Catheter-associated Urinary Tract Infection Rates Research Articles

Nursing protocols to reduce urinary tract infection caused by indwelling catheters: an integrative review.

to analyze the production of knowledge in research articles about the effectiveness of nursing protocols for reducing indwelling urinary catheter dwell time and catheter-associated urinary tract infection rate in hospitalized adult and older patients. an integrative review of three full articles, available in the MEDLINE Complete - EBSCO, Scopus and Web of Science databases, from 01/01/2015 to 04/26/2021. the three protocols reduced infection rates, and from the review/synthesis of their knowledge, a level IV body of evidence emerged to compose the nursing care process aimed at reducing indwelling urinary catheter dwell time and catheter-associated urinary tract infection. this process gathers scientific evidence to support the elaboration of nursing protocols and, consequently, the conduction of clinical trials on its effectiveness in reducing urinary tract infection by indwelling urinary catheter.

Surveillance of health-care associated infections in an intensive care unit at a tertiary care hospital in Central India.

Because the risk of health-care associated infections (HAIs) is high in intensive care units, and HAIs are one of the causes of morbidity and mortality and affects the overall quality of health care, the continuous monitoring of HAIs in intensive care patients is essential. This descriptive cross-sectional study was carried out over a period of five years in a tertiary-care teaching hospital. The aim of the study was to investigate the main and specific types of health-care associated Infections and determine the microbiological profile and antimicrobial susceptibility rates of isolates in patients with HAI. : The active surveillance method was used to detect HAIs in patients who spent over 48 hr in a targeted ICU. Patients with blood stream infections (BSI), central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infections (CAUTI) and ventilator-associated events (VAE) were included in the study. HAI were diagnosed based on the Centre for Disease Control (CDC)'s National Healthcare Safety Network (NHSN) updated definitions of HAIs. A total of 121,051 patient days, including 7,989 central line days, 64,557 urinary catheter days, and 18,443 ventilator days, were recorded in the study population and 832 HAIs were diagnosed (incidence rate 6.9%). The overall rates of BSI, CLABSI, CAUTI and possible ventilator-associated pneumonia (p-VAP) were 3.7, 10.6, 2.1 and 13.4/1,000 device days, respectively. The most common organism isolated from BSI was Acinetobacter baumanii (n=322, 29%), followed by Klebsiella pneumoniae 225 (n=225, 20.3%). 79.8% of Acinetobacter baumanii strains were resistant to imipenem, 77.1% to ciprofloxacin and 76.4% to ampicillin. The most common organisms isolated from CAUTI were non-albicans Candida species (n=38, 18%), followed by E. coli and Citrobacter spp. (each n=33, each 15.7%). A trend of increasing resistance of Acinetobacter baumannii to carbapenems was observed. Risk factor analysis showed invasive procedures during sepsis and organophosphorous poisoning as significant factors.

Impact of Implementing Key Performance Indicators on Catheter-Associated Urinary Tract Infection (CAUTI) Rates Among Adult ICU Patients in Saudi Arabia

The prevalence of catheter-associated urinary tract infections (CAUTIs) in hospitals characterizes one of the most significant problems in healthcare. This study aims to assess whether the implementation of impact of key performance indicators (KPIs) checklist reduces the number of CAUTI in adults present in intensive care unit (ICU) with indwelling catheters. This is a retrospective analytical study conducted in a tertiary hospital in Riyadh, Saudi Arabia, from June 2020 to June 2021. One hundred and thirty-four patients with CAUTIs met the criteria and were included in the study. Socio-demographic data was collected to enable informed analysis based on personal information (age, gender, marital status, monthly income, level of education, and department) and medical history (duration of catheterization, types of organisms, history of chronic illness, and duration of hospitalization). The research also used a prevention of CAUTI checklist containing 26 items. The outcome measures were 1) the rate of CAUTIs measured pre- and post-implementing performance measurement indicators (KPI) of CAUTIs prevention practice and 2) the prevention of catheter-associated urinary tract infection in three areas: general information recording, insertion practices, and maintenance practices. The study found that there was compliance with the prevention of CAUTIs in terms of recording the general patient's information (72%), insertion practices (52%), and maintenance practices (50%). However, most safety practices, including poor hygiene and safety standards, patient handling, and audited protocol programs, were not strictly followed, resulting in increased risk factors for CAUTIs. Compliance with the prevention of CAUTIs in terms of recording the general patient's information, insertion practices, and maintenance practices lies within the range of 50-75%, and the recommended practices are usually followed. A targeted education on CAUTI-prevention practices curtailing the most aggravating risk factors and adopting a safety culture driven by a patient handling and audited protocol program should be explored to reduce hospital CAUTIs.

