Urinary Catheter Care Research Articles

Nurse Led Symptom based Telephonic Triaging in Post Acute Care At Home Programme (PACH): Reduction in unnecessary Acute Hospital admissions

Introduction: To meet the healthcare challenges of an aging population and the escalating health care cost, the role of the PACH nurses is vital, as they will follow up with discharged patients with complex medical conditions in their home settings and prevent potential complications. Schmitt,B. & Thompson, D.(2015) emphasized the importance in establishing symptom-based algorithms to promote a standardized approach to telephone triage which will also improve the consistency of the home care advice given by the nurses. Aim: To develop a set of standardized telephonic algorithms for the PACH nurses and also to measure the impact of using the established telephonic algorithms in reducing the incidence of admissions to the acute hospital. Methodology: An inter-professional (IP) team of four nurses and three physicians in the team identified about 22 common symptoms that they would often receive via telephone. Algorithms based on the respective symptoms were then formulated. They are then discussed, reviewed and enhanced during the Team’s in-services teaching. In Feb 2016, the PACH nurses were briefed to utilize the pilot algorithms. The pilot was commenced for a period of 6 months from April to September 2016, every Saturday. For each telephonic response received, the PACH nurse gathered information about the reason for the call and the symptoms experienced by patient. The nurse will then determine the need for home visit, follow up telephonic review, or advise for direct admission to Emergency Department. All the data collected were analyzed using Microsoft Excel software. Findings: A total of 45 telephonic consults were facilitated by the PACH nurses on Saturdays during the period of April 2016 to September 2016. In 57.7% of the telephonic consults, phone advice was given on seven most common symptoms, namely fever management, troubleshooting for tube feeding care, wound management , managing chesty cough, clarification on medication regime, bowel and urine related issues. 26.6% were scheduled for earlier PACH review, where patients were treated at home for pneumonia, urinary tract infection, fluid overload, and nursing related issues such as feeding tube care and urinary catheter care were being addressed at home. With phone advice and earlier PACH visits, we prevented re-attendance at the emergency department, and even admissions back to the hospital. This not only reduced healthcare cost for patients, it also prevented unnecessary utilization of hospital bed, thus resulting in further cost savings. The remaining of the 15.5% of the PACH patients were advised for readmissions as they required further acute medical intervention. The reasons for admissions were mainly pneumonia, sepsis and urinary tract infection. In these cases, telephonic triaging led to timely intervention for acute medical conditions, early treatment and thus kept potential complications at bay. Discussion: The symptom based algorithms do serve as comprehensive guide for the PACH nurses to provide consistent standardized assessment and care. However, thechallenge often faced by the nurses is the carer having deferring understanding on assessment from that of the nurses, which led to either delay in timely treatment, or inappropriate admissions to hospital. Moving forward, the utilization of telehealth to complement the current methodology in accurate and timely patient’s assessment may be explored. This would enable appropriate interventions. Conclusion: The symptom based telephonic algorithms are essential in assisting PACH nurses to standardize care plan and guiding them in their clinical decision making towards appropriate care management for their patients in the community. With the development of the telephonic algorithms, the incidence of unnecessary admissions to acute hospital has been reduced, bringing about a reduction in overall healthcare cost.

Antibiotic Bladder Irrigation in Preventing and Reducing Chronic Urinary Catheter-Related Urinary Tract Infections (UTI)

