “hemodynamic instability”, and “acute kidney injury” (AKI). Missing acute changes related to perfusion or AKI was frequently reported as negative consequence of decreasing urinary catheter output measurement reporting. Being off vasopressors was the most common criteria reported to facilitate acceptance of less frequent urinary catheter output measurement reporting. Resolution of AKI and urinary retention were commonly reported as facilitators for urinary catheter removal. Conclusions: De-escalating urinary catheter output measurement reporting in the ICU is novel. There are notable barriers to this practice that need further exploration to potentially decrease urinary catheter utilization rates in the ICU.

A Clinical Nurse Specialist-Led Initiative to Reduce Catheter-Associated Urinary Tract Infection Rates Using a Best Practice Guideline.

The purpose of this clinical nurse specialist-led initiative was to reduce catheter-associated urinary tract infection rates to less than 1 infection per 1000 catheter days, to reduce catheter device utilization, and to improve staff adherence to documentation requirements on a traumatic brain injury rehabilitation unit. Catheter-associated urinary tract infections are costly hospital-acquired infections increasing length of stay and morbidity for patients. Following an education intervention, a best practice initiative was implemented. Staff performance based on electronic health record documentation, infection rates, and device utilization were compared before and after a bundle of interventions including education, staff competency, simulation, and audits. Catheter-associated urinary tract infection rates were reduced from 16.67 to 0 per 1000 catheter days and device utilization ratio from 0.122 to 0.056 per patient day. The unit maintained zero infections upon project completion. Following initiative implementation, documentation improved related to urinary catheter necessity, daily care interventions, patient education, and urine output. This initiative resulted in reductions in device utilization and catheter infection rates, which were maintained following project completion. Adherence to documentation audit criteria also improved.

Catheter-associated urinary tract infection reduction in critical care units: a bundled care model

Catheter-associated urinary tract infections (CAUTIs) represent approximately 9% of all hospital acquired infections, and approximately 65%–70% of CAUTIs are believed to be preventable. In the spring of 2013, Boston Medical...

MP55-17 REDUCING FOLEY CATHETER USAGE IN A PEDIATRIC HOSPITAL USING A BEHAVIORAL NUDGE

You have accessJournal of UrologyPediatric Urology V (MP55)1 Sep 2021MP55-17 REDUCING FOLEY CATHETER USAGE IN A PEDIATRIC HOSPITAL USING A BEHAVIORAL NUDGE Daniel Pelzman, Marc Colaco, Omar Ayyash, and Glenn Cannon Daniel PelzmanDaniel Pelzman More articles by this author , Marc ColacoMarc Colaco More articles by this author , Omar AyyashOmar Ayyash More articles by this author , and Glenn CannonGlenn Cannon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002085.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Catheter-associated urinary tract infections (CAUTI) prolong hospitalizations and increase healthcare costs. The rates of infection are monitored by the Joint Commission and the Centers for Disease Control. As a result, many adult hospitals have instituted policies to reduce their CAUTI rate, but similar efforts have not been well-studied in pediatric hospitals. We sought to investigate whether behavioral modifications including catheter teaching and a daily rounding checklist could reduce unnecessary catheter usage in a 313-bed tertiary-care pediatric hospital. METHODS: Prospectively collected data of urinary catheter utilization at a single pediatric-only hospital from Jan 2015-Dec 2019 were analyzed. In May 2017, hospital-wide mandatory workshops were performed and a nursing-driven daily checklist to assess for catheter necessity was implemented. Pre- and post-intervention catheter utilization rates were compared using the standardized utilization ratio, which is a CDC-developed quality measure of catheter usage defined as total catheter days per total patient days. The intervention was implemented during a seven-month run-in period (May-Dec 2017), which was omitted from analysis. RESULTS: A total of 455,534 patient-days were available for analysis between January 2015 and December 2019. Overall CAUTI rate decreased from 0.13/1000 patient-days to 0.04/1000 patient-days. Hospital-wide catheter utilization decreased from 9.8% (95% confidence interval (CI) [9.4% - 10.3%]) pre-intervention to 3.5% (95% CI [3.3% - 3.8%], p < 0.01) post-intervention (Figure 1). These changes were most pronounced in critical care units where utilization dropped from 35.0% (95% CI [33.5% – 36.4%]) to 12.8% (95% CI [11.6% - 14.1%], p < 0.01). Standardized utilization ratios in the critical care units fell from 2.09 (95% CI [2.00 – 2.19]) to 0.76 (95% CI [0.69 – 0.84], p < 0.01). CONCLUSIONS: Catheter teaching and institution of a daily rounding checklist successfully reduced monthly urethral catheter utilization as measured by catheter usage rates and standardized utilization ratio in a pediatric hospital. Widespread adoption of these protocols may decrease unnecessary catheter usage and catheter-associated morbidity. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e966-e966 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Pelzman More articles by this author Marc Colaco More articles by this author Omar Ayyash More articles by this author Glenn Cannon More articles by this author Expand All Advertisement Loading ...