2041. Impact of Coronavirus Disease 2019 pandemic on healthcare-associated infections at intensive care unit in South Korea: Data from Korean National Healthcare-associated Infections Surveillance System (KONIS)

Abstract Background Coronavirus Disease 2019 (COVID-19) pandemic has influenced hospital infection control practices. We evaluated the impact of the COVID-19 pandemic on healthcare-associated infections (HAIs) in the intensive care unit. Methods We conducted a retrospective analysis using data from the Korean National Healthcare-Associated Infections Surveillance System (KONIS). KONIS has conducted nationwide prospective surveillance of HAIs in intensive care units. Comparisons of incidence rates of bloodstream infection (BSI), central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated pneumonia (VAP) before (Jan 2018-Dec 2019) and during the COVID-19 pandemic (Jan 2020-Jun 2021) were performed according to hospital size. The microorganism distributions in BSI, urinary tract infection, and pneumonia were compared between the period before and during the COVID-19 pandemic. Results The incidence rate of BSI significantly decreased during the COVID-19 pandemic than in the pre-COVID-19 period (1.38 vs. 1.19 per 10,000 patient-days; P < 0.001) [Table 1]. Incidence rates of CLABSI (2.30 vs. 2.17 per 1,000 device-days; P = 0.03) and VAP (1.03 vs. 0.81 per 1,000 device-days; P < 0.001) decreased significantly during the COVID-19 pandemic than in the pre-COVID-19 period, whereas that rate of CAUTI was similar between the two periods. The annual trends of incidence rate of CLABSI and VAP also has decreased (Figure 1). According to the hospital size, the incidence rate per 1,000 device-days of CLABSI significantly decreased during the COVID-19 pandemic than in the pre-COVID-19 period in small to medium-sized hospitals (300-699 beds). The incidence rate per 1,000 device-days of VAP significantly decreased only in small-sized hospitals (200-449 beds). The microorganism distributions in HAIs did not change significantly. Conclusion The incidence rates of CLABSI and VAP decreased during the COVID-19 pandemic than in the pre-COVID-19 period, which was attributable to the changes in small to medium-sized hospitals. Disclosures All Authors: No reported disclosures.

