Reporting Catheter-Associated Urinary Tract Infections: Denominator Matters

2011 ◽  
Vol 32 (7) ◽  
pp. 635-640 ◽  
Author(s):  
Marc-Oliver Wright ◽  
Maureen Kharasch ◽  
Jennifer L. Beaumont ◽  
Lance R. Peterson ◽  
Ari Robicsek
Keyword(s):  
Quality Improvement ◽  
Urinary Tract ◽  
Quality Improvement Initiative ◽  
Infection Rates ◽  
Improvement Program ◽  
Nursing Unit ◽  
Accepted Practice ◽  
Device Associated Infection ◽  
Tract Infections ◽  
The Impact

Objective.To evaluate two different methods of measuring catheter-associated urinary tract infection (CAUTI) rates in the setting of a quality improvement initiative aimed at reducing device utilization.Design, Setting, and Patients.Comparison of CAUTI measurements in the context of a before-after trial of acute care adult admissions to a multicentered healthcare system.Methods.CAUTIs were identified with an automated surveillance system, and device-days were measured through an electronic health record. Traditional surveillance measures of CAUTI rates per 1,000 device-days (R1) were compared with CAUTI rates per 10,000 patient-days (R2) before (T1) and after (T2) an intervention aimed at reducing catheter utilization.Results.The device-utilization ratio declined from 0.36 to 0.28 between T1 and T2 (P< .001), while infection rates were significantly lower when measured by R2 (28.2 vs 23.2, P = .02). When measured by R1, however, infection rates trended upward by 6% (7.79 vs. 8.28, P = .47), and at the nursing unit level, reduction in device utilization was significantly associated with increases in infection rate.Conclusions.The widely accepted practice of using device-days as a method of risk adjustment to calculate device-associated infection rates may mask the impact of a successful quality improvement program and reward programs not actively engaged in reducing device usage.

Reducing Catheter-Associated Urinary Tract Infections: A Quality-Improvement Initiative

PEDIATRICS ◽  
2014 ◽  
Vol 134 (3) ◽  
pp. e857-e864 ◽  
Author(s):  
K. F. Davis ◽  
A. M. Colebaugh ◽  
B. L. Eithun ◽  
S. B. Klieger ◽  
D. J. Meredith ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Quality Improvement Initiative ◽  
Tract Infections

A Multimodal Intervention to Reduce Urinary Catheter Use and Associated Infection at a Veterans Affairs Medical Center

2013 ◽  
Vol 34 (6) ◽  
pp. 631-633 ◽  
Author(s):  
Brady L. Miller ◽  
Sarah L. Krein ◽  
Karen E. Fowler ◽  
Karen Belanger ◽  
Debbie Zawol ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Urinary Catheter ◽  
Medical Center ◽  
Veterans Affairs ◽  
Quality Improvement Intervention ◽  
Tract Infections ◽  
The Impact ◽  
Improvement Intervention

We assessed the impact of a quality improvement intervention to reduce urinary catheter use and associated urinary tract infections (UTIs) at a single hospital. After implementation, UTIs were reduced by 39% (P = .04). Additionally, we observed a slight decrease in catheter use and the number of catheters without an appropriate indication.

scholarly journals Impact of an interdisciplinary malnutrition quality improvement project at a large metropolitan hospital

2020 ◽  
Vol 9 (1) ◽  
pp. e000735 ◽  
Author(s):  
Kelsey Jones Pratt ◽  
Beverly Hernandez ◽  
Robert Blancato ◽  
Jeanne Blankenship ◽  
Kristi Mitchell
Keyword(s):  
At Risk ◽  
Quality Improvement ◽  
Care Delivery ◽  
Care Quality ◽  
Interdisciplinary Teams ◽  
Quality Improvement Initiative ◽  
Infection Rates ◽  
Improvement Project ◽  
Hospitalised Patients ◽  
The Impact

As many as 50% of hospitalised patients are estimated to be malnourished or at risk of malnutrition on hospital admission, but this condition often goes unrecognised, undiagnosed and untreated. Malnutrition is associated with an elevated need for continued medical interventions, higher costs of care and increased patient safety risks. Tampa General Hospital (TGH), a large teaching hospital in the southeastern USA, initiated a project to improve the quality of patient care at its institution. They did this first by focusing on improving the care quality for their malnourished patients (or patients who were at risk of malnourishment) and by using elements of the national Malnutrition Quality Improvement Initiative (MQii) Toolkit as a mechanism to measure and improve quality. The aim of this study was to evaluate the impact of quality improvement interventions on patient length of stay (LOS), infection rates and readmissions, particularly for malnourished patients. The structure of the MQii and the use of the MQii Toolkit helped staff members identify problems and systematically engage in quality improvement processes. Using the MQii Toolkit, TGH implemented a multipronged approach to improving the treatment of malnourished patients that involved creating interdisciplinary teams of staff and identifying gaps in care that could be improved through a series of changes to hospital-wide clinical workflows. They enhanced interdisciplinary coordination through increased dietitian engagement, the use of electronic health record alerts and new surgical protocols. These interventions lasted 8 months in 2016 and data reported here were collected from 985 patients before the interventions (2015) and 1046 patients after the interventions (2017). The study examines how these process changes affected LOS, infection rates and readmissions at TGH. Following implementation of these quality improvement processes, patients who were malnourished or at risk of malnutrition had a 25% reduction in LOS (from 8 to 6 days, p<0.01) and a 35.7% reduction in infection rates (from 14% to 9%, p<0.01). No statistically significant changes in readmission rates were observed. This study adds to a growing body of literature on quality improvement processes hospitals can undertake to better identify and treat malnourished patients. Hospitals and health systems can benefit from adopting similar institution-wide, quality improvement projects, while policy-makers’ support for such programmes can spur more rapid uptake of nutrition-focused initiatives across care delivery settings.