Fact or Foley: Reducing Catheter Related Urinary Tract Infections by Connecting Evidence to Drive a Multidisciplinary Urinary Program

<h3>Background</h3> Catheter Associated Urinary Tract Infections (CAUTI) are the most frequent healthcare acquired infections. Key initiatives to reduce CAUTI have been supported by multiple healthcare organizations. A quality Improvement project was created to establish a robust, sustainable, enhanced multi-disciplinary CAUTI prevention program reducing catheter utilization and CAUTI rates. <h3>Methods</h3> Collaboration to reduce the incidence of CAUTI occurred through education, product evaluation, and practice changes via Centers Disease Control (CDC) evidence-based guidelines. These guidelines are organized into five evidence-based prevention initiatives: avoiding unnecessary catheters/limiting duration, aseptic technique and standardization for insertion, catheter maintenance, catheter necessity, and engaging healthcare workers (HCW) with culture change. Engaging HCW and culture change was incorporated into each of the other four initiatives. CAUTI were defined using National Healthcare Safety Network (NHSN) patient safety chapter, patient days from finance and device days from the electronic medical record; 10 months pre-implementation was compared with 10 months post-implementation. <h3>Results</h3> Implementing evidence based practices and engaging stakeholders, resulted in decreased catheter utilization and CAUTI rates, 24% and 42%, respectively. After the implementation of the evidence based strategies,10 fewer CAUTI were identified. The evidence-based improvements included: external female collection device, daily review of duration/necessity, limiting catheter insertion in the ED and OR, daily discussions with front line staff regarding necessity/removal, and senior leadership emphasis and support driving culture change. <h3>Conclusions</h3> The equal importance of each initiative was the key to program success, including skilled communication, true collaboration, and focused shared goals are key in developing partnerships to achieve cultural change and promote safe patient care. The most powerful strategy positively impacting these results was the executive leadership promoting initiative accountability. Leadership commitment powered decreased utilization, early catheter removal, and sustainment of evidence based initiatives. Continued decrease in the utilization will promote our low rates of CAUTI.

Effect of Physician Documentation on Catheter Associate Urinary Tract Infection Rates at a Community Hospital

