Device-Associated Infection Rates for Non–Intensive Care Unit Patients

Background.Reference data from intensive care units (ICUs) are not applicable to non-ICU patients because of the differences in device use rates, length of stay, and severity of underlying diseases among the patient populations. In contrast to the huge amount of data available for ICU patients, appropriate surveillance data for non-ICU patients have been missing in Germany.Objective.To establish a new module (“DEVICE-KISS”) of the German Nosocomial Infection Surveillance System for generating stratified reference data for non-ICU wards.Setting.Non-ICU patients from 42 German hospitals.Methods.Monthly patient-days, device-days and nosocomial infections (NIs) (using Centers for Disease Control and Prevention definitions) were counted. Device use rates were calculated, and NI rates were stratified by different medical specialities.Results.From July 2002 through June 2004, among the 77 wards, there were a total of 536,955 patient-days and 74,188 device-days (for CVC-associated primary bloodstream infections, there were 181,401 patient-days and 8,317 central vascular catheter [CVC]-days in 29 wards; for urinary catheter–associated urinary tract infections, there were 445,536 patient-days and 65,871 urinary catheter–days in 65 wards) and 483 NIs (36 bloodstream infections and 447 urinary tract infections). The mean device use rates were 4.6 device-days per 100 patient-days for CVCs (29 wards) and 14.8 device-days per 100 patient-days for urinary catheters (65 wards), respectively. Mean device-associated NI rates were 4.3 infections per 1,000 CVC-days for CVC-associated bloodstream infections and 6.8 infections per 1,000 urinary catheter–days for catheter-associated urinary tract infections.ConclusionsDEVICE-KISS allows non-ICUs to recognize an outlier position with regard to NIs by providing well-founded reference data for non-ICU patients.

Download Full-text

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

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2018.251 ◽

2018 ◽

Vol 39 (12) ◽

pp. 1494-1496 ◽

Cited By ~ 2

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.

Download Full-text

Intensive care unit rounding checklists to reduce catheter-associated urinary tract infections

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.43 ◽

2020 ◽

Vol 41 (6) ◽

pp. 680-683

Author(s):

Nicholas J. Nassikas ◽

Joao Filipe G. Monteiro ◽

Barbara Pashnik ◽

Judith Lynch ◽

Gerardo Carino ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Urinary Catheter ◽

Academic Community ◽

First Year ◽

The Third ◽

Second Year ◽

Tract Infections

AbstractObjective:To assess whether the implementation of an intensive care unit (ICU) rounding checklist reduces the number of catheter-associated urinary tract infections (CAUTIs).Design:Retrospective before-and-after study that took place between March 2013 and February 2017.Setting:An academic community hospital 16-bed, mixed surgical, cardiac, medical ICU.Patients:Participants were all patients admitted to the adult mixed ICU and had a diagnosis of CAUTI.Intervention:Initiation of an ICU rounding checklist that prompts physicians to address any use of urinary catheters with analysis comparing the preintervention period before roll out of the rounding checklist versus the postintervention periods.Results:There were 19 CAUTIs and 9,288 urinary catheter days (2.04 CAUTIs per 1,000 catheter days). The catheter utilization ratio increased in the first year after the intervention (0.67 vs 0.60; P = .0079), then decreased in the second year after the intervention (0.53 vs 0.60; P = .0992) and in the third year after the intervention (0.53 vs 0.60; P = .0224). The rate of CAUTI (ie, CAUTI per 1,000 urinary catheter days) decreased from 4.62 before the checklist was implemented to 2.12 in the first year after the intervention (P = .2104). The CAUTI rate was 0.45 in the second year (P = .0275) and 0.96 in the third year (P = .0532).Conclusions:Our study suggests that utilization of a daily rounding checklist is associated with a decrease in the rates of CAUTI in ICU patients. Incorporating a rounding checklist is feasible in the ICU.

Download Full-text

Implementation of a Female External Urinary Catheter Reduces Indwelling Urinary Catheter Use and Catheter-Associated Urinary Tract Infections

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1158 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s482-s483

Author(s):

