Use of Urinary Collection Devices in Skilled Nursing Facilities in Five States

Rogers, Mary A.M.; Mody, Lona; Kaufman, Samuel R.; Fries, Brant E.; McMahon, Laurence F.; Saint, Sanjay

doi:10.1111/j.1532-5415.2008.01675.x

Cited by 61 publications

(54 citation statements)

References 31 publications

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“…The enrollment period for the study was 36 months. Based on preliminary data, 9–11 we estimated that each NH would care for a mean of 22 residents with an indwelling device per year. Power calculations were based on anticipating a 30% reduction (rate ratio, 0.70) in MDRO prevalence as a result of our intervention.…”

Section: Methodsmentioning

confidence: 99%

A Targeted Infection Prevention Intervention in Nursing Home Residents With Indwelling Devices

et al. 2015

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Indwelling devices (eg, urinary catheters and feeding tubes) are often used in nursing homes (NHs). Inadequate care of residents with these devices contributes to high rates of multidrug-resistant organisms (MDROs) and device-related infections in NHs.OBJECTIVE To test whether a multimodal targeted infection program (TIP) reduces the prevalence of MDROs and incident device-related infections. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial at 12 community-based NHs from May 2010 to April 2013. Participants were high-risk NH residents with urinary catheters, feeding tubes, or both. INTERVENTIONS Multimodal, including preemptive barrier precautions, active surveillance for MDROs and infections, and NH staff education. MAIN OUTCOMES AND MEASURESThe primary outcome was the prevalence density rate of MDROs, defined as the total number of MDROs isolated per visit averaged over the duration of a resident's participation. Secondary outcomes included new MDRO acquisitions and new clinically defined device-associated infections. Data were analyzed using a mixed-effects multilevel Poisson regression model (primary outcome) and a Cox proportional hazards model (secondary outcome), adjusting for facility-level clustering and resident-level variables. RESULTSIn total, 418 NH residents with indwelling devices were enrolled, with 34 174 device-days and 6557 anatomic sites sampled. Intervention NHs had a decrease in the overall MDRO prevalence density (rate ratio, 0.77; 95% CI, 0.62-0.94). The rate of new methicillin-resistant Staphylococcus aureus acquisitions was lower in the intervention group than in the control group (rate ratio, 0.78; 95% CI, 0.64-0.96). Hazard ratios for the first and all (including recurrent) clinically defined catheter-associated urinary tract infections were 0.54 (95% CI, 0.30-0.97) and 0.69 (95% CI, 0.49-0.99), respectively, in the intervention group and the control group. There were no reductions in new vancomycin-resistant enterococci or resistant gram-negative bacilli acquisitions or in new feeding tube-associated pneumonias or skin and soft-tissue infections.CONCLUSIONS AND RELEVANCE Our multimodal TIP intervention reduced the overall MDRO prevalence density, new methicillin-resistant S aureus acquisitions, and clinically defined catheter-associated urinary tract infection rates in high-risk NH residents with indwelling devices. Further studies are needed to evaluate the cost-effectiveness of this approach as well as its effects on the reduction of MDRO transmission to other residents, on the environment, and on referring hospitals. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01062841

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Section: Methodsmentioning

confidence: 99%

A Targeted Infection Prevention Intervention in Nursing Home Residents With Indwelling Devices

et al. 2015

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“…5 While urinary catheter prevalence is lower in nursing homes than in the acute care setting, duration of use is often prolonged. 7, 10 In a setting where utilization is low, but use is prolonged, interventions designed to reduce UTI in acutely ill patients 11 may not be as helpful for preventing infection in nursing home residents.…”

Section: Introductionmentioning

confidence: 99%

Systematic Review of Interventions to Reduce Urinary Tract Infection in Nursing Home Residents

