Facility Rate Research Articles

Intentional Leadership Rounds: A Proactive Approach to CAUTI Reduction

Background Catheter-associated urinary tract infections (CAUTI) are the most common preventable hospital-acquired infection. Our facility's rate of CAUTI was above the risk adjusted expected rate. Using intentional leadership rounds, we sought to reduce indwelling urinary catheter (IUC) utilization and thus reduce CAUTI events. Methods Using the Plan-Do-Study-Act model and a Pareto tool for data collection, intentional leader rounds were completed by an Infection Prevention (IP) nurse on two 20-bed medical-surgical units (Neuro-Oncology and Surgical). Units were identified using the National Healthcare Safety Network (NHSN) targeted assessment for prevention (TAP) strategy as units with excess burden of CAUTIs. An IP nurse rounded with nurse providers on each of these units daily (Monday – Friday) for five months, interacting with the nurse to determine if the indication for the IUC was appropriate, if care and maintenance were completed, and if the catheter could be removed or an external catheter placed. The standardized utilization ratio (SUR) was used to determine a decrease in catheter utilization and the standardized infection ratio (SIR) was used to track CAUTIs over time. Results After five months of leadership rounding on Neuro-Oncology and Surgical, the SUR decreased 22% and 12% respectively on each of these units. There were no additional CAUTI events identified during this time frame. Observations from leader rounds identified collaboration between IP and staff nurses to discover barriers on the units and engaged staff in problem-solving. In addition, sustained change was facilitated through the building of interpersonal relationships between IP and the bedside nurse. Conclusions Urinary device utilization was reduced on each unit and there were no additional CAUTI events identified. Integrating leader rounds as an added strategy to reduce CAUTIs connects leaders with clinical staff. Intentional leader rounding along with evidence-based practices to reduce preventable infections and patient harm should be integrated as a proactive overall prevention strategy.

Correlations between quality ratings of skilled nursing facilities and multidrug-resistant urinary tract infections.

The purpose of this study was to determine risk factors for the acquisition of urinary tract infections (UTIs) and multidrug-resistant organisms (MDROs) in residents of skilled nursing facilities (SNFs). Using the informational database provided by the Centers for Medicare and Medicaid Services (CMS), a retrospective logistic regression was performed on 1,523 urine cultures from 12 SNFs located in Long Island, New York. Of the 1,142 positive urine cultures, Escherichia coli was most prevalent. Additionally, 164 (14.4%) of the UTIs were attributed to an MDRO. In multivariate logistic regression, sex and overall quality rating predicted the occurrence of UTIs, whereas identification of MDROs was dependent on the level of nursing care received. The mean predicted probability of UTIs and receipt of contaminated samples was inversely dependent on the facility's rating, where the likelihood increased as overall quality ratings decreased. The CMS's quality rating system may provide some insight into the status of infection control practices in SNFs. The results of this study suggest that potential consumers should focus on the overall star ratings and the competency of the nursing staff in these facilities rather than on individual quality measures.

Lapse in Institutional Animal Care and Use Committee Continuing Reviews.

The United States federal animal welfare regulations and the Public Health Service Policy on Humane Care and Use of Laboratory Animals require that institutional animal care and use committees (IACUCs) conduct continuing reviews of all animal research activities. However, little is known about the lapse rate of IACUC continuing reviews, and how frequently investigators continue research activities during the lapse. It is also not clear what factors may contribute to an institution’s lapse in IACUC continuing reviews. As part of the quality assurance program, the Department of Veterans Affairs (VA) has collected performance metric data for animal care and use programs since 2011. We analyzed IACUC continuing review performance data at 74–75 VA research facilities from 2011 through 2015. The IACUC continuing review lapse rates improved from 5.6% in 2011 to 2.7% in 2015. The rate of investigators continuing research activities during the lapse also decreased from 47.2% in 2012 to 7.4% in 2015. The type of IACUCs used and the size of animal research programs appeared to have no effect in facility’s rates of lapse in IACUC continuing reviews. While approximately 80% of facilities reported no lapse in IACUC continuing reviews, approximately 14% of facilities had lapse rates of >10% each year. Some facilities appeared to be repeat offenders. Four facilities had IACUC lapse rates of >10% in at least 3 out of 5 years, suggesting a system problem in these facilities requiring remedial actions to improve their IACUC continuing review processes.