Reducing inappropriate urinary catheter use by involving patients via an app: the Participatient feasibility study (Preprint)

2021 ◽  
Author(s):  
Robbert G. Bentvelsen ◽  
Marguerite L. Bruijning ◽  
Niels H. Chavannes ◽  
Karin Ellen Veldkamp
Keyword(s):  
Medical Records ◽  
Infection Prevention ◽  
Urinary Catheter ◽  
Survey Methods ◽  
Patient Empowerment ◽  
University Hospital ◽  
Clinical Ward ◽  
Before And After ◽  
Nursing Ward ◽  
Tract Infections

BACKGROUND The risk of urinary tract infections is increased by the inappropriate placement and the unnecessary prolongation of use of indwelling urinary catheters. Sustained behaviour change in infection prevention could be promoted through patient empowerment trough a smartphone app. OBJECTIVE We aimed to assess the feasibility and efficacy of implementation actions on patients’ use of Participatient on a clinical ward, and to compare three survey methods for urinary catheter use. METHODS Participatient was introduced for all admitted patients at the surgical nursing ward in a university hospital in the Netherlands. In three months, the number of new app users, days of use, and sessions were recorded. In a comparison of before-and-after the app, three methods for point prevalence surveys of catheter use were tested. Surveys were conducted through manual parsing of the text in the electronic medical records, checkbox surveys, and nurse-notes surveys. RESULTS In all, 475 patients were admitted to the ward, 42(8.8%) installed the app, with 1-5 new users per week. The actions with most ensuing app use were the kick-off with clinical lesson and the recruiting of the intake nurse. Between the survey methods, there was considerable variation in catheter prevalence. Therefore, we used the standard method of manual parsing in further analyses. Catheter use prevalence decreased from 38% to 27% after app introduction. CONCLUSIONS Clinical application of Participatient, the infection prevention app for patients, could be feasible when implementation actions are combined. For surveying indwelling urinary catheter use prevalence, manual parsing is best applicable.

592 Prevention of CAUTIs in a Burn ICU

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.

scholarly journals Housestaff Knowledge Related to Urinary Catheter Use and Catheter-Associated Urinary Tract Infections

2015 ◽  
Vol 36 (11) ◽  
pp. 1355-1357 ◽  
Author(s):  
Molly L. Paras ◽  
Erica S. Shenoy ◽  
Heather E. Hsu ◽  
Rochelle P. Walensky ◽  
David C. Hooper
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Urinary Tract Infections ◽  
Teaching Hospital ◽  
Infection Prevention ◽  
Urinary Catheter ◽  
Clinical Scenarios ◽  
Prevention Guidelines ◽  
Tract Infections

Despite published catheter-associated urinary tract infection prevention guidelines, inappropriate catheter use is common. We surveyed housestaff about their knowledge of catheter-associated urinary tract infections at a teaching hospital and found most are aware of prevention guidelines; however, their application to clinical scenarios and catheter practices fall short of national goals.Infect. Control Hosp. Epidemiol. 2015;36(11):1355–1357

scholarly journals Patients with Positive Glutamine Dehydrogenase (GDH) Antigen/Toxin and Toxin Negative/PCR Positive Patients: A Comparison

2020 ◽  
Vol 41 (S1) ◽  
pp. s344-s344
Author(s):  
Raymond Chinn ◽  
Shannon Mabalot
Keyword(s):  
Antimicrobial Therapy ◽  
Medical Records ◽  
Infection Prevention ◽  
Antibiotic Exposure ◽  
Demographic Information ◽  
Before And After ◽  
Acceptable Method ◽  
Receive Treatment ◽  
Line Listing ◽  
Age And Sex

Background: A multistep algorithm using GDH antigen plus toxin with a reflex PCR is an acceptable method for detecting CDI. The use of the PCR in discordant cases can identify those patients who are colonized from those patients who have nontoxogenic strains of C. difficile. Identification of discordant patients has infection prevention implications. Treatment is not recommended for patients colonized with C. difficile. Methods: A line listing of patients with positive hospital-onset antigen/toxin positive and discordant PCR positive was created. Demographic information was extracted from medical records and the 2 cohorts were compared. Results: There were 59 discordant and 44 positive cases HO CDI cases from October 2017 through September 2019: (1) There was no difference in age and sex between the 2 groups. (2) Positive patients tended to have 3 loose stools before and after testing (57% vs 27%; P = .026). (3) Overall, 82% of positive patients had 1 of 3 signs or symptoms (leukocytosis, abdominal pain, and temperature >38°C) consistent with CDI compared to 66% of discordant patients (P = .038), and 55% of positive patients were more likely to have 2 of 3 signs or symptoms of CDI compared to 17% of discordant patients (P = .00003). (4) Also, 46% of discordant patients were either on the oncology ward or ICU compared to 32% of positive patients (P = .764). (5) There was no difference between in discordant compared to positive patients in non-CDI antimicrobial therapy within 7 days of CDI test submission (81% vs 84%, respectively). Conclusions: (1) Screening for CDI testing should include 3 loose stools and at least 2 of 3 signs or symptoms of CDI. (2) Discordant cases most likely represents colonization because only 17% of discordant patients had 2 of 3 CDI signs or symptoms at presentation. (3) Discordant cases without clinical features of CDI should not receive treatment to minimize antibiotic exposure. (4) Identification of discordant patients have infection prevention ramifications because CD can be indirectly transmitted by colonized patients; therefore, using PCR in addition to toxin testing is favored. (5) Antimicrobial therapy highly associated with CDI should be avoided, should antimicrobial therapy be necessary in PCR-positive discordant patients.Funding: NoneDisclosures: None

