Catheter-associated Urinary Tract Infection Prevention Research Articles

Review of Catheter-Associated Urinary Tract Infections and In Vitro Urinary Tract Models.

Catheter-associated urinary tract infections (CAUTIs) are one of the most common nosocomial infections and can lead to numerous medical complications from the mild catheter encrustation and bladder stones to the severe septicaemia, endotoxic shock, and pyelonephritis. Catheters are one of the most commonly used medical devices in the world and can be characterised as either indwelling (ID) or intermittent catheters (IC). The primary challenges in the use of IDs are biofilm formation and encrustation. ICs are increasingly seen as a solution to the complications caused by IDs as ICs pose no risk of biofilm formation due to their short time in the body and a lower risk of bladder stone formation. Research on IDs has focused on the use of antimicrobial and antibiofilm compounds, while research on ICs has focused on preventing bacteria entering the urinary tract or coming into contact with the catheter. There is an urgent need for in vitro urinary tract models to facilitate faster research and development for CAUTI prevention. There are currently three urinary tract models that test IDs; however, there is only a single very limited model for testing ICs. There is currently no standardised urinary tract model to test the efficacies of ICs.

Effect of instruction and implementation of a preventive urinary tract infection bundle on the incidence of catheter associated urinary tract infection in intensive care unit patients

Background and Objective:Catheter Associated Urinary Tract infection (CAUTI) is one of the most prevalent hospital acquired infections which causes increased medical costs, hospital stay and mortality. Patients in critical care units are in a higher risk. The main purpose of the present study is the Identification of the effect of instruction and implementation of a preventive urinary tract infection bundle on the incidence of CAUTI.Materials and Methods:This was a before-after quasi-experimental study. 330 patients were included (185 patients in before and 145 in after the intervention). In both phases, the incidence of CAUTI, compliance with principles of CAUTI prevention, urinary catheter utilization and indications of catheter insertion were evaluated. CAUTI was identified based on the Center for Disease Control and Prevention/ National Healthcare Safety Network (CDC/NHSN) criteria with the online INICC software. Interventions included the instruction of the bundle to all health care workers in selected intensive care units and implementing interventions to improve facilities required for the implementation of the bundle.Results:No significant decrease was seen in the incidence of the CAUTI after the intervention (3.2 v/s 1.36 in 1000 catheter-day, p<0.388). The most prevalent indication for urinary catheter utilization in both phases, were critical monitoring of urine output (80.16% and 72.26%, respectively). Before the intervention, 1.6 % of catheterized cases were labeled inappropriate by the physicians. This increased significantly to 5.5% after intervention (P<0.001). Before the intervention, 37.5% of the catheters which were labeled inappropriate were removed which increased to 42/4% after the intervention insignificantly (P<0/709). From the 88 hours of compliance monitoring. The number of observed noncompliance cases before the intervention, which was 1941, decreased significantly after the intervention (P<.001).Conclusion:This study revealed that although instruction and implementation of the preventive bundle reduced CAUTI, this reduction was not significant. Future studies should be conducted with larger sample sizes and in longer periods. The most prevalent criterion for urinary catheter utilization was the need for critical monitoring of urine output. Instruction of the bundle reduced noncompliance with principles of urinary tract infection control.

Infection control bundles in intensive care: an international cross-sectional survey in low- and middle-income countries

In low- and middle-income countries (LMICs), the burden of healthcare-associated infections (HCAIs) is not known due to a lack of national surveillance systems, standardized infection definitions, and paucity of infection prevention and control (IPC) organizations and legal infrastructure. To determine the status of IPC bundle practice and the most frequent interventional variables in LMICs. A questionnaire was emailed to Infectious Diseases International Research Initiative (ID-IRI) Group Members and dedicated IPC doctors working in LMICs to examine self-reported practices/policies regarding IPC bundles. Responding country incomes were classified by World Bank definitions into low, middle, and high. Comparison of LMIC results was then made to a control group of high-income countries (HICs). This survey reports practices from one low-income country (LIC), 16 middle-income countries (MICs) (13 European), compared to eight high-income countries (HICs). Eighteen (95%) MICs had an IPC committee in their hospital, 12 (63.2%) had an annual agreed programme and produced an HCAI report. Annual agreed programmes (87.5% vs 63.2%, respectively) and an annual HCAI report (75.0% vs 63.2%, respectively) were more common in HICs than MICs. All HICs had at least one invasive device-related surveillance programme. Seven (37%) MICs had no invasive device-related surveillance programme, six (32%) had no ventilator-associated pneumonia prevention bundles, seven (37%) had no catheter-associated urinary tract infection prevention bundles, and five (27%) had no central line-associated bloodstream infection prevention bundles. LMICs need to develop their own bundles with low-cost and high-level-of-evidence variables adapted to the limited resources, with further validation in reducing infection rates.