BackgroundRecurrent UTI is a common complication of chronic urinary catheter use. We report our experience with the use of antibiotic bladder irrigation to reduce catheter associated UTI and systemic antibiotics use.MethodsRetrospective chart review of patients treated with antibiotic bladder irrigation for recurrent UTI related to chronic urinary catheter (2013–2016). Data collected include demographic, co-morbidities, urological anomalies, symptoms, documented pathogens during episodes of infection, and irrigation medication used. Antibiotic regimen included: gentamicin, gentamicin alternated with piperacillin-tazobactam, or tobramycin once weekly. Parameters for successful therapy and alleviation of symptoms included complete relief of symptoms for six months and no systemic antibiotics use for six months post initiation of therapy, or reduced frequency of infections for one year post initiation of therapy.Results39 patients were enrolled, all were patients who had been referred to infectious disease physicians after persistence of symptoms despite multiple rounds of systemic antibiotics and had at least 6 episode of documented UTI despite following guideline for aseptic urinary catheter insertion and care. Mean age 66.5 y (range 27–92), 69% male. Most common urologic problem was neurogenic bladder in 48% and prostate or bladder surgery. 5 self-catheterize, 12 had suprapubic catheter and 22 had chronic indwelling catheter. Most common co-morbidities include: DM, BPH, paraplegia, spina bifida and multiple sclerosis. Most common presenting symptoms were abdominal pain 49% and fever 34%. Most common organisms were Escherichia coli 38%, Pseudomonas aeruginosa 23% and Enterococcus faecalis 18%. 67% used gentamicin bladder irrigation. 26 (66.67%) met the criteria for alleviation of symptoms and success with antibiotic irrigation therapy, and a further four featured improvement of frequency of symptoms despite not successfully meeting the study’s pre-set criteria for full improvement. Patient did not report any associated side effect.ConclusionUse of antibiotic bladder irrigation was successful in reducing symptom frequency and requirement of systemic antibiotics. Further Studies needed to assess the benefit of this mode of therapy.Disclosures All authors: No reported disclosures.

Engaging Our Patients to the Highest Peak with Up To Date Clinical Practice

Examine and update VA Palo Alto HCS (VAPAHCS) SCI indwelling catheter policy to reflect current PVA guidelines and to align with at home urinary catheter care; implement the policy change in SCI; determine adherence to policy and; examine the impact on CAUTI rates.

Re: Impact of the Lack of Community Urinary Catheter Care Services on the Emergency Department.

No AccessJournal of UrologyUrological Survey1 Dec 2017Re: Impact of the Lack of Community Urinary Catheter Care Services on the Emergency Department Tomas L. GrieblingMD, MPH Tomas L. GrieblingTomas L. Griebling More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.09.012AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 2017 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 198Issue 6December 2017Page: 1186-1189 Advertisement Copyright & Permissions© 2017 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tomas L. Griebling More articles by this author Expand All Advertisement PDF downloadLoading ...

Securement of the indwelling urinary catheter for adult patients: a best practice implementation.

The evidence-based project sought to improve knowledge and practice in the care and securement of indwelling urinary catheters. The project utilized a pre and post-implementation audit strategy, with the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice programs. The best practice recommendations on the care and securement of indwelling urinary catheters were retrieved from the Joanna Briggs Institute Clinical Online Network of Evidence for Care and Therapeutics database. A proposed urinary catheter securement practice, which included the use of a specifically designed securement device, was developed and implemented based on these recommendations. The implemented practice was evaluated with an audit tool which comprised two criteria recommended by the Joanna Briggs Institute Practical Application of Clinical Evidence System on the topic: Appropriate Catheter Use and Management. Audit criteria outcomes included staff compliance to training for urinary catheter securement and care and effectiveness of the implemented practice utilized to secure urinary catheters. The project was conducted in a general surgical ward over a period of 14 months, from December 2013 to January 2015. A sample of 30 inpatients was recruited at each audit phase. The sample size was decided based on recommendations from the Joint Commission International guidelines. A comparison between baseline and post-implementation audit findings indicated significant improvements in both audit criteria outcomes. For the first criterion, 100% compliance (P < 0.001) was achieved with all ward nurses being trained in application and care of the proposed urinary catheter securement practice. Criterion 2, which measured the effectiveness of the implemented practice, showed a nine-fold improvement from 10 to 90% (P < 0.001). A sustenance audit conducted 6 months post-implementation showed that compliance rates maintained at 100% for criterion 1 (P < 0.001), with further improvement from 90 to 100% for criterion 2 (P < 0.001). The proposed indwelling urinary catheter securement practice is an effective alternative to existing nursing practices. The use of a specifically designed securement device is found to complement and enhance the quality of urinary catheter securement. Nurses exhibited greater competency and knowledge in the application and care for urinary catheter securement.

