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

2004 ◽  
Vol 25 (11) ◽  
pp. 974-978 ◽  
Author(s):  
Wei-Chun Huang ◽  
Shue-Ren Wann ◽  
Shoa-Lin Lin ◽  
Calvin M. Kunin ◽  
Ming-Ho Kung ◽  
...  
Keyword(s):  
Intensive Care ◽  
Urinary Tract ◽  
Intensive Care Units ◽  
Tertiary Care ◽  
Common Source ◽  
Urinary Catheterization ◽  
Urinary Catheters ◽  
Improvement Program ◽  
Intervention Phase ◽  
Tract Infections

AbstractObjective:Indwelling urinary catheters are the most common source of infections in intensive care units (ICUs). The aim of this study was to evaluate the efficacy of nurse-generated daily reminders to physicians to remove unnecessary urinary catheters 5 days after insertion.Design:A time-sequence nonrandomized intervention study.Setting:Adult ICUs (medical, surgical, cardiovascular surgical, neurosurgical, and coronary care) of a tertiary-care university medical center.Patients:All patients admitted to the adult ICUs during a 2-year period. The study consisted of a 12-month observational phase (15,960 patient-days) followed by a 12-month intervention phase (15,525 patient-days).Intervention:Daily reminders to physicians from the nursing staff to remove unnecessary urinary catheters 5 days after insertion.Results:The duration of urinary catheterization was significantly reduced during the intervention phase (from 7.0 ± 1.1 days to 4.6 ± 0.7 days; P < .001). The rate of catheter-associated urinary tract infection (CAUTI) was also significantly reduced (from 11.5 ± 3.1 to 8.3 ± 2.5 patients with CAUTI per 1,000 catheter-days; P = .009). There was a linear relationship between the monthly average duration of catheterization and the rate of CAUTI (r = 0.50; P = .01). The excess monthly cost of antibiotics for CAUTI was reduced by 69% (from $4,021 ± $1,800 to $1,220 ± $941; P = .004).Conclusion:This study demonstrated that a simple measure instituted as part of a continuous quality improvement program significantly reduced the duration of urinary catheterization, rate of CAUTI, and additional costs of antibiotics to manage CAUTI.

Reducing Use of Indwelling Urinary Catheters and Associated Urinary Tract Infections

2009 ◽  
Vol 18 (6) ◽  
pp. 535-541 ◽  
Author(s):  
Ellen H. Elpern ◽  
Kathryn Killeen ◽  
Alice Ketchem ◽  
Amanda Wiley ◽  
Gourang Patel ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Medical Intensive Care Unit ◽  
Urinary Catheterization ◽  
Intervention Period ◽  
Urinary Catheters ◽  
Medical Intensive Care ◽  
Tract Infections

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.

Trends in Catheter-Associated Urinary Tract Infections in Adult Intensive Care Units—United States, 1990–2007

2011 ◽  
Vol 32 (8) ◽  
pp. 748-756 ◽  
Author(s):  
Deron C. Burton ◽  
Jonathan R. Edwards ◽  
Arjun Srinivasan ◽  
Scott K. Fridkin ◽  
Carolyn V. Gould
Keyword(s):  
United States ◽  
Intensive Care ◽  
Urinary Tract ◽  
Intensive Care Units ◽  
Urinary Tract Infections ◽  
Asymptomatic Bacteriuria ◽  
The United States ◽  
Symptomatic Urinary Tract Infection ◽  
Prevention Guidelines ◽  
Tract Infections

Background.Over the past 2 decades, multiple interventions have been developed to prevent catheter-associated urinary tract infections (CAUTIs). The CAUTI prevention guidelines of the Healthcare Infection Control Practices Advisory Committee were recently revised.Objective.To examine changes in rates of CAUTI events in adult intensive care units (ICUs) in the United States from 1990 through 2007.Methods.Data were reported to the Centers for Disease Control and Prevention (CDC) through the National Nosocomial Infections Surveillance System from 1990 through 2004 and the National Healthcare Safety Network from 2006 through 2007. Infection preventionists in participating hospitals used standard methods to identify all CAUTI events (categorized as symptomatic urinary tract infection [SUTI] or asymptomatic bacteriuria [ASB]) and urinary catheter–days (UC-days) in months selected for surveillance. Data from all facilities were aggregated to calculate pooled mean annual SUTI and ASB rates (in events per 1,000 UC-days) by ICU type. Poisson regression was used to estimate percent changes in rates over time.Results.Overall, 36,282 SUTIs and 22,973 ASB episodes were reported from 367 facilities representing 1,223 adult ICUs, including combined medical/surgical (505), medical (212), surgical (224), coronary (173), and cardiothoracic (109) ICUs. All ICU types experienced significant declines of 19%–67% in SUTI rates and 29%–72% in ASB rates from 1990 through 2007. Between 2000 and 2007, significant reductions in SUTI rates occurred in all ICU types except cardiothoracic ICUs.Conclusions.Since 1990, CAUTI rates have declined significantly in all major adult ICU types in facilities reporting to the CDC. Further efforts are needed to assess prevention strategies that might have led to these decreases and to implement new CAUTI prevention guidelines.

Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections: The tale of two teaching hospitals

2018 ◽  
Vol 39 (12) ◽  
pp. 1494-1496 ◽  
Author(s):  
Ana Cecilia Bardossy ◽  
Takiah Williams ◽  
Karen Jones ◽  
Susan Szpunar ◽  
Marcus Zervos ◽  
...  
Keyword(s):  
Intensive Care ◽  
Urinary Tract ◽  
Intensive Care Units ◽  
Urinary Tract Infections ◽  
Urine Culture ◽  
Urinary Catheter ◽  
Teaching Hospitals ◽  
Positive Urine ◽  
Tract Infections ◽  
Catheter Care

AbstractWe compared interventions to improve urinary catheter care and urine culturing in adult intensive care units of 2 teaching hospitals. Compared to hospital A, hospital B had lower catheter utilization, more compliance with appropriate indications and maintenance, but higher urine culture use and more positive urine cultures per 1,000 patient days.

Effectiveness of Multifaceted Hospitalwide Quality Improvement Programs Featuring an Intervention to Remove Unnecessary Urinary Catheters at a Tertiary Care Center in Thailand

2007 ◽  
Vol 28 (7) ◽  
pp. 791-798 ◽  
Author(s):  
Anucha Apisarnthanarak ◽  
Kanokporn Thongphubeth ◽  
Sirinaj Sirinvaravong ◽  
Danai Kitkangvan ◽  
Chananart Yuekyen ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Care Center ◽  
Tertiary Care ◽  
Hospital Costs ◽  
Urinary Catheterization ◽  
Urinary Catheters ◽  
Improvement Program ◽  
Improvement Programs ◽  
Intervention Team ◽  
Quality Improvement Programs

Objective.To evaluate the efficacy of a multifaceted hospitalwide quality improvement program that featured an intervention to remind physicians to remove unnecessary urinary catheters.Methods.A hospitalwide preintervention-postintervention study was conducted over 2 years (July 1, 2004, through June 30, 2006). The intervention consisted of nurse-generated daily reminders that were used by an intervention team to remind physicians to remove unnecessary urinary catheters, beginning 3 days after insertion. Clinical, microbiological, pharmaceutical, and cost data were collected.Results.A total of 2,412 patients were enrolled in the study. No differences were found in the demographic and/or clinical characteristics of patients between the preintervention and postintervention periods. After the intervention, reductions were found in the rate of inappropriate urinary catheterization (mean rate, preintervention vs postintervention, 20.4% vs 11% [P = .04]), the rate of catheter-associated urinary tract infection (CA-UTI) (mean rate, 21.5 vs 5.2 infections per 1,000 catheter-days [P <.001]), the duration of urinary catheterization (mean, 11 vs 3 days [P < .001]), and the total length of hospitalization (mean, 16 vs 5 days [P < .001]). A linear relationship was seen between the monthly average duration of catheterization and the rate of CA-UTI (r = 0.89; P < .001). The intervention had the greatest impact on the rate of CA-UTI in the intensive care units (mean rate, preintervention vs postintervention, 23.4 vs 3.5 infections per 1,000 catheter-days [P = .01]). The monthly hospital costs for antibiotics to treat CA-UTI were reduced by 63% (mean, $3,739 vs $1,378 [P < .001]), and the hospitalization cost for each patient during the intervention was reduced by 58% (mean, $366 vs $154 [P < .001]).Conclusions.This study suggests that a multifaceted intervention to remind physicians to remove unnecessary urinary catheters can significantly reduced the duration of urinary catheterization and the CA-UTI rate in a hospital in a developing country.