scholarly journals The Etiologies of Altered Level of Consciousness in the Emergency Department: Before versus after Coronavirus Disease-19

2021 ◽  
Vol 39 (3) ◽  
pp. 141-149
Author(s):  
Dong Hwan Kim ◽  
Jae Cheon Jeon ◽  
In-Cheol Kim ◽  
Yaerim Kim ◽  
Yong Won Cho ◽  
...  
Keyword(s):  
Emergency Department ◽  
South Korea ◽  
Medical Records ◽  
Clinical Characteristics ◽  
Systemic Infection ◽  
University Hospital ◽  
Altered Level ◽  
Level Of Consciousness ◽  
Before And After ◽  
Overall Mortality

Background: Altered level of consciousness (ALC) is a challenging condition in the emergency department (ED). We evaluated the clinical characteristics, causes, and prognosis of adult patients presenting with ALC at an ED of a university hospital.Methods: The medical records of patients with ALC who visited the ED of a university hospital from February 2019 to November 2020 were reviewed to compare before and after the outbreak of coronavirus disease-19 (COVID-19) in Daegu, South Korea. The cause of ALC, its classification, the patients’ destinations, and prognosis were carefully decided and compared.Results: A total of 1,851 patients with ALC in ED consisted of 1,068 before COVID-19 (BC; to February 17th, 2020) and 783 after COVID-19 (AC; from February 18th, 2020) were investigated. The all-time leading cause of ALC in ED was systemic infection (29.2% in BC, 25.0% in AC), followed by metabolic cause (21.0%) in BC and stroke (18.4%) in AC. Extra-cerebral etiologies of ALC were 1,206 (65.1%). The overall mortality of ALC in ED was 12.3%, consisting of 11.0% in BC and 14.2% in AC. During the daytime (07:00 to 18:59), patients in overall 1,179 patients (63.7%) with ALC visited ED, consisted of 665 (62.3%) in BC and 514 (65.5%) in AC.Conclusions: This study demonstrated the extra-cerebral etiologies as the major causes of ALC in the ED. And there have been shifts in the etiology of ALC in ED.

scholarly journals Trends in Antifungal Use and Epidemiology of Nosocomial Yeast Infections in a University Hospital

1999 ◽  
Vol 37 (3) ◽  
pp. 531-537 ◽  
Author(s):  
Yasmina F. Berrouane ◽  
Loreen A. Herwaldt ◽  
Michael A. Pfaller
Keyword(s):  
Amphotericin B ◽  
Medical Records ◽  
Gastrointestinal Surgery ◽  
Bloodstream Infections ◽  
Marrow Transplant ◽  
University Hospital ◽  
Fiscal Year ◽  
Surgical Intensive Care ◽  
Tract Infections ◽  
Antifungal Use

This report describes both the trends in antifungal use and the epidemiology of nosocomial yeast infections at the University of Iowa Hospitals and Clinics between fiscal year (FY) 1987–1988 and FY 1993–1994. Data were gathered retrospectively from patients’ medical records and from computerized databases maintained by the Pharmacy, the Program of Hospital Epidemiology, and the Medical Records Department. After fluconazole was introduced, use of ketoconazole decreased dramatically but adjusted use of amphotericin B decreased only moderately. However, the proportion of patients receiving antifungal therapy who were treated with amphotericin B declined markedly. In FY 1993–1994, 26 patients of the gastrointestinal surgery service received fluconazole. Among these patients, fluconazole use was prophylactic in 16 (61%), empiric in 3 (12%), and directed to a documented fungal infection in 7 (27%). Rates of nosocomial yeast infection in the adult bone marrow transplant unit increased from 6.77/1,000 patient days in FY 1987–1988 to 10.18 in FY 1989–1990 and then decreased to 0 in FY 1992–1993. Rates of yeast infections increased threefold in the medical and surgical intensive care units, reaching rates in FY 1993–1994 of 6.95 and 5.25/1,000 patient days, respectively. The rate of bloodstream infections increased from 0.044/1,000 patient days to 0.098, and the incidence of catheter-related urinary tract infections increased from 0.23/1,000 patient days to 0.68. Although the proportion of infections caused by yeast species other than Candida albicans did not increase consistently, C. glabrata became an important nosocomial pathogen.