Infection Control in the Use of Urethral Catheter: Knowledge and Practises of Nurses

Objective: To identify knowledge and practises of nurses regarding infection control in the use of urethral catheter and associated urinary tract infection in private tertiary care hospital Peshawar. Purpose: The purpose of this study was to explore the current knowledge of nurses regarding urinary catheter care. The study was also focused on practises and standard guidelines about urinary catheter care of nurses in private tertiary care hospitals. Method: A descriptive cross sectional study was conducted among nurses in private tertiary care hospital Peshawar. Participants were selected through convenient sampling technique. The data was collected through a self-developed structured questionnaire. Results: Out of 70 participants the gender distribution was 11.1% (male) and 86.1% (female). The mean knowledge of participants was 66% with standard deviation 25.3%. The Mean practise was 56.43% with Standard deviation 14.94%. Independent t-test was applied to identify the association between knowledge of participants with year of experience which was not significant. One-way Analysis Of Variance (ANOVA) test was applied to identify association between knowledge with years of practise which was significant p=0.024. Conclusion: The study result was alarming to know that the nurses had low knowledge, and poor practises about infection control in the use of urethral catheter. This indicates that nurses need to be educated and trained more on infection control in the use of urethral catheter.

Infection Prevention and Control Risk Assessment: Approach for Early Identification of Harmful Practices and Improving Quality and Safety of Healthcare Service Delivery in Acute Healthcare Settings

Background: Risk management is a process consisting of well-defined steps which, when taken in sequence, support better decision making by contributing to a greater insight into risks and their impacts. It is as much about identifying opportunity as is about avoiding losses. Effective prevention and control of infection must be part of everyday practice and be applied consistently by everyone. Methods: The study was conducted at Tygerberg Hospital in 8 clinical areas/wards during a period of 3 weeks from 23 November 2013 to 9 October 2013. Risk Assessment IPC Inspection Checklist for healthcare institutions provided by the Unit for Infection Prevention and Control (UIPC) at Stellenbosch University was used for data collection. A feedback report was shared with the unit managers and ward in-charges, and the improvement plan was developed in collaboration with them. The follow-up was done to evaluate the implementation of the improvement plan. Data was analysed using Ms Excel. Results: 6 out of 8 (75%) wards complied with ward design, hand hygiene facilities available in all wards, 5 out of 8 wards (62.5%) had inadequate and insufficient protective clothing, 7 out of 8 (87.5%) wards did not have suitable patient toilet facilities. 7 out of 8 wards (87.5%) had suitable sluice area, while 7 out of 8 wards (87.5%) had appropriate treatment area. Quality of maintenance of aseptic procedures improved from 64% (18/28) to 85% (22/26) in patients with indwelling urinary catheter. The similar improvement was noted in patients with peripheral IV lines, from 81% (57/70) to 86% (48/56) as well as in the patients with wound, from 92% (22/24) to 100% (21/21). Conclusion: 6 out of 8 (75%) assessed wards complied against IPC standards. Conducting regular IPC assessment in clinical areas in collaboration with clinical staff (unit managers and in-charges) is essential to improve the quality and safety of healthcare service delivery. Significant improvement was noted in 7 wards during follow up assessment conducted one week after the initial risk assessment, whereby urinary catheter care improved from 64% to 85% (a 21% improvement) and peripheral IV line care improved from 81% to 86% (a 5% improvement). IPC and clinical teams (nurses, doctors, etc) should work hand in hand to improve the quality and safety of healthcare service delivery.

TWOC around the clock: a multimodal approach to improving catheter care.