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.

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.

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.

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.

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.

Validity and reliability of the knowledge-attitude-practice scale for prevention catheter associated urinary tract infection measurement

Objective To develop a scale of catheter-associated urinary tract infection (CAUTI) knowledge-attitude-practice (KAP) and to test its psychometric properties, and to provide effective assessment tools for clinical evaluation of knowledge, attitude and practice of CAUTI prevention. Methods Based on KAP theory and CAUTI preventive current guideline, the scale was developed by using literature review, Delphi expert inquiry. A questionnaire survey was conducted among 300 medical workers in a third grade A hospital in Qingdao. Exploratory factor analysis and confirmatory factor analysis were both conducted to screen the items further. The psychometric properties of scale was tested. Results The finalized scale included 4 subscales and 45 items, amount to 63.21% of the variance contribution rate. The total Cronbach's alpha was 0.914, and the split half reliability was 0.812. The content validity of the scale was 0.895, while it ranged from 0.846-1.000 for each subscale. The correlation of item-to total was 0.711-0.862, and the correlation coefficient of item-to-item ranged from 0.425-0.564. Conclusions The scale of CAUTI KAP has good reliability and validity. It can be used to evaluate CAUTI related knowledge, attitude and practice level of medical workers. Key words: Catheter associated urinary tract infection; Knowledge-attitude-practice; Scale; Reliability; Validity

Impact of a change in surveillance definition on performance assessment of a catheter-associated urinary tract infection prevention program at a tertiary care medical center

In January 2015, the Centers for Disease Control and Prevention (CDC)/National Health Safety Network (NHSN) changed the definition of catheter-associated urinary tract infection (CAUTI). We evaluated the outcomes of a robust CAUTI prevention program when we performed surveillance using the old definition (before 2015) versus the new definition (after 2015). This is the first study to evaluate how the change in CDC/NHSN definitions affected the outcomes of a CAUTI reduction program. Baseline was from January 2012 to September 2014; the intervention period was from October 2014 to February 2016. Staff nurses were trained to be liaisons of infection prevention (Link Nurses) with clearly defined CAUTI prevention goals and with ongoing monthly activities. CAUTI incidence per 1000 catheter days was compared between the baseline and intervention periods, using the 2 definitions. With the new definition, CAUTIs decreased by 33%, from 2.69 to 1.81 cases per 1000 catheter days (incidence rate ratio [IRR] = 0.67; 95% confidence interval [CI]: 0.48-0.93; P < .016). With the old definition, CAUTIs increased by 12%, from 3.38 to 3.80 cases per 1000 catheter days (IRR = 1.12; 95% CI: 0.88-1.43; P = .348). We aggressively targeted CAUTI prevention, but a reduction was observed only with the new definition. Our findings stress the importance of having a reasonably accurate surveillance definition to monitor infection prevention initiatives.

Economic Evaluation of a Catheter-Associated Urinary Tract Infection Prevention Program in Nursing Homes.

To assess the economic effect and cost effectiveness of a targeted catheter-associated urinary tract infection (CAUTI) prevention intervention in the nursing home (NH) setting. Randomized clinical trial. Community-based NHs (N=12). NH residents with indwelling urinary catheters (N=418). Standard care versus infection prevention program involving barrier precautions, active surveillance, and NH staff education. Costs of the intervention, costs of disease, and health outcomes were used to calculate an incremental cost-effectiveness ratio for the intervention. Data came from intervention results and the literature and outcomes were analyzed over one year. A 120-bed NH would have program costs of $20,279/year. The cost of disease treatment would be reduced by $54,316 per year, resulting in a $34,037 net cost savings. Most of this savings would come from fewer CAUTI hospitalizations ($39,180), with $15,136 in savings from CAUTI care within the NH. The intervention also yielded a gain of 0.197 quality-adjusted life-years (QALYs). Taking into account uncertainty in all parameters suggests there is an 85% chance that the intervention is cost-saving. The CAUTI prevention program is expected to benefit payers by reducing costs and improving health outcomes. Because the savings accrue to payers and not to NHs, payers such as Medicare and private insurers may want to provide incentives for NHs to implement such programs. clinicaltrials.gov Identifier: NCT01062841.