2240. Implementation of a Clinical Decision Support Panel for Urine Culture Ordering

Abstract Background Standard urine culture collection techniques have a high risk of false positive results in catheterized patients. IDSA guidelines recommend replacing long-term catheters before specimen collection for cultures. Our goal was to evaluate the impact of clinical decision support (CDS) during the urine culture computerized provider order entry (CPOE) on test use and patient-level outcomes. Methods In March 2021, CDS was added to the urine culture CPOE in the electronic health record (EHR). The order panel includes education regarding appropriate clinical indications for urine culturing, and protocolizes urine collection to determine (A) if a urinalysis was ordered, (B) if special patient population (i.e., PICU), (C) the presence and duration of an indwelling urinary catheter, and (D) whether the catheter had difficulty with placement. Depending on the criteria identified in A, B, C, and D, the panel recommends catheter removal prior to urine culture (Figure 1). We retrospectively evaluated the impact of panel implementation in our pre- (7/2020- 3/2021) and post-intervention periods (4/2021- 3/2022) using an interrupted time series analysis with Poisson regression. Outcomes included urine cultures/1000 patient days (pd), number of catheter removal orders, catheter-associated urinary tract infection (CAUTI)/1000 catheter days, and days of antibiotic therapy with urinary tract infection (UTI) indication/1000pd Order Panel Framework Results Clinicians selected catheter removal in 183 of 2133 (8.5%) instances of ordering a urine culture when a catheter was detected by the panel (Figure 2). Analysis revealed a significant decrease in urine culture orders (1.1% decrease/month, p< 0.05), a decreasing trend of antibiotic use with UTI indications (Figure 3, 2.8% decrease/month, p< 0.05), but no significant change in CAUTI rates (Figure 4). Evaluation of the safety reporting system revealed no identifiable increase in safety events related to catheter removal or reinsertion. Catheter Associated Urinary Tract Infections Black boxes indicate Poisson regression model estimates Black boxes indicate Poisson regression model estimates Conclusion CDS can aid in improving urine culture practice habits, including removal of long-standing catheters before urine culture. The decreasing trend in total urine culture orders (Figure 5) may reflect a ”culture change” over time to avoid urine cultures in inappropriate instances. Total Urine Cultures Ordered Black boxes indicate Poisson regression model estimates. Red circles indicate predicted outcome without ‘intervention’. Disclosures Sonali D. Advani, MBBS, MPH, FIDSA, Locus Biosciences: Advisor/Consultant|Locus Biosciences: Honoraria|Sysmex America: Advisor/Consultant.

790. Can Electronic Clinical Decision Support Systems Improve the Diagnosis of Urinary Tract Infections?: A Systematic Review and Meta-Analysis

Abstract Background Urinary tract infection (UTI) is a commonly misdiagnosed infectious condition. Stewardship interventions which successfully reduce rates of asymptomatic bacteriuria treatment (ASB) are often labor intensive, and thus a systematic solution is desirable. In this study, our objective was to systematically review studies to evaluate the effect of implementing a clinical decision support system on the ordering of urine culture tests for the diagnosis of UTI across diverse clinical settings. Methods We conducted a comprehensive electronic search of 5 databases and manual reference list review for peer-reviewed articles published prior to July 2, 2021. Studies which described an intervention designed to reduce unnecessary or incorrect diagnosis of UTI through utilization of CDS were included. The primary outcome of interest was rate of urine culture tests ordered. Two investigators independently screened studies and extracted and compiled data. Results A total of 5,013 studies were screened, of which 14 met inclusion criteria for the systematic review (Table 1). The most common intervention was urinalysis with reflex to urine culture based on pre-specified urinalysis parameters, such as a threshold level of pyuria. All 9 studies with statistical comparisons reported a decreased urine culture rate post-intervention, 8 of which were statistically significant (Table 2). Overall, a 37% decrease in urine culture rate was detected after CDS implementation (Table 3). Several studies also reported improvements in antimicrobial-related measures such as days of therapy and guideline-concordant therapy. Catheter-associated urinary tract infection rate was decreased in 2 studies and unchanged in 1 study. A limited number of included studies reported no adverse outcomes including increased bloodstream infection and mortality rates. Conclusion Electronic clinical decision support systems appear to be effective in decreasing unnecessary urine culture tests and improving UTI diagnosis. Prospective studies are needed to evaluate the impact on antimicrobial prescribing, patient-relevant outcomes, and potential adverse effects. Disclosures Elie Saade, MD, MPH, Janssen: Advisor/Consultant Curtis Donskey, MD, Pfizer, Clorox, Ecolab, and Professional Disposables International: Grant/Research Support Abhishek Deshpande, MD, PhD, Clorox: Grant/Research Support|Merck & Co., Inc., Kenilworth, NJ, USA: Advisor/Consultant|Merck & Co., Inc., Kenilworth, NJ, USA: Stocks/Bonds|Seres Therapeutics: Grant/Research Support.

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.

