External urinary collection devices (EUCDs) may reduce indwelling catheter usage and catheter-associated urinary tract infections (CAUTIs). In this retrospective quasi-experimental study, we demonstrated that EUCD implementation in women was associated with significantly decreased indwelling catheter usage and a trend (P = .10) toward decreased CAUTI per 1,000 patient days.
Background: Catheter-associated urinary tract infections (CAUTIs) are a common hospital-acquired infection (HAI) resulting in excess morbidity, mortality, and cost. Urine management can be a challenging issue, particularly in women, due to limited options for control of urinary incontinence. Issues with urinary leakage and worry for subsequent skin break down often leads to indwelling catheter insertion. In the spring of 2018, our facility implemented a female external urine collection device (EUCD) in efforts to decrease catheter days and to limit CAUTIs. Methods: Retrospective, 32-month (January 2017–August 2019), quasi-experimental, before-and-after study. Catheter use and CAUTI were defined according to CDC NHSN criteria. Poisson regression was used to model the rate of CAUTI (per 1,000 patient days [PD] and per 1,000 catheter days [CD]) comparing the 14 months prior to EUCD introduction with the 14 months after introduction and allowing a 3-month introduction period. Results: The CAUTI rate did not change significantly. The overall CAUTI rate per 1,000 PD decreased slightly from 0.24 to 0.20 (P = 0.44; model risk, 0.86; 95% CI, 0.58–1.26) whereas the rate per 1,000 CD increased slightly 1.5 to 1.6 (P = 0.76; model risk, 1.06; 95% CI, 0.73-–1.56). The CAUTI rate for men increased from 0.09 to 0.11 per 1,000 PD (P = 0.42; model risk, 1.29) and from 0.99 to 1.55 per 1,000 CD (P = 0.17; model risk, 1.56). For women, the rate of CAUTI decreased from 0.15 to 0.09 per 1,000 PD (P = 0.10; model risk, 0.61) and from 2.12 to 1.65 per 1,000 CD (P = 0.38; model risk, 0.38). A significant decrease in catheter days (CD per 1,000 PD; P < .0001) was observed for all hospitalized patients (from 158.56 to 128.3; model risk, 0.81), for men (from 87.06 to 72.15; model risk, 0.83), and for women (from 71.49 to 56.15; model risk, 0.79). Of 2,347 adverse events, 5 (0.2%) involved perineal skin breakdown and redness. Three events were related to malposition of the ECUD or inappropriate level of suction and 1 event was related to latex allergy and EUCD use. Conclusions: The introduction of a EUCD for women was associated with a significant decrease in indwelling catheter usage. A trend toward a decrease in CAUTI per 1,000 PD for women was observed (P = .10). Additional studies on whether the EUCD is associated with changes in UTI rates (both CAUTIs and noncatheter UTIs) as well as cost implications of EUCD are warranted.Funding: NoneDisclosures: None
BackgroundCentral line-associated blood stream infections (CLABSI) result in increased patient morbidity. Guidelines recommend against peripheral venous catheters when access is required for longer than 6 days, often leading to central venous catheter (CVCs) placement. To improve vascular access device choice and reduce the potential risk of CLABSIs, we implemented a quality improvement initiative compromised of a new vascular access algorithm with introduction of midline utilization and sought to evaluate the impact of midline use on CLABSI rates.MethodsA prospective quality improvement assessment from October 2017 through March 2018 analyzed the infection rates of midline catheters and CVCs. When a consult was placed for a peripherally inserted central catheter (PICC) that the patient would be evaluated via the vascular access algorithm (Figure 1) for whether they should receive a midline catheter, a PICC or a traditional CVC. The midline catheters, PICCs, and CVCs were monitored for duration of indwell and bloodstream infections consistent with reportable CLABSI definitions.ResultsIn the month prior to implementation, the institutional CLABSI rate was 1.36 per 1,000 CVC (including PICC) days. Since October 2017, there have been 4,588 midline catheter days, with two midline infections, for a cumulative rate over those 6 months of 0.435 midline catheter infections per 1,000 midline days. This was compared with 26,575 CVC days, with 33 documented CLABSIs, for a rate of 1.242 per 1,000 CVC days. Since the vascular algorithm was implemented, the infection rate from the compilation of CVC and midline catheters is 1.12 per 1,000 catheter days.ConclusionThe implementation of a vascular access algorithm including midlines may effectively reduce central line insertions and thereby decrease CLABSIs through appropriate utilization of a lower risk device (midline). Further research into comparing additional risks, benefits, complications and costs of midline catheters and all styles of central venous catheters is warranted. Disclosures All authors: No reported disclosures.
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