Effectiveness of a bundled approach to reduce urinary catheters and infection rates in trauma patients

Catheter-associated urinary tract infections (CAUTIs) are common nosocomial infections. In 2015, the Centers for Medicare and Medicaid Services began imposing financial penalties for institutions where CAUTI rates are higher than predicted. However, the surveillance definition for CAUTI is not a clinical diagnosis and may represent asymptomatic bacteriuria. The objective of this study was to compare rates of urinary catheterization and CAUTI before and after the implementation of a bundled intervention. This retrospective review evaluated trauma patients from January 2013-January 2015. The bundled intervention optimized the urinary catheterization process and culturing practices to reduce false positives. The CAUTI rate was defined as a positive surveillance CAUTI divided by total catheter days multiplied by 1,000 days. A total of 6,236 patients were included (pre: n = 5,003; post: n = 1,233). Fewer patients in the post bundle group received a urinary catheter (pre: 25% vs post: 16%; P < .001). After bundle implementation, the CAUTI rate reduced over one third (pre: 4.07 vs post: 2.56; incidence rate ratio, 0.63; 95% confidence interval, 0.19-2.07). Although the number of patients exposed to urinary catheters and catheter days was decreased, optimization of culturing practices was essential to prevent the CAUTI rate from increasing from a reduced denominator. Implementation of a CAUTI prevention bundle works synergistically to improve patient safety and hospital performance.

Trauma and Intensive Care Nursing Knowledge and Attitude of Foley Catheter Insertion and Maintenance.

In the acute care setting, the majority of urinary tract infections are associated with indwelling urinary catheters. Despite guidelines for proper use, catheter-associated urinary tract infections (CAUTIs) continue to occur in critically ill/injured patients. There is a paucity of data on the translation between CAUTI prevention education and behavioral change. This project evaluated nurse's clinical knowledge and attitude toward Foley catheter insertion and maintenance to determine the benefits of addressing gaps in knowledge and inconsistencies in attitude through education.A prospective cohort study was conducted with registered nurses from the emergency room, trauma/surgical, and medical intensive care units. Participant's clinical knowledge and attitude toward Foley catheter usage and CAUTIs were evaluated using a 20-question survey tool before and after a CAUTI education program.Forty-eight nurses completed the presurvey, educational training, and postsurvey. The mean postsurvey score was significantly higher (86.9 ± 8.3%) than the presurvey score (76.0 ± 12.3%) for the knowledge section of the survey. There was no marked difference in participant attitude following the educational training, with mean presurvey and postsurvey scores of 91.3 ± 7.0% and 89.8 ± 5.3%, respectively. After the course, participants were more confident in their clinical knowledge; however, perception regarding CAUTI prevention did not improve. A series of unannounced rounding observations before and after the intervention showed an improvement in proper Foley catheter maintenance.Catheter-associated urinary tract infection prevention education was an effective countermeasure to address gaps in clinical knowledge, but modifying attitudes was difficult to achieve. In the short term, the training appeared to improve proper maintenance in clinical practice.

Role of “bladder care bundle” and “infection control nurse” in reducing catheter-associated urinary tract infection in a peripheral hospital

Background: Care bundles are an effective means of reducing catheter-associated urinary tract infection (CAUTI) when they are implemented with high impact interventions. Care bundle approach only works when every element of the bundle is implemented for every appropriate patient, every time and with high impact. Aim: This study aims to study the efficacy of CAUTI Care Bundle and of infection control nurse (ICN) in reducing the incidence of CAUTI in a zonal hospital. Materials and Methods: The study was with an initial baseline phase (observational) of 8 months followed by an intervention Phase of 21 months. The intervention phase was further divided into intervention Phase I (8 months) and intervention Phase II (13 months). Intervention Phase I included a multidimensional approach of education and training of health-care staff for catheter management and prevention of CAUTI and implementation of catheter care bundle. In intervention Phase II education of health-care workers and implementation of catheter care bundle was done under constant supervision and guidance of ICN. Results: We recorded a total of 834 urinary catheter days: 309 in baseline phase, 314 in intervention Phase I, and 211 in intervention Phase II. It was found that the incidence rate of CAUTI, measured as episodes per 1000 catheter days is 64.72 in baseline phase, 25.47 in intervention Phase I, and 18.95 in intervention Phase II. The catheter care bundle approach along with education of the staff reduced the CAUTI incidence by 60.64 and when the same was applied under the constant supervision of ICN for the CAUTI reduction rate was clinically significant with 70.72. Conclusions: The catheter care bundle approach along with the education of the staff reduced the CAUTI incidence by 60.64 episodes/1000 catheter days and when the same was applied under constant supervision of ICN for the CAUTI reduction rate was clinically significant with 70.72

Review of Strategies to Reduce Central Line-Associated Bloodstream Infection (CLABSI) and Catheter-Associated Urinary Tract Infection (CAUTI) in Adult ICUs.

