scholarly journals Catheter-associated urinary tract infection reduction in critical care units: a bundled care model

2021 ◽  
Vol 10 (4) ◽  
pp. e001534
Author(s):  
Stephanie Grana Van Decker ◽  
Nicholas Bosch ◽  
Jaime Murphy
Keyword(s):  
Urinary Tract ◽  
Medical Center ◽  
Low Cost ◽  
Foley Catheter ◽  
Daily Basis ◽  
High Yield ◽  
Process Maps ◽  
Healthcare Improvement ◽  
Control And Prevention ◽  
Tract Infections

Catheter-associated urinary tract infections (CAUTIs) represent approximately 9% of all hospital acquired infections, and approximately 65%–70% of CAUTIs are believed to be preventable. In the spring of 2013, Boston Medical Center (BMC) began an initiative to decrease CAUTI rates within its intensive care units (ICUs). A CAUTI taskforce convened and reviewed process maps and gap analyses. Based on Centers for Disease Control and Prevention (CDC) and Institute for Healthcare Improvement (IHI) guidelines, and delineated by the Healthcare Infection Control Practices Advisory Committee 2009 guidelines, all BMC ICUs sequentially implemented plan–do–study–act cycles based on which measures were most easily adaptable and believed to have the highest impact on CAUTI rates. Implementation of five care bundles spanned 5 years and included (1) processes for insertion and maintenance of foley catheters; (2) indications for indwelling foley catheters; (3) appropriate testing for CAUTIs; (4) alternatives to indwelling devices; and (5) sterilisation techniques. Daily rounds by unit nursing supervisors and inclusion of foley catheter necessity on daily ICU checklists held staff accountable on a daily basis. With these interventions, the total number of CAUTIs at BMC decreased from 53 in 2013 to 9 in 2017 (83% reduction) with a 33.8% reduction in indwelling foley catheter utilisation during the same time period. Adapted protocols showed success in decreasing the CAUTI rate and indwelling foley catheter usage in all of the BMC ICU’s. While all interventions had favourable and additive trends towards decreasing the CAUTI rate, the CAUTI awareness education, insertion and removal protocols and implementation of PureWick female incontinence devices had clear and significant effects on decreasing CAUTI rates. Our project provides a framework for improving HAIs using rapid cycle testing and U-chart data monitoring. Targeted education efforts and standardised checklists and protocols adapted sequentially are low-cost and high yield efforts that may decrease CAUTIs in ICU settings.

scholarly journals The Impact of Differences in Surveillance Definitions of Hospital Acquired Urinary Tract Infections (HAUTI)

Antibiotics ◽  
2021 ◽  
Vol 10 (10) ◽  
pp. 1262
Author(s):  
Yossef Levi ◽  
Debby Ben-David ◽  
Inna Estrin ◽  
Hodaya Saadon ◽  
Maya Krocker ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Scientific Literature ◽  
Medical Center ◽  
Agreement Rate ◽  
Positive Urine ◽  
Control And Prevention ◽  
Tract Infections ◽  
Hospital Acquired ◽  
The Impact

Hospital-acquired urinary tract infections (HAUTI) are common and most cases are related to catheters (CAUTI). HAUTI and CAUTI surveillance is mandatory in many countries as a measure to reduce the incidence of infections and appropriately direct the allocation of preventable resources. The surveillance criteria issued by the Israeli Ministry of Health (IMOH), differ somewhat from that of the U.S. Centers for Disease Control and Prevention (CDC). Our study aims were to query and quantify the impact of these differences. In a retrospective cohort study conducted at Shamir Medical Center, for calendar year 2017, the surveillance criteria of both IMOH and CDC were applied on 644 patient-unique adults with “positive” urine cultures (per similar definitions). The incidence of HAUTI per IMOH was significantly higher compared to CDC (1.24/1000 vs. 1.02/1000 patient-days, p = 0.02), with no impact on hospitalization’s outcomes. The agreement rate between methods was high for CAUTI (92%), but much lower for all HAUTI (83%). The major error rate, i.e., patients diagnosed with HAUTI per IMOH but had no UTI per CDC, was 31%. To conclude, in order for surveillance to reflect the relative situation and direct allocation of preventable resources based on scientific literature, the process should be uniform worldwide.

scholarly journals Reducing urinary tract infections in care homes by improving hydration

2019 ◽  
Vol 8 (3) ◽  
pp. e000563 ◽  
Author(s):  
Katie Lean ◽  
Rasanat Fatima Nawaz ◽  
Sundus Jawad ◽  
Charles Vincent
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Hospital Admissions ◽  
Low Cost ◽  
Care Home ◽  
Kidney Injury ◽  
Care Staff ◽  
Care Homes ◽  
Raising Awareness ◽  
Tract Infections