scholarly journals Infecção do trato urinário associada ao cateter: fatores associados e mortalidade

2020 ◽  
Vol 11 (2) ◽  
Author(s):  
Andressa Midori Sakai ◽  
Jaqueline Meira Uelse dos Santos ◽  
Giovana Ciquinato ◽  
Maria Fernanda Razaboni Del Conti ◽  
Renata Aparecida Belei ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Cohort Study ◽  
Urinary Tract ◽  
Nursing Care ◽  
Medical Records ◽  
Urinary Catheter ◽  
Urinary Catheterization ◽  
Convenience Sample ◽  
Factors Associated ◽  
Tract Infections

Objetivo: Identificar os fatores associados ao desenvolvimento de Infecção do Trato Urinária Associada ao Cateter (ITU-AC) e mortalidade entre pacientes com cateter urinário. Metodologia: Estudo de coorte, prospectivo, com amostragem por conveniência envolvendo 790 pacientes com idade superior a 12 anos, em uso de cateter durante hospitalização. Os dados coletados do prontuário e fichas de notificação de infecção hospitalar foram analisados pelo programa SPSS. Resultados: Contribuíram para o desenvolvimento da ITU-AC a permanência com o cateter urinário por período >20 dias (OR 26,5; p<0,001), ser cateterizado mais de uma vez (OR 8,92; p<0,001) e hospitalização >30 dias (OR 26,8; p<0,001). Pacientes que desenvolveram ITU-AC apresentaram chance maior de mortalidade (OR 2,7; p<0,001). Conclusão:Frequência da inserção do dispositivo urinário, períodos prolongados de hospitalização e de permanência com o cateter contribuíram para o desenvolvimento de ITU-AC, e as chances de mortalidade foram aumentadas entre pacientes com essa infecção. Descritores: Infecções Urinárias; Cateterismo Urinário; Infecções Relacionadas a Cateter; Controle de Infecções; Cuidados de Enfermagem. Objective: To identify factors associated with the development of Catheter-related Urinary Tract Infection (CR-UTI) and mortality among patients using urinary catheter. Methodology: Prospective cohort study in a convenience sample of 790 patients older than 12 years using catheter during hospitalization.[A1]  The data collected from medical records and hospital infection notification were analyzed using the SPSS program. Results: Permanence with the urinary catheter >20 days (OR 26.5; p<0.001), being catheterized more than once (OR 8.92; p<0.001) and hospitalization >30 days (OR 26.8; p<0.001) contributed to the development of CR-UTI. Patients who developed CR-UTI presented a greater chance of mortality (OR 2.7; p<0.001). Conclusion: Frequency of urinary device insertion, prolonged periods of hospitalization and of permanence with the catheter contributed to the development of CR-UTI, and the chances of mortality were increased among patients with this infection.Descriptors: Urinary Tract Infections; Urinary Catheterization; Catheter-Related Infections; Infection Control; Nursing Care. Objetivo: Identificar los factores asociados con el desarrollo de Infección del Tracto Urinario Asociada con el Catéter (ITU-AC) y la mortalidad entre los pacientes que usan catéter urinario. Metodología: Estudio de cohorte, prospectivo con una muestra de conveniencia de 790 pacientes mayores de 12 años, que usan catéter durante su hospitalización. Los datos recopilados de los registros médicos y los formularios de notificación de infección nosocomial fueron analizados por el programa SPSS. Resultados: Contribuyendo al desarrollo de la (ITU-AC) la permanencia con el catéter urinario por un plazo >20 días (OR 26,5; p <0,001), tener recibido catéter más de una vez (OR 8,92; p<0,001) y hospitalización >30 días (OR 26,8; p<0,001). Los pacientes que desarrollaron (ITU-AC) presentaron una mayor posibilidad de mortalidad (OR 2,7; p<0,001). Conclusión: Frecuencia de inserción del dispositivo urinario, períodos prolongados de hospitalización y de permanencia con el catéter contribuyeron al desarrollo de (ITU-AC), y las posibilidades de mortalidad aumentaron entre los pacientes con esta infección.Descriptores: Infecciones Urinarias; Cateterismo Urinario; Infecciones Relacionadas con Catéteres; Control de Infecciones; Atención de Enfermería.