Another look at the culture-quality-performance link

2008 ◽  
Vol 14 (2) ◽  
pp. 35 ◽  
Author(s):  
Shandell Elmer ◽  
Sue Kilpatrick
Keyword(s):  
Quality Improvement ◽  
Organisational Learning ◽  
Quality Improvement Program ◽  
Quality Improvement Initiative ◽  
Improvement Program ◽  
Quality Performance ◽  
Organisational Capacity ◽  
Improvement Programs ◽  
Quality Improvement Programs ◽  
The Impact

Quality improvement is usually driven by quality, safety and risk agendas leading to a focus on measurements of the outputs of care; outputs such as fewer complaints, fewer accidents and adverse events. An oft-neglected theme is the impact of the quality improvement initiative within the organisation itself. This paper presents the findings of the first stage of an evaluation that has examined the changes which have occurred within organisations since participating in a quality improvement initiative. These findings indicate that engaging with a quality improvement program can change the nature of social interactions within the organisation. In this way, quality improvement programs can impact on organisational culture, particularly in relation to organisational learning. Thus, this paper argues that successful engagement with a quality improvement program can enhance organisational learning, and, in turn, build organisational capacity.

scholarly journals Risk Factors for Postoperative Urinary Tract Infections in Patients Undergoing Total Joint Arthroplasty

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Andrew P. Alvarez ◽  
Alysen L. Demzik ◽  
Hasham M. Alvi ◽  
Kevin D. Hardt ◽  
David W. Manning
Keyword(s):  
Risk Factors ◽  
Quality Improvement ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Total Joint Arthroplasty ◽  
Joint Arthroplasty ◽  
Improvement Program ◽  
Steroid Use ◽  
Female Sex ◽  
Tract Infections

Background. Urinary tract infections (UTIs) are the most common minor complication following total joint arthroplasty (TJA) with incidence as high as 3.26%. Bladder catheterization is routinely used during TJA and the Centers for Medicare and Medicaid Services (CMS) has recently identified hospital-acquired catheter associated UTI as a target for quality improvement. This investigation seeks to identify specific risk factors for UTI in TJA patients.Methods.We retrospectively studied patients undergoing TJA for osteoarthritis between 2006 and 2013 in the American College of Surgeon’s National Surgical Improvement Program Database (ACS-NSQIP). A univariate analysis screen followed by multivariate logistic regression identified specific patient demographics, comorbidities, preoperative laboratory values, and operative characteristics independently associated with postoperative UTI.Results.1,239 (1.1%) of 115,630 TJA patients we identified experienced a postoperative UTI. The following characteristics are independently associated with postoperative UTI: female sex (OR 2.1, 95% CI 1.6–2.7), chronic steroid use (OR 2.0, 95% CI 1.2–3.2), ages 60–69 (OR 1.5, 95% CI 1.0–2.1), 70–79 (OR 2.0, 95% CI 1.4–2.9), and ≥80 (OR 2.3, 95% CI 1.5–3.6), ASA Classes 3–5 (OR 1.5, 95% CI 1.2–1.9), preoperative creatinine >1.35 (OR 1.8, 95% CI 1.3–2.6), and operation time greater than 130 minutes (OR 1.8, 95% CI 1.3–2.4).Conclusions.In this large database query, postoperative UTI occurs in 1.1% of patients following TJA and several variables including female sex, age greater than 60, and chronic steroid use are independent risk factors for occurrence. Practitioners should be aware of populations at greater risk to support efforts to comply with CMS initiated quality improvement.

scholarly journals Reducing the rate of post-surgical urinary tract infections in orthopedic patients

2018 ◽  
Vol 7 (2) ◽  
pp. e000177 ◽  
Author(s):  
Amit Thakker ◽  
Natasha Briggs ◽  
Azusa Maeda ◽  
Julie Byrne ◽  
John Roderick Davey ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Urinary Tract ◽  
Nurse Practitioners ◽  
Improvement Program ◽  
Indwelling Catheter ◽  
Indwelling Catheters ◽  
Inappropriate Use ◽  
Acs Nsqip ◽  
Leadership Group ◽  
Tract Infections