Dehydration may increase the risk of urinary tract infections (UTIs), which can lead to confusion, falls, acute kidney injury and hospital admission. We aimed to reduce the number of UTIs in care home residents which require admission to hospital. The principal intervention was the introduction of seven structured drink rounds every day accompanied by staff training and raising awareness. UTIs requiring antibiotics reduced by 58% and UTIs requiring hospital admissions reduced by 36%, when averaged across the four care homes. Care home residents benefited from greater fluid intake, which in turn may have reduced infection. Structured drink rounds were a low-cost intervention for preventing UTIs and implemented easily by care staff.

scholarly journals 1039. Forty-eight-hour Antibiotic Time-out: Impact on Antibiotic Duration and Clinical Outcomes

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S365-S366
Author(s):  
Natasha N Pettit ◽  
Palak Bhagat ◽  
Cynthia T Nguyen ◽  
Victoria J L Konold ◽  
Madan Kumar ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Medical Center ◽  
Inpatient Setting ◽  
Core Element ◽  
Time Out ◽  
Before And After ◽  
Control And Prevention ◽  
Quasi Experimental ◽  
Tract Infections ◽  
The Impact

Abstract Background A core element of the Centers for Disease Control and Prevention Antimicrobial Stewardship standard for the inpatient setting includes a 48-hour antibiotic time-out (ATO) process to reassess antibiotic indication. We implemented an automated alert in the electronic health record (EHR) that identifies patients that have received >=48hours of antibiotic therapy. The alert requires the clinician (physician or pharmacist) to note an indication for continuation or plan for discontinuation. Within the alert, a dashboard was developed to include relevant patient information (e.g., temperature, white blood cell count, microbiology, etc). We sought to evaluate the impact of the ATO alert on the duration of therapy (DOT) of cefepime (CFP), ceftazidime (CTZ) and vancomycin (VAN), for the treatment of pneumonia (PNA) and urinary tract infections (UTI) for adult and pediatric patients. Methods This quasi-experimental, retrospective analysis included adult and pediatric patients that received ≥48 hours of CFP, CTZ, or VAN for UTI or PNA between April 1, 2017 and July 31, 2017 (pre-48H ATO) and October 1, 2018–December 31, 2018 (post-48H ATO). Fields at order-entry to specify an antibiotic indication were not available prior to our EHR interventions. A randomized subset from the Pre-48Hr ATO group was selected for detailed analysis. The primary endpoint was to evaluate the average DOT of CFP/CTZ combined, VAN alone, and the combination of CFP/CTZ/VAN. We also evaluated length of stay (LOS), all-cause inpatient mortality, and 30-day readmissions. Results A total of 157 antibiotic orders (n = 94 patients) were evaluated in the pre-48h ATO group, and 2093 antibiotic orders (n = 521 patients) post-48H ATO group. Pre-48H ATO, 85 patients received CFP/CTZ and 72 VAN. Post-48H ATO, 322 patients received CFP/CTZ and 198 VAN. PNA was the most common indication pre- and post-48H ATO. DOT significantly decreased pre- vs. post-48H ATO (Figure 1). LOS was 2 days shorter (P = 0.01) in the post-48H ATO group, mortality and 30-day readmissions was similar between groups (Table 1). Conclusion Average antibiotic DOT for CFP/CTZ, and VAN significantly decreased following the implementation of the 48H ATO at our medical center. LOS was reduced by 2 days, while mortality and 30-day readmissions were similar before and after. Disclosures All authors: No reported disclosures.

Accuracy of Electronic Surveillance of Catheter-Associated Urinary Tract Infection at an Academic Medical Center

2014 ◽  
Vol 35 (06) ◽  
pp. 685-691 ◽  
Author(s):  
H. L. Wald ◽  
B. Bandle ◽  
A. Richard ◽  
S. Min
Keyword(s):  
Urinary Tract ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Medical Center ◽  
Academic Medical Center ◽  
University Hospital ◽  
Reference Standard ◽  
Electronic Surveillance ◽  
Tract Infections ◽  
Sensitivity Specificity

Objective.To develop and validate a methodology for electronic surveillance of catheter-associated urinary tract infections (CAUTIs).Design.Diagnostic accuracy study.Setting.A 425-bed university hospital.Subjects.A total of 1,695 unique inpatient encounters from November 2009 through November 2010 with a high clinical suspicion of CAUTI.Methods.An algorithm was developed to identify incident CAUTIs from electronic health records (EHRs) on the basis of the Centers for Disease Control and Prevention (CDC) surveillance definition. CAUTIs identified by electronic surveillance were compared with the reference standard of manual surveillance by infection preventionists. To determine diagnostic accuracy, we created 2 × 2 tables, one unadjusted and one adjusted for misclassification using chart review and case adjudication. Unadjusted and adjusted test statistics (percent agreement, sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and κ) were calculated.Results.Electronic surveillance identified 64 CAUTIs compared with manual surveillance, which identified 19 CAUTIs for 97% agreement, 79% sensitivity, 97% sensitivity, 23% PPV, 100% NPV, and κ of .33. Compared with the reference standard adjusted for misclassification, which identified 55 CAUTIs, electronic surveillance had 98% agreement, 80% sensitivity, 99% specificity, 69% PPV, 99% NPV, and κ of .71.Conclusion.The electronic surveillance methodology had a high NPV and a low PPV compared with the reference standard, indicating a role of the electronic algorithm in screening data sets to exclude cases. However, the PPV markedly improved compared with the reference standard adjusted for misclassification, suggesting a future role in surveillance with improvements in EHRs.Infect Control Hosp Epidemiol2014;35(6):685–691