55: REDUCING CAUTI EVENTS WITH ACTIVE DRAIN LINE CLEARANCE: A RETROSPECTIVE OBSERVATIONAL STUDY

Introduction: Catheter-associated urinary tract infections (CAUTIs), represent approximately 9% of all hospital-associated infections and are associated with increased morbidity, mortality, and cost in intensive care units (ICUs). We performed a quality improvement study to assess if the use of a bladder catheter with integrated active drain line clearance reduced the rate of catheter-associated urinary tract infections (CAUTIs) in a burn ICU. Methods: We performed an eight-year (2015–2022) retrospective cohort study in a single-center burn ICU with seven beds. CAUTI events were compared from a 48-month period in which gravity bladder catheters had been the standard of care to a 28-month period after the implementation of a novel urinary catheter system. This urinary monitoring system features an active drain line clearance, two one-way valves preventing urinary backflow, and automation of intra-abdominal pressure measurements. Charts were reviewed to characterize the patients. Results: A total of 42 CAUTIs in 2243 patients were identified using the National Health and Safety Network (NHSN) definition during the analyzed period. The incidence of CAUTI events pre-implementation was 0.030 (mean 10 CAUTI events per year) compared to 0.002 (mean 1 CAUTI event per year) post-implementation of an automatic drain line clearing UO monitoring system showing a significant reduction in CAUTI events (P < 0.01, risk ratio Accuryn vs. no gravity bladder catheter 0.071, 95% confidence interval: 0.017-0.294). Median [IQR] urinary catheter dwell time to CAUTI events was 4.5 [2.0, 6.2] pre- and 6.0 [5.5, 6.5] post-novel catheter implementation. Conclusions: A novel urinary catheter system with integrated active drain line clearance reduced the rate of CAUTI after implementation. Active drain line clearance preventing standing urine in the bladder and tubing system and two one-way valves eliminating urine backflow might be favorable features potentially leading to a reduction in CAUTI events compared to gravity urinary catheters.

Preventing pediatric catheter-associated urinary tract infections utilizing urinary catheter Kamishibai cards (K-cards)

We instituted Kamishibai (K-card rounding) with the goals of improving indwelling urinary catheter maintenance bundle reliability and decreasing catheter-associated urinary tract infection (CAUTI) rates. In a free-standing children's hospital, we undertook a hospital-wide quality improvement project from January 2019 to June 2021 after developing a K-card based on our urinary catheter maintenance bundle. Auditors used K-cards to ask standardized questions during weekly rounds. Bundle reliability and CAUTI rates were analyzed prospectively. During the study period, 826 K-card audits were performed for 657 unique patients. While overall maintenance bundle reliability remained stable at 84%, there was a statistically significant improvement in reliability to the bundle element "medical discussion of need for the urinary catheter" from 88% to 94% (P=.01). The hospital-wide CAUTI rate significantly decreased (incidence rate ratio, 0.38; 95% CI, 0.15-0.93; P=.04). Hospital-wide urinary catheter K-card rounding facilitated standardized data collection, discussion of reliability and real-time feedback to nurses. Maintenance bundle reliability remained stable after implementation, accompanied by a significant decrease in the CAUTI rate. Implementation of hospital-wide urinary catheter K-card rounding was associated with reduction in CAUTI rates. The project demonstrated likelihood of reproducibility with support of a multidisciplinary team.

A Retrospective, Observational Study of Catheter-Associated Urinary Tract Infection Events Post-Implementation of a Novel Urinary Catheter System with Active Drain Line Clearance and Automated Intra-Abdominal Pressure Monitoring.