Urinary tract infections (UTI) are the second-largest group of healthcare-associated infections (HCAI). The Saving Lives Urinary Catheter Care Bundle was introduced to reduce catheter-associated urinary tract infections (CAUTI). In response, we implemented a catheter care group to examine ways to improve catheter care in an acute hospital NHS Trust. We adopted a multimodal approach, revolving around four components: (1) Catheter Care Pathway; (2) HOUDINI checklist; (3) catheter magnets; and (4) use of bladder ultrasound scanners. The yearly CAUTI prevalence survey showed an annual reduction in CAUTI from 2012-2013 to 2014-2015 (3.5% to 2.4%). Evaluations of the multimodal approach have highlighted limitations, leading to priorities being established around provision of tools, education, and use of measurement and feedback. Our multimodal approach demonstrates CAUTI rate improvements are achievable, directly benefiting patients. However, long-term maintenance of multimodal components is required to ensure sustained benefit. Engagement and accountability have emerged as significant challenges to the effectiveness and longevity of the catheter care group. We suggest greater emphasis on such challenges if long-term national or international improvement is to be achieved.

An Innovative Educational Approach to Reducing Catheter-Associated Urinary Tract Infections: A Case Study.

Best practices for urinary catheter insertion and care are well documented in the literature. However, the development of educational methods to address best practice standards has been relatively stagnant. A novel educational approach to teach practicing providers proper catheter insertion and care was developed under a blended learning model with online videos and hands-on simulations. The education was custom created for each participant role. This education also highlighted the providers' own hospitals' catheter-associated urinary tract infections (CAUTI) rates, the negative patient outcomes that have occurred as a result of CAUTIs, and the financial burdens caused by CAUTIs. Results showed a significant inverse relationship between whether the education was occurring and the number of monthly CAUTIs. The results provided evidence that engaging frontline workers in blended learning catheter care simulation education was significantly associated with a lower number of monthly CAUTIs. Other institutions can design similar educational interventions to reduce their CAUTI rates. J Contin Educ Nurs. 2016;47(10):473-476.

Nurse-Driven Catheter-Associated Urinary Tract Infection Reduction Process and Protocol: Development Through an Academic-Practice Partnership.

Translating evidence-based practices to the bedside can be facilitated by an active academic-practice partnership between nursing faculty and frontline nursing staff. A collaborative effort between the university's academic nurses and the medical center's clinical nurses explored, created, implemented, and evaluated an evidence-based nurse-driven protocol for decreasing the rate of catheter-associated urinary tract infections. The nurse-driven protocol was piloted in 4 intensive care units and included nurse-driven orders for catheter discontinuation, utilization of smaller bore urinary catheters, addition of silver-based cleansing products for urinary catheter care, and education of staff on routine catheter care and maintenance. Data were collected for more than 8 months pre- and postimplementation of the nurse-driven protocol. Postimplementation data revealed a 28% reduction in catheter-associated urinary tract infections in the intensive care units as compared with preimplementation. Secondary benefits of this academic-practice partnership included strengthening the legitimacy of classroom content as lessons learned were integrated into courses in the nursing curriculum. The result of the partnership was a stronger sense of collaboration and collegiality between hospital staff and the university faculty. Transformative leadership engaged numerous stakeholders through collaborative efforts to realize best practices. An academic-practice partnership facilitates transformative change and provides structural stability and sustainability.