<h3>Background</h3> Urinary tract infections (UTIs) account for more than 30% of healthcare-associated infections. Urinary catheters are often placed and continued for inappropriate indications. Urine cultures are also frequently obtained when not indicated. <h3>Methods</h3> Twenty-one catheter associated urinary tract infections (CAUTIs) were identified during the surveillance time-frame of October 2018 to March 2019. Chart review was done to identify provider order for urinary catheter insertion, documentation for appropriate indication of catheter and urine culture. <h3>Results</h3> Of the twenty-one CAUTIs, there was no provider order or documentation of appropriate indication for urinary catheter insertion in 48% of the charts that were reviewed. Sixty seven percent of these CAUTIs did not have daily documentation of urinary catheter necessity. Inappropriate continued urinary catheter use was identified in 57%. Urine culture was ordered when not clinically indicated in 48% of the patients. <h3>Conclusions</h3> Through this study, we identified opportunities to improve physician documentation for urinary catheter insertion, continued use and urine culture orders. Lack of diagnostic stewardship was noted, with half of the urine cultures obtained when not indicated. Efforts to improve physician awareness included education through presentation at grand rounds, medical staff orientation, communication in newsletters, emails and fliers in the physician's lounge. Urinary catheter order has been removed from all order sets with a few exceptions that are approved by the CAUTI committee (examples: preoperative, trauma, genital urinary). A request has been made to the Information Technology department to include the appropriate indications for urine catheter and urine culture to the respective orders and to have a hard stop option in the electronic medical record for provider documentation of daily catheter necessity. Our efforts have to date shown decreased Foley use. The house-wide utilization rate prior to these implementations was 0.22 compared to our current rate of 0.18. Critical care utilization rate decreased to 0.56 from 0.60.

Implementation of External Urine Collection Devices to Decrease the Standardized Utilization Ratio of Indwelling Urinary Catheters

<h3>Background</h3> Catheter associated urinary tract infections (CAUTIs) are one of the most common hospital acquired infections. CAUTIs are associated with numerous complications including increased length of stay. The most significant risk factor for developing a CAUTI is the prolonged use of an indwelling catheter. Our purpose is to determine if the introduction of external urine collection devices for both male and female patients would impact the utilization of indwelling urinary catheters and subsequently, reduce our CAUTI events in our 24-bed Intensive Care Unit (ICU). <h3>Methods</h3> We established our baseline by measuring our urinary catheter utilization rate in our ICU for all 12-months in 2017. In June 2018, a qualitative trial was performed for three weeks for a female external device and then followed by the male external device. Prior to our trial, all team members were educated on the use of the external urine collection systems. Unit based Intensivists were updated on the product trial and encouraged to participate. During the trial, a light duty nurse rounded on each patient with an indwelling catheter to discuss the need for catheter necessity. If the patient required a device, it was advocated to remove the indwelling device and use an external device. Standardized Likert scale evaluations were completed by bedside nursing and nursing assistants during the trial. <h3>Results</h3> Based on the positive trial results, both products were implemented in the ICU and subsequently expanded hospital wide. Our baseline SUR for 2017 was 1.067. In 2018, our SUR decreased by 9.7% to 0.964. To date, our SUR data for January 2019 to October 2019 is 0.736. This is an overall 31% reduction in urinary catheter utilization from our baseline data. <h3>Conclusions</h3> In conjunction with daily conversations regarding catheter necessity, the implementation of external urine collection devices has significantly decreased the SUR on indwelling catheters.

Quick to Wick: External Female Catheters and Urinary Catheter Utilization

<h3>Background</h3> Urinary tract infections (UTI) are common hospital-acquired infections (HAI), causing increased morbidity and hospital costs among patients. Over 75% of HAI UTI are associated with urinary catheters (CAUTI), and between 15-25% of hospitalized patients have urinary catheters. Avoidance of urinary catheters is a primary method to prevent CAUTIs. <h3>Methods</h3> Two community hospitals (450 and 472 licensed beds) implemented an external female urinary catheter device in an effort to decrease prolonged urinary catheterization. To facilitate implementation of the device, nursing education was provided to augment traditionally accepted indwelling catheter necessity with external devices. A retrospective review compared electronic pre-implementation data (1/2017 – 8/2018), to post-implementation data (10/2018 – 10/2019). Urinary catheter utilization measured by device utilization ratio (DUR) and CAUTI were compared using Chi-square analysis (Epi Info, CDC). Urinary catheter DUR and CAUTI were compared for both ICU and non-ICU patient populations. The impact on urinary catheter device utilization ratios (DUR) and CAUTI standardized infection ratios (SIR) were evaluated. <h3>Resultsw</h3> Hospital-wide urinary catheter DUR significantly decreased 13% (pre-DUR 0.15, post-DUR 0.13, p < 0.01). While Hospital A observed a reduced DUR in the ICU, Hospital B did not observe a reduction. Both hospitals saw 18% decrease in non-ICU urinary catheter DUR (p < 0.01). Hospital A saw a 34% reduction in CAUTI while Hospital B saw an increase in CAUTI, although neither were statistically significant. <h3>Conclusions</h3> Implementation of a female external catheter at two hospitals resulted in significant reduction of indwelling urinary catheter utilization, but no significant impact on CAUTI. Female gender and prolonged catheterization have been repeatedly cited in the literature as risk factors for CAUTI. This device may have a considerable impact on urinary catheter utilization and CAUTI, improving patient outcomes, reimbursement programs, and hospital ratings.

