Catheter-Associated Urinary Tract Infections in Intensive Care Units Can Be Reduced by Prompting Physicians to Remove Unnecessary Catheters

Chi

American Journal of Critical Care

et al. 2013

Background Duration of indwelling urinary catheterization is an important risk factor for urinary tract infection. Objectives To determine whether a reminder approach reduces the use of urinary catheters and the incidence of catheterassociated urinary tract infections. Methods A randomized control trial was performed in 2 respiratory intensive care units in a 2990-bed tertiary referral medical center. Patients who had urinary catheters in place for more than 2 days from April through November 2008 were randomly assigned to either the intervention group (use of a criteria-based reminder to remove the catheter) or the control group (no reminder). Results A total of 278 patients were recruited. Utilization rate of indwelling urinary catheters was decreased by 22% in the intervention group compared with the control group (relative risk, 0.78; 95% CI, 0.76-0.80; P < .001). The intervention significantly shortened the median duration of catheterization (7 days vs 11 days for the control group; P < .001). The success rate for removing the catheters in the intervention group by day 7 was 88%. The reminder intervention reduced the incidence of catheter-associated infections by 48% (relative risk, 0.52; 95% CI, 0.32-0.86; P = .009) in the intervention group compared with the control group. Conclusions Use of a criteria-based reminder to remove indwelling urinary catheters can diminish the use of urinary catheterization and reduce the likelihood of catheter-associated urinary infections. This reminder approach can prevent catheter-associated urinary infections, and its use should be strongly considered as a way to enhance the safety of patients.

Section: Characteristics Of the Patientsmentioning

confidence: 80%

Using A Criteria-Based Reminder To Reduce Use Of Indwelling Urinary Catheters And Decrease Urinary Tract Infections

Chi

American Journal of Critical Care

et al. 2013

American Journal of Critical Care

“…Successful strategies have included educating nursing staff to limit catheter use and providing monthly reports of CAUTI rates, 15 daily reminders to physicians and nurses to remove unnecessary catheters, [16][17][18] implementation of criteria-based catheter guidelines and daily determination of whether or not patients meet the criteria, [19][20][21] and introduction of nurse-promoted protocols for discontinuing catheters. 18,19 All strategies have resulted in a reduction in the duration of catheterization or in the number of CAUTIs or both.…”

Section: Discussionmentioning

confidence: 99%

Reducing Use of Indwelling Urinary Catheters and Associated Urinary Tract Infections

Elpern

Killeen

Ketchem

et al. 2009

Background Use of indwelling urinary catheters can lead to complications, most commonly catheter-associated urinary tract infections. Duration of catheterization is the major risk factor. These infections can result in sepsis, prolonged hospitalization, additional hospital costs, and mortality. Objectives To implement and evaluate the efficacy of an intervention to reduce catheter-associated urinary tract infections in a medical intensive care unit by decreasing use of urinary catheters. Methods Indications for continuing urinary catheterization with indwelling devices were developed by unit clinicians. For a 6-month intervention period, patients in a medical intensive care unit who had indwelling urinary catheters were evaluated daily by using criteria for appropriate catheter continuance. Recommendations were made to discontinue indwelling urinary catheters in patients who did not meet the criteria. Days of use of a urinary catheter and rates of catheter-associated urinary tract infections during the intervention were compared with those of the preceding 11 months. Results During the study period, 337 patients had a total of 1432 days of urinary catheterization. With use of guidelines, duration of use was significantly reduced to a mean of 238.6 d/mo from the previous rate of 311.7 d/mo. The number of catheter-associated urinary tract infections per 1000 days of use was a mean of 4.7/mo before the intervention and zero during the 6-month intervention period. Conclusions Implementation of an intervention to judge appropriateness of indwelling urinary catheters may result in significant reductions in duration of catheterization and occurrences of catheter-associated urinary tract infections.

“…Several studies have reported that patients often undergo unnecessary catheterization and that catheters are left in place for longer than needed, 30 and limiting catheter use has been found to be associated with significant decreases in rates of UTI. 17,30 Use of silver alloy urinary catheters and catheters impregnated with antimicrobial agents have been shown to reduce bacteriuria, 7,13,17,30 and even simple measures, such as ensuring that the drainage tube sits below the level of the bladder but above the collecting bag, have a significant effect on decreasing the incidence of UTIs.…”

Section: 40mentioning

confidence: 99%

Unplanned readmissions and survival following brain tumor surgery

Dickinson¹,

Carico²,

Nuño³

et al. 2015

JNS

OBJect Research on readmissions has been influenced by efforts to reduce hospital cost and avoid penalties stipulated by the Centers for Medicare and Medicaid Services. Less emphasis has been placed on understanding these readmissions and their impact on patient outcomes. This study 1) delineates reasons for readmission, 2) explores factors associated with readmissions, and 3) describes their impact on the survival of glioblastoma patients. MetHODS The authors conducted a retrospective review of 362 cases involving patients with glioblastoma undergoing biopsy or tumor resection at their institution between 2003 and 2011. Reasons for re-hospitalization were characterized according to whether or not they were related to surgery and considered preventable. Multivariate analyses were conducted to identify the effect of readmission on survival and determine factors associated with re-hospitalizations. reSultS Twenty-seven (7.5%) of 362 patients experienced unplanned readmissions within 30 days of surgery. Six patients (22.2%) were readmitted by Day 7, 14 (51.9%) by Day 14, and 20 (74.1%) by Day 21. Neurological, infectious, and thromboembolic complications were leading reasons for readmission, accounting for, respectively, 37.0%, 29.6%, and 22.2% of unplanned readmissions. Twenty-one (77.8%) of the 27 readmissions were related to surgery and 19 (70.4%) were preventable. The adjusted hazard ratio of mortality associated with a readmission was 2.03 (95% CI 1.3-3.1). Higher-functioning patients (OR 0.96, 95% CI 0.9-1.0) and patients discharged home (OR 0.21, 95% CI 0.1-0.6) were less likely to get readmitted. cOncluSiOnS An overwhelming fraction of documented unplanned readmissions were considered preventable and related to surgery. Patients who were readmitted to the hospital within 30 days of surgery had twice the risk of mortality compared with patients who were not readmitted.http://thejns.org/doi/abs/10.3171/2014.8.JNS1498Key WOrDS unplanned readmission; glioblastoma; complications; functional status; oncology aBBreviatiOnS DVT = deep venous thrombosis; HR = hazard ratio; KPS = Karnofsky Performance Status; LOS = length of hospital stay; PE = pulmonary embolism; SOI = severity of illness; SSI = surgical site infection; UTI = urinary tract infection; VTE = venous thromboembolism.