Catheter-Associated Urinary Tract Infection: Single Institution Experience

SESSION TITLE: Sepsis II SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: Catheter associated urinary tract infections (CAUTI) are directly associated with longer stays in the ICU and hospital, increased health care cost and increased risk of disability and death. We list key strategies that was attempted to reduced CAUTI in our institution. METHODS: As part of a performance improvement project, we collected CAUTI data per 1000 Foley catheter days for the years 2012-2015. This was collected every quarter in a mixed 31 bed medical/surgical intensive care unit. CAUTI was defined based on the national healthcare safety network definition. Standard staff and nurse driven protocol was used for urinary catheter care. Due to increased CAUTI rates per 1000 Foley catheter days, comprehensive unit based safety program (CUSP) was introduced in the 3rd quarter of 2013. The CUSP model introduced has 5 key components, namely: assemble the team, engage senior leadership, understand the science of safety, identify and learn from defects and implement teamwork and communication tools. In addition to the CUSP model, technical aspects that were focused upon include appropriate catheter use intervention, proper catheter insertion and maintenance intervention and prompt catheter removal. Staff education and coaching support was provided through monthly webinars, coaching calls and learning sessions. This was aimed primarily at nursing and resident physicians. Compliance to these steps was monitored during daily interdisciplinary rounds. RESULTS: For the year 2012, per quarter the rate of CAUTI per 1000 Foley catheter days were 3.5, 3.2, 0.9 and 1.1 respectively. There was an increase in CAUTI per 1000 Foley catheter days to 7.0, 4.3 for the 1st and 2nd quarter that peaked to 8.2 followed by 5.6 for the 3rd and 4th quarter. The CUSP initiative and other catheter use, insertion and maintenance took effect after the 3rd quarter of 2013. This intervention led to a decrease in CAUTI rates to 1.9, 4.2, 3.7, 2.5 per 1000 Foley catheter days for the year 2014 per quarter. For the year 2015 CAUTI rates are 2.5, 4.4, and 1.5 (per 1000 Foley catheter days) per quarter until the 3rd quarter. As a comparison for the years 2012-2015 the national healthcare safety network pooled mean has ranged from 2.2-2.4 per 1000 Foley catheter days. CONCLUSIONS: Despite CUSP and other comprehensive catheter based initiatives introduced in the ICU, it is frustrating to note that there has been no significant impact in the reduction of CAUTI. This emphasizes the need to develop more approaches that will deliver better results in reducing CAUTI. CLINICAL IMPLICATIONS: Reduction of catheter associated urinary tract infections in the intensive care unit needs multiple approaches at different levels DISCLOSURE: The following authors have nothing to disclose: Arjun Madhavan, Paris Charilaou, Amy Gram, Patricia Ford No Product/Research Disclosure Information

Making infection prevention education interactive can enhance knowledge and improve outcomes: Results from the Targeted Infection Prevention (TIP) Study.

The purpose of this study was to assess effectiveness of an interactive educational program in increasing knowledge of key infection prevention and control (IPC) principles with emphasis on indwelling device care, hand hygiene, and multidrug-resistant organisms (MDROs) among nursing home (NH) health care personnel (HCP). We conducted a multimodal randomized controlled study involving HCP at 12 NHs. Ten comprehensive and interactive modules covered common IPC topics. We compared intervention and control scores to assess differences in pretest scores as a result of field interventions, pre- and post-test scores to assess knowledge gain, and magnitude of knowledge gain based on job categories. We conducted over 200 in-services across 10 topics at six intervention sites over 36 months. There were 4,962 tests returned over the course of the study, ranging from 389-633 per module. Participants were mostly female certified nursing assistants (CNAs). Score improvement was highest for modules emphasizing hand hygiene, urinary catheter care, and MDROs (15.6%, 15.9%, and 22.0%, respectively). After adjusting for cluster study design, knowledge scores were significantly higher after each educational module, suggesting the education delivery method was effective. When compared with CNAs, nursing and rehabilitation personnel scored significantly higher in their knowledge tests. Our intervention significantly improved IPC knowledge in HCP, especially for those involved in direct patient care. This increase in knowledge along with preemptive barrier precautions and active surveillance has enhanced resident safety by reducing MDROs and infections in high-risk NH residents.