scholarly journals 1116. Impact of Antimicrobial Stewardship Incentive Goals for Pharmacists on Overall Antibiotic Use and Appropriate Duration of Therapy in Urinary Tract Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S397-S397
Author(s):  
Matthew A Miller ◽  
Mattie Huffman ◽  
Nichole Neville ◽  
Misha Huang ◽  
Gerard Barber
Keyword(s):  
Urinary Tract ◽  
Antimicrobial Stewardship ◽  
Group Performance ◽  
Respiratory Infections ◽  
Medical Center ◽  
Academic Medical Center ◽  
Antibiotic Use ◽  
Days Of Therapy ◽  
Essential Resource ◽  
Tract Infections

Abstract Background Urinary tract (UTI), skin and soft tissue, and respiratory infections are among the most frequently reported indications for antibiotics, such that focusing stewardship efforts here would expectedly have dramatic effects. Antimicrobial stewardship (AMS) programs vary in structure and available resources. At the University of Colorado Hospital, a 740-bed academic medical center, dedicated resources for AMS are limited to a pharmacist, pharmacy resident, and physician; however, there is a large clinical pharmacist group. For the past 2 years, pharmacy management incorporated AMS targets as group goals tied to performance bonuses. Methods This is a descriptive report utilizing incentives to achieve AMS goals. The first goal (July 1, 2016 to June 30, 2017) set out to reduce inpatient antibiotic use by 10%. The second goal (July 1, 2018 to June 30, 2018) was a 10% reduction in median antibiotic duration for UTIs. The AMS team provided guidelines, education, and oversight throughout target periods. Antibiotic use was calculated as days of therapy (DOT) per 1000 patient-days. Data related to UTI treatment was collected retrospectively on a quarterly basis. This was compared with baseline data previously collected during a statewide hospital stewardship collaborative project. Results During the first period, overall antibiotic use declined from 497 to 403 DOT per 1000 patient-days (18.9%), and broad-spectrum antibiotic use declined 22%. During the second period, 30 patient charts were reviewed quarterly, and the median UTI duration declined from 10 to 7 days (P = 0.002). The most common UTI diagnoses were similar between periods with complicated cystitis and pyelonephritis comprising 60–70% of cases. The 30-day readmission rate was not different between the baseline and goal period, 11% vs. 6% respectively (P = 0.18). Conclusion The use of group pharmacist goals tied to annual performance bonuses was effective in achieving AMS goals at our institution. In larger facilities with fewer dedicated AMS personnel, clinical pharmacists covering ward and intensive care units are an essential resource to achieving AMS goals. Group performance incentives may be a feasible strategy to generate interest and motivation to achieve AMS program goals. Disclosures All authors: No reported disclosures.

Evaluation of a Urinary Catheter with a Preconnected Closed Drainage Bag

1988 ◽  
Vol 9 (2) ◽  
pp. 72-76 ◽  
Author(s):  
Jane DeGroot-Kosolcharoen ◽  
Rhonda Guse ◽  
Jeffrey M. Jones
Keyword(s):  
Urinary Tract ◽  
Urinary Catheter ◽  
Foley Catheter ◽  
Drainage System ◽  
Catheter Insertion ◽  
Standard System ◽  
Adult Males ◽  
Catheter Drainage ◽  
Closed Drainage ◽  
Tract Infections

AbstractThe incidence of hacteriuria, significant urinary tract infection, and cost associated with the use of two urinary catheter drainage systems were evaluated in a population of hospitalized adult males. A commercially available device comprised of a Foley catheter attached with a heat-shrunk plastic seal to the tubing of a closed drainage hag (preconnected system) was compared with a standard system that had the Foley catheter attached to the closed drainage hag after it had been inserted. Using a randomized prospective design, the performance of the preconnected system in 97 patients was compared with that of the standard system in 105 patients. Catheters were left in place a mean of 6.4 and 7.6 days in the respective groups. Bacteriuria occurred after catheter insertion in 11.3% of patients receiving the preconnected system and 13.3% of patients receiving the standard system (not statistically significant). When bacteriuria developed, it occurred within seven days of catheter insertion in 50% of instances, irrespective of drainage system employed, suggesting that manipulations related to catheter insertion were important in initiating bacteriuria. Significant urinary tract infections occurred in only 2% of all patients studied. The higher cost for purchasing the preconnected system was not warranted for the population of patients studied.

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