Meddings

Saint

Krein

et al. 2017

Journal of Hospital Medicine

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BACKGROUND Urinary tract infections (UTIs) in nursing homes are common, costly, and morbid. PURPOSE Systematic literature review of strategies to reduce UTIs in nursing home residents DATA SOURCES Ovid MEDLINE, Cochrane Library, CINAHL, Web of Science and Embase through June 22, 2015. STUDY SELECTION Interventional studies with a comparison group reporting at least one outcome for: catheter-associated UTI (CAUTI), UTIs not identified as catheter-associated, bacteriuria, or urinary catheter use. DATA EXTRACTION Two authors abstracted study design, participant and intervention details, outcomes, and quality measures. DATA SYNTHESIS Of 5,794 records retrieved, 20 records describing 19 interventions were included: 8 randomized controlled trials, 10 pre-post non-randomized interventions, and 1 non-randomized intervention with concurrent controls. Quality (range 8-25, median 15) and outcome definitions varied greatly. Thirteen studies employed strategies to reduce catheter use or improve catheter care; nine studies employed general infection prevention strategies (e.g., improving hand hygiene, surveillance, contact precautions, reducing antibiotics). The nineteen studies reported 12 UTI outcomes, 9 CAUTI outcomes, 4 bacteriuria outcomes, and 5 catheter use outcomes. Five studies showed CAUTI reduction (1 significantly); nine studies showed UTI reduction (none significantly); 2 studies showed bacteriuria reduction (none significantly). Four studies showed reduced catheter use (1 significantly). LIMITATIONS Studies were often underpowered to assess statistical significance; none were pooled given variety of interventions and outcomes. CONCLUSIONS Several practices, often implemented in bundles, appear to reduce UTI or CAUTI in nursing home residents such as improving hand hygiene, reducing and improving catheter use, managing incontinence without catheters, and enhanced barrier precautions.

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“…10,21 ' 22 While prior studies have also demonstrated regional variation in the use of urinary catheters after accounting for patient-level characteristics, these studies have been limited to claims data from older surgical populations 23 " 25 and patients residing in longterm care facilities. 26 Starting in August 2011, the Health Research and Educational Trust of the American Hospital Association and its academic partners have led On the CUSP: Stop CAUTI, an Agency for Healthcare Research and Quality-funded national initiative to reduce CAUTI in acute care hospitals. The organizational structure and key components of this national initiative have been described previously.…”

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confidence: 99%

Regional Variation in Urinary Catheter Use and Catheter-Associated Urinary Tract Infection: Results from a National Collaborative

Greene

Fakih

Fowler

et al. 2014

Infect. Control Hosp. Epidemiol.

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OBJECTIVE. To examine regional variation in the use and appropriateness of indwelling urinary catheters and catheter-associated urinary tract infection (CAUTI). DESIGN AND SETTING. Cross-sectional study.PARTICIPANTS. US acute care hospitals.METHODS. Hospitals were divided into 4 regions according to the US Census Bureau. Baseline data on urinary catheter use, catheter appropriateness, and CAUTI were collected from participating units. The catheter utilization ratio was calculated by dividing the number of catheter-days by the number of patient-days. We used the National Healthcare Safety Network (NHSN) definition (number of CAUTIs per 1,000 catheter-days) and a population-based definition (number of CAUTIs per 10,000 patient-days) to calculate CAUTI rates. Logistic and Poisson regression models were used to assess regional differences.RESULTS. Data on 434,207 catheter-days over 1,400,770 patient-days were collected from 1,101 units within 726 hospitals across 34 states. Overall catheter utilization was 31%. Catheter utilization was significantly higher in non-intensive care units (ICUs) in the West compared with non-ICUs in all other regions. Approximately 30%-40% of catheters in non-ICUs were placed without an appropriate indication. Catheter appropriateness was the lowest in the West. A total of 1,099 CAUTIs were observed (NHSN rate of 2.5 per 1,000 catheter-days and a population-based rate of 7.8 per 10,000 patient-days). The population-based CAUTI rate was highest in the West (8.9 CAUTIs per 10,000 patient-days) and was significantly higher compared with the Midwest, even after adjusting for hospital characteristics (P = .02).CONCLUSIONS. Regional differences in catheter use, appropriateness, and CAUTI rates were detected across US hospitals.

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Use of Urinary Collection Devices in Skilled Nursing Facilities in Five States

Cited by 61 publications

References 31 publications

A Targeted Infection Prevention Intervention in Nursing Home Residents With Indwelling Devices

A Targeted Infection Prevention Intervention in Nursing Home Residents With Indwelling Devices

Systematic Review of Interventions to Reduce Urinary Tract Infection in Nursing Home Residents

Regional Variation in Urinary Catheter Use and Catheter-Associated Urinary Tract Infection: Results from a National Collaborative

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