Preventing Hospital-Acquired Urinary Tract Infection in the United States: A National Study

Saint, Sanjay; Kowalski, Charles J.; Kaufman, Samuel R.; Hofer, Timothy P.; Kauffman, Carol A.; Olmsted, Russell N.; Forman, Jane; Banaszak-Holl, Jane; Damschroder, Laura J.; Krein, Sarah L.

doi:10.1086/524662

Cited by 210 publications

(170 citation statements)

References 30 publications

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“…Unfortunately, as of a 2005 survey, most hospitals do not systematically track urinary catheter insertions and removals. 8 The above concerns are highlighted for surgical patients among whom indwelling urinary catheter use is particularly high. In a 2001 sample of Medicare beneficiaries, 85% of major surgical patients had perioperative urinary catheters.…”

mentioning

confidence: 99%

Feasibility of audit and feedback to reduce postoperative urinary catheter duration

Wald

Kramer

2011

Journal of Hospital Medicine

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BACKGROUND:Indwelling urinary catheter duration is an important risk factor for catheter‐associated urinary tract infections (CAUTIs).OBJECTIVE:To audit patient‐level postoperative catheter duration and measure the impact of its feedback to nursing staff on postoperative catheter duration and CAUTI rates.DESIGN:Preobservational and postobservational study.SETTING:Two surgical units at an urban academic medical center.PATIENTS:Postoperative patients with indwelling urinary catheters.INTERVENTION:Audit and feedback of postoperative urinary catheter duration to nurses during an educational session.MEASUREMENTS:Patient‐level postoperative catheter duration obtained from electronic clinical documentation. Mean catheter duration and proportion of patients with postoperative catheter duration <3 days were determined.RESULTS:Following the intervention, the mean postoperative catheter duration decreased (1.7‐1.4 days [P = 0.01] on orthopedic surgery, and 2.6 to 2.2 days [P = 0.01] on general surgery). The proportion of patients with catheter duration <3 days increased significantly on orthopedic surgery (86‐92% [P = 0.04]), and nonsignificantly on general surgery (56‐63% [P = 0.14]). When adjusted for length of stay differences, the odds of catheter duration <3 days on general surgery increased from 1.38 (P = 0.14) to 1.69 (P = 0.02). The CAUTI rates did not significantly decrease. The rate on orthopedic surgery dropped from 8.9 infections per 1000 device‐days to 0 (confidence interval [CI], −1.1 to 18.3); on general surgery the rate was constant at 7 infections per 1000 device‐days (CI, −12.1 to 10.8).CONCLUSIONS:Audit and feedback of aggregated patient‐level urinary catheter duration determined from electronic documentation may prove effective in improving urinary catheter management for surgical patients. Journal of Hospital Medicine 2010;. © 2010 Society of Hospital Medicine.

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confidence: 99%

Feasibility of audit and feedback to reduce postoperative urinary catheter duration

Wald

Kramer

2011

Journal of Hospital Medicine

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“…Some of these included nurse-driven approaches such as automatic stop orders, nurse-driven protocols to remove IUCs that failed to meet speciic checklist criteria and nurse-driven physician reminders [29]. Other programs were physician focused with IUC renewals as a required daily order or documentation of continued indication as a required part of the daily patient note [30,31].…”

Section: Remembering the Forgoten Iuc (Quality Improvement)mentioning

confidence: 99%

“…In Michigan, the Keystone Bladder Bundle [34]. A nationwide survey of 470 hospitals revealed that CAUTI incidence decreased by 25% in Michigan hospitals and by 6% in non-Michigan hospitals during the same period [29]. A big component of the success of this initiative was due to the appointment of "champions" that were responsible for addressing individual questions and encouraging continued engagement in the reduction of catheter use [23].…”

Section: Remembering the Forgoten Iuc (Quality Improvement)mentioning

confidence: 99%

“…This was largely atributed to multifaceted prevention programs employing IUC removal protocols. Despite the strength of the evidence supporting the use of writen and bundle protocols to ight the CAUTI epidemic, a study published in 2012 found that only 42% of ICUs had developed writen policies to decrease urinary catheter days [29]. Bundled prevention programs rely heavily on continuing education and providing individual and group level feedback.…”

Section: Remembering the Forgoten Iuc (Quality Improvement)mentioning

confidence: 99%

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Unnecessary Complications: The Forgotten Indwelling Urinary Catheter

Hromatka¹,

Guo²

2017

Vignettes in Patient Safety - Volume 1

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Complications of indwelling urinary catheters (IUCs) are common, with the infectious one accounting for 40% of all reported healthcare-associated infections. Myths and rituals exist among healthcare professionals in the application of the urinary catheter, and the catheter is often forgoten after the placement, resulting in a potentially signiicant impact on patient outcomes and healthcare cost. The implementation of institutional protocols through a bundled approach can signiicantly reduce forgoten IUCs and dramatically improve patient safety.