Central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) are costly and morbid. Despite evidence-based guidelines, Some intensive care units (ICUs) continue to have elevated infection rates. In October 2015, we performed a systematic search of the peer-reviewed literature within the PubMed and Cochrane databases for interventions to reduce CLABSI and/or CAUTI in adult ICUs and synthesized findings using a narrative review process. The interventions were categorized using a conceptual model, with stages applicable to both CAUTI and CLABSI prevention: (stage 0) avoid catheter if possible, (stage 1) ensure aseptic placement, (stage 2) maintain awareness and proper care of catheters in place, and (stage 3) promptly remove unnecessary catheters. We also looked for effective components that the 5 most successful (by reduction in infection rates) studies of each infection shared. Interventions that addressed multiple stages within the conceptual model were common in these successful studies. Assuring compliance with infection prevention efforts via auditing and timely feedback were also common. Hospitalists with patient safety interests may find this review informative for formulating quality improvement interventions to reduce these infections.

Nurse-driven protocols and the prevention of catheter-associated urinary tract infections: A systematic review

Catheter-associated urinary tract infections (CAUTIs) are one of the most common hospital-acquired conditions and no longer reimbursable from Medicare as of 2008. Nurse-driven protocols (NDPs), which provide a medically approved rubric for professional nurses to make autonomous care decisions, can facilitate appropriate catheter use and timely removal, as advised in the Centers for Disease Control and Prevention's 2009 CAUTI prevention guidelines. However, little attempt has been made to systematically evaluate their effect on clinical outcomes. A systematic review of studies published in the United States since 2006 was performed, following guidelines from the Institute of Medicine. Sources included CINAHL, Medline, professional agencies, hand-searching, and expert consultation. Clinical predictors and prevalence of CAUTI were examined and synthesized qualitatively; heterogeneity of outcomes made a statistical meta-analysis inappropriate. Twenty-nine studies were found eligible for inclusion. All used a case-control (pre-post) approach, and all reported reductions in clinical predictors of CAUTI, particularly indwelling-urinary catheter utilization and CAUTI rates. However, the number of CAUTIs remained unchanged in 1 study. A formal quality assessment revealed a high risk of bias; included studies met an average of 4.9 out of 11 quality indicators. Specifically, many did not use standardized measures. NDPs appear to have a positive impact on the clinical predictors and prevalence of CAUTI. However, this review identified need for improving the study design of quality improvement projects conducted within the patient care setting.

Incorporation of Leadership Rounds in CAUTI Prevention Efforts.

Leadership engagement is an important aspect of integrating best practices at the bedside. The catheter-associated urinary tract infection (CAUTI) prevention workgroup at our academic medical center implemented leadership rounding in partnership with clinical staff to increase participation in CAUTI prevention initiatives on inpatient units. There was an associated decrease in urinary catheter utilization and CAUTI rates. Implementation of leadership rounds should be considered as a part of comprehensive CAUTI prevention efforts in health care settings.

Effectiveness of a Nurse-Led Initiative, Peer-to-Peer Teaching, on Organizational CAUTI Rates and Related Costs.

A nurse-led initiative of peer-to-peer teaching positively impacted organizational incidence of catheter-associated urinary tract infections (CAUTIs). The initiative included validating the competency of the nursing staff, highlighting the importance of CAUTI prevention, identifying CAUTI costs, quantifying the value of nursing care, and supporting nurses as teachers. The project demonstrated that peer-to-peer teaching and competency validation can be effective methods to engage nurses in quality improvement.

A national collaborative approach to reduce catheter-associated urinary tract infections in nursing homes: A qualitative assessment

Reducing health care-associated infections (HAIs), such as catheter-associated urinary tract infection (CAUTI), is a critical performance improvement target in nursing homes. The Agency for Healthcare Research and Quality Safety Program for Long-term Care: Health Care-Associated Infections/Catheter-Associated Urinary Tract Infection, a national performance improvement program, was designed to promote implementation of a CAUTI prevention program through state-based or regional collaboratives in more than 500 nursing homes across the United States. Qualitative interviews were conducted with 8 purposefully selected organizational leads (who led implementation activities for a group of facilities) and 8 facility leads (who led implementation activities at a given facility) to understand implementation successes and challenges and experiences of participants involved in the program. Key themes were identified using a rapid analysis approach. Key themes related to general perceptions, changes due to program participation, and factors influencing program implementation were identified. In general, the program was viewed positively by organizational and facility leads with changes in catheter care practices, staff empowerment, and improvements in knowledge identified as benefits. Implementation challenges included the time required for program start-up as well as issues with staff and physician support, logistic barriers, and staffing turnover. Despite some challenges, the observed program success and positive views of those participating suggest that collaboratives are an important strategy for providing nursing homes with enhanced expertise and support to prevent HAIs and ensure resident safety.

Sustaining a CAUTI Prevention Bundle

Catheter Associated Urinary Tract Infection (CAUTI) prevention is an institutional effort to reduce the rate of nosocomial infection in acutely ill oncology patients. Sustaining a CAUTI prevention program in the Post Anesthesia Care Units (PACU) can present challenges. The onboarding of new staff members and practice change for tenured staff presented opportunities for improvement in maintaining CAUTI prevention measures.