A quality improvement study to assess catheter-associated urinary tract infection (CAUTI) rate post-implementation of a bladder catheter with integrated active drain line urine clearance and automated intra-abdominal pressure monitoring in a burn intensive care unit (ICU). Eight-year retrospective before and after study (2015-2022). A single American Burn Association-verified Burn Center with 14 inpatient beds. Patients meeting criteria for admission to a Burn Center. Retrospective cohort study following the implementation of a novel urine output monitoring system with integrated drain line and urine clearance. Data from a 48-month (from January 2015-December 2018) historical control (period 1) were compared to data from a 28-month (from January 2020 to April 2022) post-implementation period (period 2). Pre- and post-implementation CAUTI event incidences were compared. Patients were transferred from outside hospitals with gravity bladder. A distinction in the chart between catheter types was impossible. Charts were reviewed to characterize patients with CAUTI events. A total of 42 CAUTIs in 2243 patients were identified using the National Health and Safety Network (NHSN) definition during the analyzed period. There were 40 CAUTI events in period 1 and two CAUTIs in period 2. The incidence of CAUTI events pre-implementation was 0.030 (mean of 10 CAUTI events per year) compared to 0.002 (mean of 1 CAUTI event per year) post-implementation of an automatic drain line clearing UO monitoring system showing a significant reduction in CAUTI events (p &lt; 0.01, risk ratio novel vs. gravity bladder catheter 0.071, 95% confidence interval: 0.017-0.294). CAUTIs were reduced in the period following the implementation of a novel urinary catheter system with an integrated active drain line and urine clearance in burn patients.

Prediction of Catheter-Associated Urinary Tract Infections Among Neurosurgical Intensive Care Patients: A Decision Tree Analysis

Catheter-associated urinary tract infections (CAUTIs) are the most common device-associated infections in hospitals and can be prevented. To identify the risk factors and develop a risk prediction model for CAUTIs among neurosurgical intensive care unit (NICU) patients. All patients admitted to the NICU of a tertiary hospital between January 2019 and January 2020 were enrolled. Two decision tree models were applied to analyze the risk factors associated with CAUTIs in NICU patients. The performance of the decision tree model was evaluated. A total of 537 patients admitted to the NICU with indwelling catheters were recruited for this study. The rate of CAUTIs was 4.44 per 1000 catheter days, and Escherichia coli was the predominant pathogen causing CAUTIs among indwelling catheter patients. The classification and regression tree model displayed good power of prediction (area under the curve : 0.920). Nine CAUTI risk factors (age ≥60years (P=0.004), Glasgow Coma Scale score ≤8 (P=0.009), epilepsy at admission (P=0.007), admission to the hospital during the summer (P<0.001), ventilators use (P=0.007), receiving less than 2 types of antibiotics (P<0.001), albumin level <35g/L (P=0.002), female gender (P=0.002), and having an indwelling catheter for 7-14days (P=0.001) were also identified. We developed a novel scoring model for predicting the risk of CAUTIs in patients with neuro-critical illness in daily clinical practice. This model identified several risk factors for CAUTI among NICU patients, novel factors including epilepsy and admission during the summer, can be used to help providers prevent and reduce the risk of CAUTI among vulnerable groups.

Characteristics and outcomes of hospitalised inpatients with indwelling urinary catheter-a retrospective study from a large regional hospital in Queensland

Indwelling urinary catheters (IDCs) are a common invasive device in hospitalised patients. Their use is associated with increased risks of developing catheter associated urinary tract infections (CAUTI), and blood stream infections (BSI). To examine the characteristics and outcomes of adult inpatients with an IDC inserted in hospital and identify risk factors for developing CAUTI and BSI. We performed a retrospective observational study of 430 patients with IDC admitted to medical and surgical units of a leading (tertiary) hospital between Nov 2019 till April 2020. Multiple logistic regression analysis was performed to determine independent risk factors for developing urinary tract infection and blood stream infection. The prevalence of CAUTI in our study was 7.4%. Results of multiple logistic regression indicated that with each day of IDC in situ, the likelihood of UTI development increased by 9% (OR 1.09; 95% CI 1.00 to 1.18; p=0.03). Age, gender, and catheter reinsertion were not associated with UTI development. Longer duration of IDC was associated with elevated risk of developing CAUTI. CAUTI rates were higher than some of those previously published. There was no statistical significance in frequency of CAUTI between medical and surgical patients. No statistically significant variables that contributed to the development of BSI were found. Interventions targeted at reducing catheter days should be used to improve CAUTI rates.

Effect of external urinary collection device implementation on female surgical patients.