Detecting the presence of an indwelling urinary catheter and urinary symptoms in hospitalized patients using natural language processing

ObjectiveTo develop a natural language processing pipeline to extract positively asserted concepts related to the presence of an indwelling urinary catheter in hospitalized patients from the free text of the electronic medical note. The goal is to assist infection preventionists and other healthcare professionals in determining whether a patient has an indwelling urinary catheter when a catheter-associated urinary tract infection is suspected. Currently, data on indwelling urinary catheters is not consistently captured in the electronic medical record in structured format and thus cannot be reliably extracted for clinical and research purposes. Materials and methodsWe developed a lexicon of terms related to indwelling urinary catheters and urinary symptoms based on domain knowledge, prior experience in the field, and review of medical notes. A reference standard of 1595 randomly selected documents from inpatient admissions was annotated by human reviewers to identify all positively and negatively asserted concepts related to indwelling urinary catheters. We trained a natural language processing pipeline based on the V3NLP framework using 1050 documents and tested on 545 documents to determine agreement with the human reference standard. Metrics reported are positive predictive value and recall. ResultsThe lexicon contained 590 terms related to the presence of an indwelling urinary catheter in various categories including insertion, care, change, and removal of urinary catheters and 67 terms for urinary symptoms. Nursing notes were the most frequent inpatient note titles in the reference standard document corpus; these also yielded the highest number of positively asserted concepts with respect to urinary catheters. Comparing the performance of the natural language processing pipeline against the human reference standard, the overall recall was 75% and positive predictive value was 99% on the training set; on the testing set, the recall was 72% and positive predictive value was 98%. The performance on extracting urinary symptoms (including fever) was high with recall and precision greater than 90%. ConclusionsWe have shown that it is possible to identify the presence of an indwelling urinary catheter and urinary symptoms from the free text of electronic medical notes from inpatients using natural language processing. These are two key steps in developing automated protocols to assist humans in large-scale review of patient charts for catheter-associated urinary tract infection. The challenges associated with extracting indwelling urinary catheter-related concepts also inform the design of electronic medical record templates to reliably and consistently capture data on indwelling urinary catheters.

Catheter securement: a need for the right device

Nursing and Residential CareVol. 18, No. 5 EditorialCatheter securement: a need for the right deviceAnn YatesAnn YatesSearch for more papers by this authorAnn YatesPublished Online:20 Apr 2016https://doi.org/10.12968/nrec.2016.18.5.252AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Bierman S, Carignan M (2003) The prevention of adverse events with urinary tract catheterisation. Managing Infection Control 42–7 Google ScholarCarignan M (2004) Mechanical reduction of catheter – associated urinary tract infection risk. http://bit.ly/1ZjcUGK (accessed 21 March 2016) Google ScholarEuropean Association of Urology Nurses (2012) Evidenced – based Guidelines for Best Practice in Urological Health Care – Catheterisation Indwelling catheters in adults – urethral and suprapubic. http://bit.ly/1RuvPyq (accessed 21 March 2016) Google ScholarFreeman C (2009) Why more attention must be given to catheter fixation. Nurs Times 105(29): 35–6 Google ScholarHanchett M (2002) Techniques for stabilising urinary catheters. Am J Nurs 103(3): 44–8 Crossref, Google ScholarHealth Protection Surveillance Centre (2011) Guidelines for the prevention of catheter-associated urinary Tract Infection. http://bit.ly/1Zje9Wo (accessed 21 March 2016) Google ScholarLoveday HP, Wilson JA, Pratt RJ et al. (2014) Epic 3 National Evidenced-Based Guidelines for Preventing Healthcare – Associated Infections in NHS Hospitals in England. J Hosp Infect 86(Suppl 1): S1–70. doi: https://doi.org/10.1016/S0195-6701(13)60012-2 Crossref, Google ScholarNHS Quality Improvement Scotland (2004) Urinary catheterisation and catheter care. Best Practice Statement. NHS Quality Improvement Scotland. http://bit.ly/1Zb2aeP (accessed 21 March 2016) Google ScholarNational Institute for Health and Care Excellence (2012) Infection: prevention and control of healthcare – associated infections in primary and community care. Clinical Guideline 139. http://bit.ly/1CK83Vv (accessed 21 March 2016) Google ScholarRoyal College of Nursing (2012) Catheter care – RCN guidance for nurses (2nd edition). http://bit.ly/1pvmtpi (accessed 21 March 2016) Google ScholarSpinks J (2013) Urinary incontinence and the importance of catheter fixation. http://bit.ly/1ReoPAc (accessed 21 March 2016) Google ScholarWound, Ostomy and Continence Nurses Society (2012) Indwelling Urinary Catheter Securement: Best Practice for Clinicians. http://bit.ly/1Ly0ubi (accessed 21 March 2016) Google ScholarYates A (2008) Urinary Catheters part 5 – catheter drainage and support systems. Nurs Times 104(43): 22–3 Google Scholar FiguresReferencesRelatedDetails 2 May 2016Volume 18Issue 5ISSN (print): 1465-9301ISSN (online): 2052-2932 Metrics History Published online 20 April 2016 Published in print 2 May 2016 Information© MA Healthcare LimitedPDF download