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“…UTI is the most common bacterial infection (4) and one of the most prevalent hospital-acquired infections, with economic repercussions, sequelae, complications and immeasurable harm to the population. It represents about 40% of all hospital-acquired infections and 70% to 88% of them are caused by the use of catheters (5)(6)(7) . In intermittent catheterization, the catheters are removed shortly after emptying the bladder, which is associated with lower UTI rates, while indwelling catheters are connected to a urine collector, which increases the risk of infection (2,8) .…”

Section: Introductionmentioning

confidence: 99%

Cateter urinário: mitos e rituais presentes no preparo do paciente

et al. 2012

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Objective: This study aimed to identify and describe myths and rituals in preparing patients for urinary catheter insertion. Methods: This was an observational, exploratory and descriptive study conducted in nine hospitals of a city in the interior of Brazil. Following ethical precepts, data were collected by interview, with the nurse designated by the institution, using a semistructured instrument. Among the 13 institutions of the municipality, nine participated in the study. Results: All hospitals had a standardized, implemented procedure for urinary catheterization. During the preparation of patients, five participants (55.5%) made no reference to orientation, privacy and humanization. All adopted divergent procedures for hygiene and antisepsis of the urethral meatus, with the presence of myths and rituals that exist outside the scientific evidence and highlight the functionalist model of the procedures performed by nursing staff. Conclusion: There is a need to reassess the intervention of urinary catheterization, with interdisciplinary discussions, emphasizing the use of scientific principles. Keywords: Urinary catheterization; Nursing; Cerimonial behavior; Antisepsis RESUMOObjetivo: Este estudo buscou identificar e descrever mitos e rituais no preparo do paciente para a inserção do cateter urinário. Métodos: Trata-se de um estudo observacional, exploratório e descritivo, realizado em nove hospitais de um município do interior paulista. Seguidos os preceitos éticos, os dados foram coletados por entrevista, junto ao enfermeiro designado pela instituição, utilizando-se um instrumento semiestruturado. Dentre as 13 instituições do município, nove participaram do estudo. Resultados: Todos os hospitais possuíam o procedimento de cateterismo urinário padronizado e implantado. Durante o preparo do paciente, 5 (55,5%) não fizeram referência à orientação, privacidade e humanização. Todas adotam procedimentos divergentes para higiene e antissepsia do meato uretral, com presença de mitos e rituais que se sobressaem às evidências científicas e destacam o modelo funcionalista nos procedimentos realizados pela equipe de enfermagem. Conclusão: Há necessidade de reavaliar a intervenção de cateterismo urinário, com discussões interdisciplinares, dando ênfase à utilização de princípios científicos. Descritores: Cateterismo urinário; enfermagem; Comportamento ritualístico; Antissepsia RESUMENObjetivo: En este estudio se buscó identificar y describir los mitos y rituales en la preparación del paciente para la inserción del catéter urinario. Méto-dos: Se trata de un estudio observacional, exploratorio y descriptivo, realizado en nueve hospitales de un municipio del interior paulista. Siguiéndose los preceptos éticos, los datos fueron recolectados por entrevista, junto al enfermero designado por la institución, utilizándose un instrumento semiestructurado. De las 13 instituciones del municipio, nueve participaron en el estudio. Resultados: Todos los hospitales poseían el procedimiento de cateterismo urinario patronizado e ...

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Preventing Hospital-Acquired Urinary Tract Infection in the United States: A National Study

Cited by 210 publications

References 30 publications

Feasibility of audit and feedback to reduce postoperative urinary catheter duration

Feasibility of audit and feedback to reduce postoperative urinary catheter duration

Unnecessary Complications: The Forgotten Indwelling Urinary Catheter

Cateter urinário: mitos e rituais presentes no preparo do paciente

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