The Centers for Disease Control and Prevention reports that catheter-associated urinary tract infections (CAUTIs) are the most common hospital-acquired infection. Female external urinary collection devices (EUCDs) may be an alternative to indwelling urethral catheters (IUCs), thereby decreasing CAUTIs. However, no study has demonstrated that EUCDs can help reduce CAUTIs in female surgical patients. We sought to compare CAUTI rate and the median number of days an IUC was used before and after availability of this female EUCD for surgical patients. A retrospective analysis of adult female surgical patients admitted to a single academic institution who received an IUC and/or EUCD was performed. Patients who received an IUC three months before (PRE) EUCD availability (08/2017-10/2017) were compared to patients receiving an IUC and/or EUCD 12 months after (POST) (11/2017-11/2018). From 906 surgical patients receiving an IUC/EUCD, 127 received an EUCD in the POST cohort. Compared to the PRE, the POST had a higher rate of CAUTIs (infections per 1000 catheter days, 11.2 vs. 4.6, p=0.017) and overall UTI rate (infections per 1000 catheter days, 5.4 vs. 4.8, p=0.036), whereas IUC days were similar between cohorts (median, two vs. two days, p=0.18). The POST cohort rate of EUCD UTI was 4.6 infections per 1000 device days. While EUCDs appear to be a promising alternative to IUCs for female surgical patients, this study found increased CAUTIs after introduction of an EUCD. Further research is needed to clarify if female EUCDs are effective in decreasing CAUTI prior to widespread adoption.

Multinational Prospective Cohort Study of Mortality Risk Factors in 198 ICUs of 12 Latin American Countries over 24 Years: The Effects of Healthcare-Associated Infections

BackgroundThe International Nosocomial Infection Control Consortium (INICC) has found a high ICU mortality rate in Latin America.MethodsA prospective cohort study in 198 ICUs of 96 hospitals in 46 cities in 12 Latin American countries to identify mortality risk factors (RF), and data were analyzed using multiple logistic regression.ResultsBetween 07/01/1998 and 02/12/2022, 71,685 patients, followed during 652,167 patient-days, acquired 4700 HAIs, and 10,890 died. We prospectively collected data of 16 variables. Following 11 independent mortality RFs were identified in multiple logistic regression: ventilator-associated pneumonia (VAP) acquisition (adjusted odds ratio [aOR] = 1.17; 95% CI: 1.06–1.30; p < 0.0001); catheter-associated urinary tract infection (CAUTI) acquisition (aOR = 1.34; 95% CI: 1.15–1.56; p < 0.0001); older age, rising risk 2% yearly (aOR = 1.02; 95% CI: 1.01–1.02; p < 0.0001); longer indwelling central line(CL)-days, rising risk 3% daily (aOR = 1.03; 95% CI: 1.02–1.03; p < 0.0001); longer indwelling urinary catheter(UC)-days, rising risk 1% daily (aOR = 1.01; 95% CI: 1.01–1.26; p < 0.0001); higher mechanical ventilation (MV) (aOR = 6.47; 95% CI: 5.96–7.03; p < 0.0001) and urinary catheter-utilization ratio (aOR = 1.19; 95% CI: 1.11–1.27; p < 0.0001); lower-middle level income country (aOR = 2.94; 95% CI: 2.10–4.12; p < 0.0001); private (aOR = 1.50; 95% CI: 1.27–1.77; p < 0.0001) or public hospital (aOR = 1.47; 95% CI: 1.24–1.74; p < 0.0001) compared with university hospitals; medical hospitalization instead of surgical (aOR = 1.67; 95% CI: 1.59–1.75; p < 0.0001); neurologic ICU (aOR = 4.48; 95% CI: 2.68–7.50; p < 0.0001); adult oncology ICU (aOR = 3.48; 95% CI: 2.14–5.65; p < 0.0001); and others.ConclusionSome of the identified mortality RFs are unlikely to change, such as the income level of the country, facility ownership, hospitalization type, ICU type, and age. But some of the mortality RFs we found can be changed, and efforts should be made to reduce CL-days, UC-days, MV-utilization ratio, UC-utilization ratio, and lower VAPs and CAUTI rates.