Persistent Barriers to Timely Catheter Removal Identified from Clinical Observations and Interviews

Indwelling urinary and vascular catheters are valuable devices in patient care, but prolonged or unnecessary use increases the risk of infectious and noninfectious catheter harms. To understand persistent barriers to detecting and removing unnecessary catheters, researchers conducted a multimethod qualitative study that included observations and in-person interviews with clinicians working on a progressive care unit of a large hospital. Observations consisted of shadowing nurses during shift change and while admitting patients, and observing physicians during morning rounds. Observational data were gathered using unstructured field notes. Interviews were conducted using a semistructured guide, audio-recorded, and transcribed. Qualitative content analysis was conducted to identify main themes. Barriers to timely removal identified during 19 interviews with clinicians and 133 hours of field observations included physicians not routinely reviewing catheter necessity during rounds, catheters going unnoticed or hidden under clothing, common use of "Do Not Remove" orders, and little or no discussion of catheters among clinicians. Five overall themes emerged: (1) Catheter data are hard to find, not accurate, or not available; (2) Catheter removal is not a priority; (3) Confusion exists about who has authority to remove catheters; (4) There is a lack of agreement on, and awareness of, standard protocols and indications for removal; and (5) Communication barriers among clinicians create challenges. To address barriers and facilitate detection and timely removal, clinicians need ready access to accurate catheter data, more clearly delineated clinician roles for prompting removal, effective tools to facilitate discussions about catheter use, and standardized catheter removal protocols.

Candidemia in children: Epidemiology, prevention and management.

Candidemia is the leading cause of invasive fungal infections in hospitalised children. The highest rates of candidemia have been recorded in neonates and infants <1year of age. Candidemia is more frequent in neonates and young infants than in adults, and is associated with better clinical outcomes, but higher inpatient costs. Over the last 10years, a declining trend has been noted in the incidence of paediatric candidemia in the US and elsewhere due to the hospital-wide implementation of central-line insertion and maintenance bundles that emphasise full sterile barrier precautions, chlorhexidine skin preparation during line insertion, meticulous site and tubing care, and daily discussion of catheter necessity. Additional interventions aiming at reducing gut-associated candidemia are required in immunocompromised and critically ill children.

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).

Reduction in Catheter Associated Urinary Tract Infection Rates and Device Utilization in a Medical Unit and a Respiratory Stepdown Unit

Among urinary tract infections acquired in the hospital, approximately 75% are associated with a urinary catheter. The lack of a framework for daily inter-disciplinary communication of catheter necessity and the monitoring of maintenance bundle practices can lead to prolonged catheter utilization that results in an increased risk for catheter associated urinary tract infections (CAUTIs). The objective of this project is to demonstrate that the daily use of effective communication strategies and monitoring tools will decrease CAUTI rates and device utilization on both a medical and a respiratory step down unit. We chose a medical unit and a pulmonary step down unit that had fluctuating CAUTI rates, standardized infection ratios (SIR), and device utilization rates prior to the start of this study. Patients with indwelling urinary catheters on each of these units were followed on a daily basis for a period of one year. All rates, SIRs, and percentiles were compared to NHSN benchmarks using the “Rate Table for Catheter-Associated UTI Data” and the “SIR for All Catheter-Associated UTI Data” in NHSN. A year's data was analyzed for this study. SIRs, infection rates and device utilization ratios were calculated and compared to the results of the same NHSN analysis performed for these units for the baseline year prior to the start of the project. Please see Table 1. We found that the implementation of daily interdisciplinary communication strategies and bundle monitoring tools led to a decrease in CAUTI rates, SIRs, and device utilization on both units. Tools that guide health care providers to ensure compliance with maintenance bundles and removal of urinary catheters in a timely manner leads to the prevention of CAUTIs in hospitalized patients.