Impact of the lack of community urinary catheter care services on the Emergency Department.

To conduct an audit of patients presenting with long-term urinary catheter (LTC)-associated problems to our Emergency Department (ED) and to assess the availability of community nursing support for their LTC. We also estimated the cost implication to the health service and the potential solutions to this issue, as although catheter care is provided by community nurses, LTC problems are common presentations to the ED and are often significant burdens to the services. A study was carried out of all patients presenting to the ED with a urinary catheter problem, specifically studying LTCs and the reason for presentation, district nurses' involvement, and the intervention received. In all, 78 patients with a urinary catheter problem presented to the ED over a 69-day period, of whom 59 (68%) had a LTC. In all, 33 patients (42%) attended during normal working hours between 0900 and 1700 h. The mean (range) age was 74 (42-93) years and the duration the LTC had been in situ was 11 (1-120) months. The most common reasons for attendance were blocked catheter (37 patients, 47%) and catheter-bypass (18, 23%). Only 28 patients (36%) were known to district nursing services, and 14% were referred by a district nurse. Most of the remaining patients self-referred to the ED. No patient had any documented contact with their general practitioner. In addition, 64 patients (82%) had their catheter issues addressed adequately by ED nurses or doctors, without any urology involvement. The high morbidity of LTCs causes a considerable demand on ED services, and has heavy cost implications to the health system. Most patients had minimal community nurse support, and their catheter problems were easily dealt with by ED nurses and doctors.

Reducing Central Line Bloodstream and Catheter-Associated Urinary Tract Infections in the Neuro Critical Care Unit Using a Bundled Approach

Central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) represent adverse outcomes for patients and healthcare organizations. Critically ill patients who experience neurological deficits are at increased risk of infection. In our neuro critical care unit (NCCU), baseline CLABSI and CAUTI rates were above institutional goals and national benchmarks, indicating an opportunity for improvement. NCCU leadership and staff created and implemented a bundled improvement plan to reduce the incidence of CLABSI and CAUTI in January, 2014. The bundle consisted of aseptic insertion and care and maintenance processes. Identification of a physician champion was also identified in the early stages and provided leadership for the multidisciplinary rounding process, including daily assessment of device necessity, line status, planning for device discontinuation. Specific unit based education was provided to all frontline clinical staff that included assessment of competency and education related to daily chlorhexidine bathing for all patients. In April, 2014, peri care with a chlorhexidine product was added to the indwelling urinary catheter care and maintenance bundle and external male catheters were more frequently utilized as an alternative to indwelling urinary catheters. Midline venous access devices were introduced as an alternative to central venous access devices when appropriate. Aseptic urine and blood specimen collection processes were reviewed with all care providers responsible for their collection. All identified CLABSI and CAUTI’s are reviewed in real time with frontline staff and healthcare providers. Data related to infection control is provided to NCCU leadership and staff monthly. Compared to infection rates reported in 2013, statistically significant reduction in CLABSI and CAUTI rates was achieved January to November, 2014. The CLABSI reduction was 100%, (p = 0.03); CAUTI reduction was 47% (p=0.04). Device utilization was significantly reduced for both indwelling urinary catheters and central venous access devices Iincluding PICCs. A bundled approach to prevention of device-associated infections can be successful in a NCCU when implemented by a multidisciplinary team that includes a physician champion.