Device-associated healthcare-associated infections surveillance in an intensive care unit of a tertiary care hospital in COVID-19 patients

Background: Surveillance for healthcare-associated infections has a major role in hospital infection prevention and control programmes. In the present study, we estimated the impact of the COVID-19 pandemic on device-associated healthcare-associated infections (DA-HAI) ventilator-associated events (VAE), central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infections (CAUTI). Methods: This was a prospective surveillance study from January 2021 to June 2021 conducted in a 30-bed intensive care unit (ICU) of tertiary care, and academic healthcare organisations. Targeted surveillance was carried out by the National Healthcare Safety Network surveillance requirements of the Centers for Disease Control and Prevention. Results: A total of 249 patients admitted to the ICU with 2920 patient days of surveillance data were included during the study. A DA-HAIs attack rate of 17.67/100 admissions was seen during the study. The device utilisation ratios of central line, ventilator and urinary catheters were 0.49, 0.60 and 0.83, respectively. VAE, CLABSI and CAUTI rates were 12.44, 6.91 and 9.01/1000 device days, respectively. Among 54 DA-HAIs reported, pathogens could be identified for 41 DA-HAI cases. The most common organisms causing VAE, CAUTI and CLABSI were Acinetobacter baumannii (42.1%), Escherichia coli (30%) and Pseudomonas aeruginosa (41.7%), respectively. Of the Gram-negative organisms 61.7% were carbapenem resistant and 50% of Staphylococcus aureuswere methicillin resistant. Conclusions: The present study shows high rates of ICU-acquired DA-HAIs and moderately high resistance patterns of the organisms causing HAIs, which poses a great risk to patient safety.

Reduction of Catheter-Associated Urinary Tract Infections: A Multidisciplinary Approach to Driving Change.

Despite the many advancements in infection prevention, catheter-associated urinary tract infections (CAUTI) continue to be problematic for many hospitals. The large urban teaching hospital featured in this article developed a team that consisted of a registered nurse quality Lean coach, bedside nurses from each inpatient nursing unit, physicians, an infection prevention specialist nurse, an education specialist nurse, and members of the quality department to study this matter. The team focused on understanding current practice related to the use and duration of indwelling urinary catheters. It was discovered that while some indwelling urinary catheters were justified, others could have been avoided altogether or removed earlier. Multifaceted measures were instituted at this hospital to decrease indwelling urinary catheter days and reduce CAUTI rates. The team's journey to successfully decreasing indwelling urinary catheter days by 19.79% and CAUTI rates by 38% is highlighted.

Reducing Catheter-Associated Urinary Tract Infections Across a Hospital System Through Urine Culture Stewardship

ObjectiveTo evaluate the effectiveness and safety of an evidence-based urine culture stewardship program in reducing hospital catheter-associated urinary tract infections (CAUTIs) and the rate of CAUTIs across a 3-hospital system. Patients and MethodsThis is a prospective, 2-year quality improvement program conducted from October 1, 2018, to September 30, 2020. An evidence-based urine culture stewardship program was designed, which consisted of the following: criteria for allowing or restricting urine cultures from catheterized patients, a best practice advisory integrated into the ordering system of an electronic medical record, and a systematic provider education and feedback program to ensure compliance. The system-wide rates of CAUTIs (total CAUTIs/catheter days×1000), changes in intercepts, trends, mortality, length of stay, rates of device utilization, and rates of hospital-onset sepsis were compared for 3 years before and 2 years after the launch of the program. ResultsCatheter-associated urinary tract infections progressively decreased after the initiation of the program (B=−0.21, P=.001). When the trends before and after the initiation of the program were compared, there were no statistically significant increases in the ratio of actual to predicted hospital length of stay, intensive care unit length of stay, system-wide mortality, and intensive care unit mortality. Although the rates of hospital-acquired sepsis remained consistent after the implementation of the stewardship program through the first quarter of 2020, the rates showed an increase in the second and third quarters of 2020. However, hospital-onset sepsis events associated with the diagnosis of a urinary tract infection did not increase after the intervention. ConclusionUrine culture stewardship is a safe and effective way to reduce CAUTIs among patients in a large multihospital health care system. Patient safety indicators appeared unchanged after the implementation of the program, and ongoing follow-up will improve confidence in the long-term sustainability of this strategy.

