Reduction of catheter-associated urinary tract infections among patients in a neurological intensive care unit: a single institution's success

Titsworth, W. Lee; Hester, Jeannette; Correia, Tom; Reed, Richard; Williams, Miranda; Guin, Peggy; Layon, A. Joseph; Archibald, Lennox K.; Mocco, J

doi:10.3171/2011.11.jns11974

Cited by 84 publications

(77 citation statements)

References 48 publications

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“…This emphasizes the importance of minimizing UTIs, and prior reports in neurosurgical patients have shown that the implementation of a UTI quality improvement program including maintenance of sterility during catheter insertion, product standardization, and early discontinuation can significantly decrease the incidence of UTIs. 63 Although the optimal modality of venous thromboembolism prophylaxis-mechanical alone or in conjunction with pharmacological prophylaxis-remains debated, the strong association between length of hospital stay and both deep venous thrombosis and pulmonary emboli emphasizes the importance of this prophylaxis. Although many of the postoperative complications collected by the NSQIP had the greatest effect size in multivariate regression models evaluating predictors of prolonged hospitalization, it is notable that their addition to models only slightly improved their discriminatory capacity.…”

Section: Discussionmentioning

confidence: 99%

Length of hospital stay after craniotomy for tumor: a National Surgical Quality Improvement Program analysis

Dasenbrock

Liu

Devine

et al. 2015

FOC

140

103

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OBJECT Although the length of hospital stay is often used as a measure of quality of care, data evaluating the predictors of extended hospital stay after craniotomy for tumor are limited. The goals of this study were to use multivariate regression to examine which preoperative characteristics and postoperative complications predict a prolonged hospital stay and to assess the impact of length of stay on unplanned hospital readmission. METHODS Data were extracted from the National Surgical Quality Improvement Program (NSQIP) database from 2007 to 2013. Patients who underwent craniotomy for resection of a brain tumor were included. Stratification was based on length of hospital stay, which was dichotomized by the upper quartile of the interquartile range (IQR) for the entire population. Covariates included patient age, sex, race, tumor histology, comorbidities, American Society of Anesthesiologists (ASA) class, functional status, preoperative laboratory values, preoperative neurological deficits, operative time, and postoperative complications. Multivariate logistic regression with forward prediction was used to evaluate independent predictors of extended hospitalization. Thereafter, hierarchical multivariate logistic regression assessed the impact of length of stay on unplanned readmission. RESULTS The study included 11,510 patients. The median hospital stay was 4 days (IQR 3-8 days), and 27.7% (n = 3185) had a hospital stay of at least 8 days. Independent predictors of extended hospital stay included age greater than 70 years (OR 1.53, 95% CI 1.28%-1.83%, p < 0.001); African American (OR 1.75, 95% CI 1.44%-2.14%, p < 0.001) and Hispanic (OR 1.68, 95% CI 1.36%-2.08%) race or ethnicity; ASA class 3 (OR 1.52, 95% CI 1.34%-1.73%) or 4-5 (OR 2.18, 95% CI 1.82%-2.62%) designation; partially (OR 1.94, 95% CI 1.61%-2.35%) or totally dependent (OR 3.30, 95% CI 1.95%-5.55%) functional status; insulin-dependent diabetes mellitus (OR 1.46, 95% CI 1.16%-1.84%); hematological comorbidities (OR 1.68, 95% CI 1.25%-2.24%); and preoperative hypoalbuminemia (OR 1.78, 95% CI 1.51%-2.09%, all p ≤ 0.009). Several postoperative complications were additional independent predictors of prolonged hospitalization including pulmonary emboli (OR 13.75, 95% CI 4.73%-39.99%), pneumonia (OR 5.40, 95% CI 2.89%-10.07%), and urinary tract infections (OR 11.87, 95% CI 7.09%-19.87%, all p < 0.001). The C-statistic of the model based on preoperative characteristics was 0.79, which increased to 0.83 after the addition of postoperative complications. A length of stay after craniotomy for tumor score was created based on preoperative factors significant in regression models, with a moderate correlation with length of stay (p = 0.43, p < 0.001). Extended hospital stay was not associated with differential odds of an unplanned hospital readmission (OR 0.97, 95% CI 0.89%-1.06%, p = 0.55). CONCLUSIONS In this NSQIP analysis that evaluated patients who underwent craniotomy for tumor, much of the variance in hospital stay was attributable to baseline patient characteristics, suggesting length of stay may be an imperfect proxy for quality. Additionally, longer hospitalizations were not found to be associated with differential rates of unplanned readmission.

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Section: Discussionmentioning

confidence: 99%

Length of hospital stay after craniotomy for tumor: a National Surgical Quality Improvement Program analysis

Dasenbrock

Liu

Devine

et al. 2015

FOC

140

103

View full text Add to dashboard Cite

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“…However, 27.4% (26) reported to be performing meatal care once per shift with 5.3% (5) not performing meatal care as shown in Figure 3. Solution used for meatal care 43 (45%) of the respondents reported to be using antiseptic solution, 28% (27) used plain water and 27% (25) used soap and water as shown in Figure 4. …”

Section: Meatal Carementioning

confidence: 99%

“…The drainage bag should be positioned below the level of the bladder to utilize gravity hence facilitating drainage. Correct positioning of the tubing should be by the use of a securement device or tape to facilitate drainage into the bag and prevent reflux of old urine into the bladder as reflux and stagnation contributes to CAUTI [27]. It has been demonstrated that the use of a securement device to prevent movement of the catheter as the patient moves as well as keeping the drainage bag below the level of the bladder are effective in reducing CAUTI rates by 70% [25].…”

Section: Nursing Practice On Utilization and Adherence To Cauti Bundlementioning

confidence: 99%

Evaluation of the Utilization of Catheter Associated Urinary Tract Infection Bundle Among Critical Care Nurses - Kenyatta National Hospital

Assanga¹

2016

AJNS

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“…Introducing a UTI bundle (avoidance of catheter insertion, maintenance of sterility, product standardization, early catheter removal) in a single-center neurologic ICU significantly decreased catheter utilization from 100% to 73% and CAUTI from 13.3 to 4.0 per 1,000 catheter-days. 42 7. A CAUTI prevention program including education, implementation of common CAUTI prevention practices, outcomes and process measures, and feedback of CAUTI outcomes and process measures was implemented in pediatric ICUs in 6 developing countries, and a decrease in CAUTI rates from 5.9 to 2.6 per 1,000 catheter-days (relative risk, 0.43 [95% CI, 0.21-1.0]) was reported.…”

Section: Cmentioning

confidence: 99%

Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals: 2014 Update

Nicolle

Coffin

et al. 2014

Infect. Control Hosp. Epidemiol.

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Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their catheter-associated urinary tract infection (CAUTI) prevention efforts. This document updates “Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.

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Reduction of catheter-associated urinary tract infections among patients in a neurological intensive care unit: a single institution's success

Abstract: This single-center prospective study demonstrated that a comprehensive UTI prevention bundle along with a continuous quality improvement program can significantly reduce the duration of urinary catheterization and rate of catheter-associated UTI in a neuro ICU.

Cited by 84 publications

References 48 publications

Length of hospital stay after craniotomy for tumor: a National Surgical Quality Improvement Program analysis

Length of hospital stay after craniotomy for tumor: a National Surgical Quality Improvement Program analysis

Evaluation of the Utilization of Catheter Associated Urinary Tract Infection Bundle Among Critical Care Nurses - Kenyatta National Hospital

Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals: 2014 Update

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