Effectiveness of electronic learning on urinary catheter care in an acute tertiary hospital

Effectiveness of electronic learning on urinary catheter care in an acute tertiary hospital

Risk factors for catheter-associated urinary tract infections in critically ill patients with subarachnoid hemorrhage.

Catheter-associated urinary tract infections (CAUTIs) are preventable adverse outcomes that cause increased morbidity, mortality, and financial burdens to hospitals. These are particularly prevalent in intensive care units (ICUs). Patients with subarachnoid hemorrhage (SAH) in neurological ICUs have extended lengths of stay and may be at higher risk for CAUTIs. The purpose of this study was to assess the prevalence of and risk factors for CAUTIs among patients with SAH in the neurological ICU of a large urban teaching hospital in the eastern United States. This is a retrospective analysis using the Columbia University SAH Outcomes Project data set collected between 2005 and 2012. Logistic regression is used to identify predictors of CAUTI. Catheterized adult patients (n = 242) with SAH over the 8-year period were included. The rate of CAUTIs was 20.7 per 1,000 catheter days, six times higher than the reported national average. Variables significantly associated with CAUTI were older age (odds ratio [OR] = 1.06, 95% confidence interval [CI] [1.01, 1.11]), blood sugar > 200 mg/dl (OR = 13.0, 95% CI [1.28, 107.4]), and anemia requiring transfusion (OR = 3.78, 95% CI [0.977, 14.67]). Higher CAUTI rates in this study were likely associated with prolonged catheterization. On the basis of these findings, careful assessment of the need for catheterization and increased vigilance regarding urinary catheter care in patients with SAH is indicated, particularly among those who are older, with anemia requiring transfusion and elevated blood glucose levels.

Eliminating catheter-associated urinary tract infections in the intensive care unit: is it an attainable goal?

BackgroundPurpose of this study is to determine strategies to decrease catheter-associated urinary tract infection (CAUTI) in intensive care unit (ICU) patients. MethodsICU patients with an indwelling urinary catheter (UC) in one tertiary hospital were monitored for CAUTI. Interventions were implemented sequentially with quarterly data collection. Outcome measures were infection ratio (IR = number of infections/catheter days [CD] × 1000) and device utilization rate (DUR = catheter days/patient days). ResultsCDs and DUR decreased (fiscal year 2008: CD, 11,414; DUR, .85 vs fiscal year 2013: CD, 8,144; DUR, .70). IR increased with suspension of prepackaged baths (IR, 3.2 to 3.5 to 4.9 to 5.0), twice daily UC care (IR, 4.8 to 6.7), emptying UC bags at 400 mL (IR, 6.7 to 9.2). Two-person UC placement (IR, 5.6 to 4.8), physician notification of CAUTI (IR, 6.1 to 4.8), and reinstitution of prepackaged baths and daily UC care (IR, 4.8 to 3.7) decreased CAUTI rates. ConclusionsDecreasing CAUTI in the ICU requires diligent monitoring and constant practice re-evaluation. Elimination of CAUTI in the ICU may not be possible.

Indwelling urinary catheter use at the end of life: a retrospective audit.

This audit aimed to measure: the prevalence of indwelling urinary catheters in patients at the end of life; the use of nursing documentation relating to catheter insertion and care; and prevalence of continence screening on admission. The audit involved a retrospective examination of case notes of patients who died on two oncology wards and a hospice at a large teaching hospital in the south of England. The audit showed that 63% of patients had an indwelling catheter during their admission. Documentation relating to urinary catheter insertion and care was present in 75% of cases, and 75% of patients received continence screening on admission. The findings confirm that indwelling urinary catheters are frequently used as a tool to manage urinary difficulties at the end of life, but that the indications for insertion and continued use can be unclear. Research is needed to establish appropriate use.