Paul Gentile ◽

Jesse Jacob ◽

Shanza Ashraf

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Urinary Catheter ◽

Improve Patient Safety ◽

Academic Medical Center ◽

Secondary Outcome ◽

Successful Implementation ◽

Urinary Catheters ◽

Tract Infections ◽

The Impact

Background: Using alternatives to indwelling urinary catheters plays a vital role in reducing catheter-associated urinary tract infections (CAUTIs). We assessed the impact of introducing female external catheters on urinary catheter utilization and CAUTIs. Methods: In a 500-bed academic medical center, female external catheters were implemented on October 1, 2017, with use encouraged for eligible females with urinary incontinence but not meeting other standard indications for urinary catheters. Nurses were educated and trained on female external catheter application and maintenance, and infection prevention staff performed surveillance case reviews with nursing and medical staff. We determined the number of catheter days for both devices based on nursing documentation of device insertion or application, maintenance, and removal. We used the CAUTI and DUR (device utilization ratio) definitions from the CDC NHSN. Our primary outcomes were changes in DUR for both devices 21 months before and 24 months after the intervention in both intensive care units (ICUs) and non-ICU wards. We used a generalized least-squares model to account for temporal autocorrelation and compare the trends before and after the intervention. Our secondary outcome was a reduction in CAUTIs, comparing females to males. Results: In total, there were 346,213 patient days in 35 months. The mean rate of patient days per month increased from 7,436.4 to 7,601.9 after the implementation of female external catheters, with higher catheter days for both urinary catheters (18,040 vs 19,625) and female external catheters (22 vs 12,675). After the intervention, the DUR for female external catheters increased (0 vs 0.07; P < .001) and for urinary catheters the DUR decreased (0.12 vs 0.10; P < .001) (Fig. 1). A reduction in urinary catheter DUR was observed in ICUs (0.29 vs 0.27; P < .001) but not wards (0.08 vs 0.08; P = NS) (Fig. 2). Of the 39 CAUTIs, there was no significant overall change in the rate per 1,000 catheter days (1.22 vs 0.87; P = .27). In females (n = 20 CAUTI), there was a 61% reduction in the CAUTI rate per 1,000 catheter days (0.78 vs 0.31; P = .02), but no significant change in the rate in males (0.44 vs 0.56; P = .64). The CAUTI rate per 1,000 catheter days among females decreased in the ICUs (1.14 vs 0.31; P = .04) but not in wards (0.6 vs 0.33; P = .96). Conclusions: In a setting with a baseline low UC DUR, successful implementation of female external catheters further modestly reduced UC DUR and was associated with a 61% decrease in CAUTI among females in the ICU but not in wards. Further interventions to better identify appropriate patients for female external catheters may improve patient safety and prevent patient harm.Funding: NoneDisclosures: None

Download Full-text

Increase in catheter associated urinary tract infections in intensive care units at a tertiary care centre: a cause of concern

International Journal of Biomedical Research ◽

10.7439/ijbr.v6i10.2482 ◽

2015 ◽

Vol 6 (10) ◽

pp. 815

Author(s):

Sarita Yadav ◽

Shikha Goel ◽

Amod Kumar Yadav

Keyword(s):

Intensive Care ◽

Urinary Tract ◽

Intensive Care Units ◽

Urinary Tract Infections ◽

Tertiary Care ◽

Care Centre ◽

Tertiary Care Centre ◽

Tract Infections

Download Full-text

592 Prevention of CAUTIs in a Burn ICU

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.218 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S138-S138

Author(s):

Vina Vargas ◽

Emiko Rivera ◽

Teresa Sidhu ◽

Lea Lyn Zaballero ◽

Yvonne L Karanas

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Infection Prevention ◽

Urinary Catheter ◽

Antimicrobial Use ◽

Research To Practice ◽

Urinary Catheters ◽

Open Forum ◽

Excellent Care ◽

Tract Infections

Abstract Introduction Catheter-associated urinary tract infections (CAUTIs) are the most common hospital-associated infection (HAI). Urinary catheter use is associated with urinary tract infections (UTIs) that can lead to complications such as cystitis, pyelonephritis, bacteremia, septic shock, and death. CAUTIs are associated with an excess length of stay of 2–4 days, increase costs of $0.4–0.5 billion per year nationally, and lead to unnecessary antimicrobial use. Through numerous implementations, a Burn ICU was able to drastically decrease their incidence of CAUTIs. Methods A Burn ICU implemented several interventions to reduce CAUTI rates. These interventions included: Results When this project was initiated in September of 2017, there were 9 CAUTIs identified in a Burn ICU, per the hospital’s Infection Prevention Department. By the end of 2017, there were 11, which equated to a rate of 14.67 per 1000 urinary catheter days. In 2018, the Burn ICU had 1 CAUTI, with a rate of 1.92 per 1000 urinary catheter days. In 2019 (through quarter 2), the Burn ICU has not had a CAUTI per the Infection Prevention Department. We believe the interventions made have drastically decreased the incidence of CAUTIs. Conclusions A Burn ICU implemented many new practices in 2017 when the CAUTI rate and SIR were above the hospital’s overall SIR. The Burn ICU staff now practice proper care and maintenance of urinary catheters and continue to provide excellent care. Although we have decreased our incidence of CAUTIs for 2018 and 2019, it is equally important we sustain this improvement. Therefore, we will continue to provide an open forum for discussion with staff so we can all do our part in keeping patients safe. Applicability of Research to Practice A Burn ICU decreased the incidence of CAUTIs by educating staff on proper care and maintenance of urinary catheters, removing catheters as soon as possible, and testing for UTIs upon admission to determine the patient’s baseline. By doing so, CAUTI rates went from 14.67 to 0 per 1000 urinary catheter days.

Download Full-text

Control catheter-associated urinary tract infections in a neurosurgery intensive care unit

Journal of Microbiology Immunology and Infection ◽

10.1016/j.jmii.2015.02.261 ◽

2015 ◽

Vol 48 (2) ◽

pp. S74

Author(s):

Wei-Ya Cheng

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Tract Infections

Download Full-text

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

Infection Control and Hospital Epidemiology ◽

10.1086/660872 ◽

2011 ◽

Vol 32 (8) ◽

pp. 748-756 ◽

Cited By ~ 55

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.

Download Full-text