scholarly journals Prevalence of blaCTX-M, blaSHV, and blaTEM Genes in Escherichia coli Strains Isolated From Urinary Tract Infection Samples of Patients in the Intensive Care Unit in Qom, Iran

2020 ◽  
Vol 7 (2) ◽  
Author(s):  
Shima Sadat Lesani ◽  
Mohammad Soleimani ◽  
Pegah Shakib ◽  
Mohammad Reza Zolfaghari
Keyword(s):  
Escherichia Coli ◽  
Drug Resistance ◽  
Urinary Tract Infection ◽  
Intensive Care ◽  
Urinary Tract ◽  
Tract Infection ◽  
Intensive Care Units ◽  
Diffusion Method ◽  
E Coli ◽  
Tract Infections

Background: Escherichia coli is considered as one of the causes of opportunistic infections. Nowadays, due to the increase in drug resistance, the treatment of these infections has become very difficult and they are recognized as the main causes of death in hospitalized patients. Objectives: The aim of this study was to determine the prevalence of blaTEM, blaSHV, and blaCTX-M genes in E. coli strains isolated from the urinary tract infection in patients in Intensive Care Units of three different hospitals in Qom, Iran. Methods: This study was conducted in three months from October to December 2014. A total of 200 E. coli samples were taken from the patients with urinary tract infections in Intensive Care units of Qom hospital. The disc diffusion method was used to determine the susceptibility pattern of antibiotic and phenotypic confirmatory tests for screening of the expanded spectrum beta-lactamase (ESBL) isolates. The presence of blaTEM, blaSHV, and blaCTX-M genes was evaluated by the polymerase chain reaction (PCR) assay. Results: Of 200 samples, ampicillin (96%) and nitrofurantoin (19.5%) showed the highest and lowest drug resistance, respectively. A total of 156 isolates (78%) were identified as ESBLs using the phenotypic method. Moreover, 76 (38%), 90 (45%), and 123 (61.5%) isolates consisted of blaCTX-M, blaSHV, and blaTEM, respectively. Conclusions: Overall, the findings of this study showed that blaTEM was the most common gene with a frequency of 61.5% in ESBL E. coli.

Impact of an antimicrobial stewardship intervention in India: Evaluation of post-prescription review and feedback as a method of promoting optimal antimicrobial use in the intensive care units of a tertiary-care hospital

2019 ◽  
Vol 40 (05) ◽  
pp. 512-519 ◽  
Author(s):  
Priscilla Rupali ◽  
Prasannakumar Palanikumar ◽  
Divyashree Shanthamurthy ◽  
John Victor Peter ◽  
Subramani Kandasamy ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Antimicrobial Stewardship ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Antimicrobial Use ◽  
Care Hospital ◽  
Baseline Phase ◽  
Intervention Phase

AbstractObjective:Antimicrobial stewardship programs (ASPs) are effective in developed countries. In this study, we assessed the effectiveness of an infectious disease (ID) physician–driven post-prescription review and feedback as an ASP strategy in India, a low middle-income country (LMIC).Design and setting:This prospective cohort study was carried out for 18 months in 2 intensive care units of a tertiary-care hospital, consisting of 3 phases: baseline, intervention, and follow up. Each phase spanned 6 months.Participants:Patients aged ≥15 years receiving 48 hours of study antibiotics were recruited for the study.Methods:During the intervention phase, an ID physician reviewed the included cases and gave alternate recommendations if the antibiotic use was inappropriate. Acceptance of the recommendations was measured after 48 hours. The primary outcome of the study was days of therapy (DOT) per 1,000 study patient days (PD).Results:Overall, 401 patients were recruited in the baseline phase, 381 patients were recruited in the intervention phase, and 379 patients were recruited in the follow-up phase. Antimicrobial use decreased from 831.5 during the baseline phase to 717 DOT per 1,000 PD in the intervention phase (P &lt; .0001). The effect was sustained in the follow-up phase (713.6 DOT per 1,000 PD). De-escalation according to culture susceptibility improved significantly in the intervention phase versus the baseline phase (42.7% vs 23.6%; P &lt; .0001). Overall, 73.3% of antibiotic prescriptions were inappropriate. Recommendations by the ID team were accepted in 60.7% of the cases.Conclusion:The ID physician–driven implementation of an ASP was successful in reducing antibiotic utilization in an acute-care setting in India.

Sign in / Sign up

Export Citation Format

Share Document