Reducing catheter-associated urinary tract infections: a quality-improvement initiative.

Catheter-associated urinary tract infections (CAUTIs) are among the most common health care-associated infections in the United States, yet little is known about the prevention and epidemiology of pediatric CAUTIs. An observational study was conducted to assess the impact of a CAUTI quality improvement prevention bundle that included institution-wide standardization of and training on urinary catheter insertion and maintenance practices, daily review of catheter necessity, and rapid review of all CAUTIs. Poisson regression was used to determine the impact of the bundle on CAUTI rates. A retrospective cohort study was performed to describe the epidemiology of incident pediatric CAUTIs at a tertiary care children's hospital over a 3-year period (June 2009 to June 2012). Implementation of the CAUTI prevention bundle was associated with a 50% reduction in the mean monthly CAUTI rate (95% confidence interval: -1.28 to -0.12; P = .02) from 5.41 to 2.49 per 1000 catheter-days. The median monthly catheter utilization ratio remained unchanged; ∼90% of patients had an indication for urinary catheterization. Forty-four patients experienced 57 CAUTIs over the study period. Most patients with CAUTIs were female (75%), received care in the pediatric or cardiac ICUs (70%), and had at least 1 complex chronic condition (98%). Nearly 90% of patients who developed a CAUTI had a recognized indication for initial catheter placement. CAUTI is a common pediatric health care-associated infection. Implementation of a prevention bundle can significantly reduce CAUTI rates in children.

Sustained reductions in urinary catheter use over 5 years: Bedside nurses view themselves responsible for evaluation of catheter necessity

Multiple approaches are needed to improve urinary catheter use and sustain compliance with the appropriate indications for catheter use. We evaluated the effect of 3 interventions over 5 years: a nurse-driven multidisciplinary effort for early urinary catheter removal, an intervention in an emergency department to promote appropriate placement, and twice-weekly assessment of urinary catheter prevalence with periodic feedback on performance for nonintensive care units. We also assessed the views of bedside nurses, case managers, and nurse managers with respect to appropriate catheter use, how often need is assessed, and who they consider responsible for the evaluation of urinary catheter need. There was a significant reduction in urinary catheter use from 17.3%-12.7% during the 5-year period (linear regression with time as independent variable, R(2), 0.61; P < .0001). Of bedside nurses responding to the questionnaire, 222 of 227 (97.8%) identified themselves as responsible or as sharing the responsibility for catheter necessity evaluation, 223 of 229 (97.4%) were confident in their knowledge, and 166 of 222 (74.8%) viewed physicians as receptive to their requests for catheter removal >70% of the time. A multifaceted approach to promote appropriate urinary catheter use is associated with sustained reductions in catheter use. Bedside nurses view themselves responsible for the evaluation of catheter presence and need.

Infection Prevention Component of Process Improvement Project to Reduce Regulated Medical Waste

reviewed the CLABSIs and determined any commonalities. For instance, if the central venous catheter had a sluggish blood return, it was noted that this increased the risk for a CLABSI. These huddles were expanded to include all hospital CLABSI events. 5. Bedside rounding tool templates were developed that could be individualized to meet the needs of a specific unit. These tools discussed catheter necessity and any issues with that patient's central venous catheter. Results: Following the implementation of these initiatives, the CLABSI rates decreased throughout the institution. In 2010 the numbers of CLABSIs were 54, for a rate of 2.4. The number of CLABSIs for 2011 totaled 17, for a rate of 0.8. Lesson Learned: Collaboration from all areas of the institution is necessary to develop a standardization of central venous catheter care and foster a zero tolerance culture.