Urinary tract infection (UTI) is the fourth leading cause of healthcare-associated infections, with approximately 70%–80% being attributed to the inappropriate use of indwelling catheters. In many cases, indwelling catheters are used inappropriately without any valid indication, creating potentially avoidable and significant patient distress, discomfort, pain and activity restrictions, together with substantial care burden, cost and hospitalisation. In the Division of Orthopedic Surgery at Toronto Western Hospital (TWH), we identified UTI rate reduction as a quality improvement priority. Patients who underwent total hip and knee joint replacements and hip fracture repairs at TWH were monitored for the incidence of UTI and the usage of catheters. The data collected as part of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) revealed UTI rate of 2.1% among 666 patients who were treated between January and June 2016. Data collected through a custom field in the ACS NSQIP workstation further revealed that indwelling catheters were overused, with 55.2% of patients receiving indwelling catheters in the same time period. These data were presented to the orthopaedic leadership group and surgeons at TWH in July 2016 to set the quality improvement target and create the working group. Nursing staff was provided education to strictly follow the institutional catheter-associated UTI prevention guidelines and change ideas based on the guidelines were implemented in July 2016. As a result, the rate of UTI decreased to 1.1% and the use of indwelling catheter decreased to 19.8% among 883 patients who were treated between July 2016 and March 2017. The study indicated that a systematic approach, engaging all front-line staff including nurse educators and nurse practitioners, helps to facilitate implementation of practice changes. We expect that ongoing reminders and education ensure that the changes are sustainable.

Sustained reduction in catheter-associated urinary tract infections using multi-faceted strategies led by champions: A quality improvement initiative

2021 ◽  
pp. 1-5
Author(s):  
Staci S. Reynolds ◽  
Chris D. Sova ◽  
Sarah S. Lewis ◽  
Becky A. Smith ◽  
Rebekah H. Wrenn ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Intensive Care ◽  
Quality Improvement ◽  
Urinary Tract ◽  
Tract Infection ◽  
Urine Culture ◽  
Incidence Rates ◽  
Quality Improvement Initiative ◽  
Sustained Reduction ◽  
Tract Infections

Abstract We reviewed the sustainability of a multifaceted intervention on catheter-associated urinary tract infection (CAUTI) in 3 intensive care units. During the 4-year postintervention period, we observed reductions in urine culture rates (from 80.9 to 47.5 per 1,000 patient days; P < .01), catheter utilization (from 0.68 to 0.58; P < .01), and CAUTI incidence rates (from 1.7 to 0.8 per 1,000 patient days; P = .16).

scholarly journals 216. Are Automatic Antimicrobial Stop Orders an Effective Stewardship Tool for Urinary Tract and Intra-Abdominal Infections?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S110-S110
Author(s):  
Christina Maguire ◽  
Dusten T Rose ◽  
Theresa Jaso
Keyword(s):  
Urinary Tract ◽  
Antimicrobial Therapy ◽  
Source Control ◽  
Clostridioides Difficile ◽  
Days Of Therapy ◽  
Before And After ◽  
The Difference ◽  
Tract Infections ◽  
Length Of Therapy ◽  
The Impact

Abstract Background Automatic antimicrobial stop orders (ASOs) are a stewardship initiative used to decrease days of therapy, prevent resistance, and reduce drug costs. Limited evidence outside of the perioperative setting exists on the effects of ASOs on broad spectrum antimicrobial use, discharge prescription duration, and effects of missed doses. This study aims to evaluate the impact of an ASO policy across a health system of adult academic and community hospitals for treatment of intra-abdominal (IAI) and urinary tract infections (UTI). ASO Outcome Definitions ASO Outcomes Methods This multicenter retrospective cohort study compared patients with IAI and UTI treated before and after implementation of an ASO. Patients over the age of 18 with a diagnosis of UTI or IAI and 48 hours of intravenous (IV) antimicrobial administration were included. Patients unable to achieve IAI source control within 48 hours or those with a concomitant infection were excluded. The primary outcome was the difference in sum length of antimicrobial therapy (LOT). Secondary endpoints include length and days of antimicrobial therapy (DOT) at multiple timepoints, all cause in hospital mortality and readmission, and adverse events such as rates of Clostridioides difficile infection. Outcomes were also evaluated by type of infection, hospital site, and presence of infectious diseases (ID) pharmacist on site. Results This study included 119 patients in the pre-ASO group and 121 patients in the post-ASO group. ASO shortened sum length of therapy (LOT) (12 days vs 11 days respectively; p=0.0364) and sum DOT (15 days vs 12 days respectively; p=0.022). This finding appears to be driven by a decrease in outpatient LOT (p=0.0017) and outpatient DOT (p=0.0034). Conversely, ASO extended empiric IV LOT (p=0.005). All other secondary outcomes were not significant. Ten patients missed doses of antimicrobials due to ASO. Subgroup analyses suggested that one hospital may have influenced outcomes and reduction in LOT was observed primarily in sites without an ID pharmacist on site (p=0.018). Conclusion While implementation of ASO decreases sum length of inpatient and outpatient therapy, it may not influence inpatient length of therapy alone. Moreover, ASOs prolong use of empiric intravenous therapy. Hospitals without an ID pharmacist may benefit most from ASO protocols. Disclosures All Authors: No reported disclosures

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