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

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

Health-care-associated bloodstream and urinary tract infections in a network of hospitals in India: a multicentre, hospital-based, prospective surveillance study

Health-care-associated infections (HAIs) cause significant morbidity and mortality globally, including in low-income and middle-income countries (LMICs). Networks of hospitals implementing standardised HAI surveillance can provide valuable data on HAI burden, and identify and monitor HAI prevention gaps. Hospitals in many LMICs use HAI case definitions developed for higher-resourced settings, which require human resources and laboratory and imaging tests that are often not available. A network of 26 tertiary-level hospitals in India was created to implement HAI surveillance and prevention activities. Existing HAI case definitions were modified to facilitate standardised, resource-appropriate surveillance across hospitals. Hospitals identified health-care-associated bloodstream infections and urinary tract infections (UTIs) and reported clinical and microbiological data to the network for analysis. 26 network hospitals reported 2622 health-care-associated bloodstream infections and 737 health-care-associated UTIs from 89 intensive care units (ICUs) between May 1, 2017, and Oct 31, 2018. Central line-associated bloodstream infection rates were highest in neonatal ICUs (>20 per 1000 central line days). Catheter-associated UTI rates were highest in paediatric medical ICUs (4·5 per 1000 urinary catheter days). Klebsiella spp (24·8%) were the most frequent organism in bloodstream infections and Candida spp (29·4%) in UTIs. Carbapenem resistance was common in Gram-negative infections, occurring in 72% of bloodstream infections and 76% of UTIs caused by Klebsiella spp, 77% of bloodstream infections and 76% of UTIs caused by Acinetobacter spp, and 64% of bloodstream infections and 72% of UTIs caused by Pseudomonas spp. The first standardised HAI surveillance network in India has succeeded in implementing locally adapted and context-appropriate protocols consistently across hospitals and has been able to identify a large number of HAIs. Network data show high HAI and antimicrobial resistance rates in tertiary hospitals, showing the importance of implementing multimodal HAI prevention and antimicrobial resistance containment strategies. US Centers for Disease Control and Prevention cooperative agreement with All India Institute of Medical Sciences, New Delhi. For the Hindi translation of the abstract see Supplementary Materials section.

Effecting the culture: Impact of changing urinalysis with reflex to culture criteria on culture rates and outcomes.

To evaluate the impact of changes to urinalysis with reflex to culture (UARC) reflex criteria on culture performance and clinical decision outcomes. Retrospective study utilizing interrupted time series analysis from December 2018 to November 2020. Primary outcomes were measures of culture performance. Secondary outcomes were rates of antimicrobial prescription for suspected urinary tract infection (UTI) and catheter-associated urinary tract infection (CAUTI). We also assessed harmful events related to antimicrobial prescription for all causes and UTI, UTI symptoms, and sepsis. A 415-bed, academic, tertiary-care, medical center. Hospitalized adult patients with urine testing performed. UARC reflex criteria were changed on October 22, 2019, from ≥5×109/L white blood cells (WBCs) or trace leukocyte esterase or positive nitrite units on urinalysis to only ≥15×109/L WBCs. The study included 11,322 unique UARC tests. We detected a significant decrease in the rate of urine cultures performed from UARC after the intervention (32.5-8.7 cultures per 1,000 patient days; P < .001), with improved diagnostic efficacy (ie, culture positivity increased from 34.8% to 62.1%). CAUTI rates did not change. We detected a significant decrease in antimicrobial prescription rates (P = .05), this was primarily driven by preintervention changes. One case of sepsis occurred secondary to a missed UTI, and UTIs were rarely missed after the intervention. Implementation of a stricter UARC reflex criterion was associated with a decrease in culture rates with improved diagnostic efficacy without significant adverse events. Continued education is needed to change antimicrobial prescribing practices.