scholarly journals Treatment of Laryngeal Granulomas

2019 ◽  
Vol 23 (03) ◽  
pp. e322-e324 ◽  
Author(s):  
Regina Helena Garcia Martins ◽  
Norimar Hernandes Dias ◽  
Carlos Segundo Paiva Soares ◽  
Andrea Cristina Joia Gramuglia
Keyword(s):  
Proton Pump ◽  
Medical Records ◽  
Beclomethasone Dipropionate ◽  
Treatment Time ◽  
Laryngopharyngeal Reflux ◽  
Botulinum Toxin A ◽  
University Hospital ◽  
Inhaled Steroids ◽  
Second Surgery ◽  
Before And After

Introduction Laryngeal granulomas are benign, recurrent lesions of many causes (reflux, voice abuse, intubation, and idiopathic), which renders its treatment difficult. Objective To describe our experience in the treatment of laryngeal granulomas. Methods From 16 medical records of the patients with laryngeal granulomas seen between 2010 and 2017 in a university hospital, the following data were analyzed: age, gender, vocal and gastroesophageal symptoms, vocal overuse, intubation, treatments, videolaryngoscopy before and after the treatment. Results Gender: female, 10; male, 6. Age: between 20 and 60 years old (11). Etiology of the granulomas: intubation (9), reflux (4), idiopathic (3). The initial treatments adopted in all cases were: inhaled beclomethasone dipropionate 100 µg 12/12 hours (1 month), proton pump inhibitor, omeprazole 40 mg/day (2 months), and dietary and voice education. After this period, 10 patients (7 postintubation, 3 idiopathic) were submitted to surgery, since no improvements in the symptoms or in the lesions were seen. Of these, two recurred, requiring a second surgery, one of which recurred six times and received botulinum toxin A. Only one patient with granulomas due to laryngopharyngeal reflux presented no improvement in the symptoms nor in the lesion after the pharmacological treatment and had been submitted to microsurgery. All of the other patients with reflux granulomas were successfully treated with the drug treatment, and the longest treatment time for complete remission of the symptoms and of the lesions was 9 months. Conclusions In laryngeal granulomas caused by reflux, treatment with inhaled steroids and proton pump inhibitors proved to be effective, although prolonged. In postintubation and idiopathic granulomas, surgery was the best treatment.

scholarly journals Impact of a hospital-wide huddle on device utilisation and infection rates: a community hospital’s journey to zero

2020 ◽  
Vol 21 (6) ◽  
pp. 228-233
Author(s):  
Alfredo J Mena Lora ◽  
Mirza Ali ◽  
Candice Krill ◽  
Sherrie Spencer ◽  
Eden Takhsh ◽  
...  
Keyword(s):  
Infection Prevention ◽  
Cost Savings ◽  
Bloodstream Infections ◽  
Central Line ◽  
Culture Of Safety ◽  
Before And After ◽  
Quasi Experimental ◽  
Tract Infections ◽  
Healthcare Associated ◽  
The Impact

Background: Device utilisation ratios (DUR) correlate with device-associated complications and rates of infection. We implemented a hospital-wide Daily Interdisciplinary Safety Huddle (DISH) with infection control and device components. The aim of this study was to evaluate the impact of DISH on DURs and rates of infection for indwelling urinary catheters (IUC) and central venous catheters (CVC). Methods: A quasi-experimental study assessing DURs and rates of infection before and after implementation of DISH. At DISH, usage of IUC and CVC is reported by managers and the infection preventionist reviews indications and plans for removal. Data before and after implementation were compared. Paired T-test was used to assess for differences between both groups. Results: DISH was successfully implemented at a community hospital. The average DUR for IUC in intensive care unit (ICU) and non-ICU settings was reduced from 0.56 to 0.35 and 0.27 to 0.12, respectively. CVC DUR decreased from 0.29 to 0.26 in the ICU and 0.14 to 0.12 in non-ICU settings. Catheter-associated urinary tract infections (CAUTIs) decreased by 87% and central line-associated bloodstream infections (CLABSIs) by 96%. Conclusion: DISH was associated with hospital-wide reductions in DUR and device-associated healthcare-associated infections. Reduction of CLABSIs and CAUTIs had estimated cost savings of $688,050. The impact was more profound in non-ICU settings. To our knowledge, an infection prevention hospital-wide safety huddle has not been reported in the literature. DISH increased device removal, accountability and promoted a culture of safety.

Participant Reactions to Suicide-Focused Research

Crisis ◽  
2020 ◽  
Vol 41 (5) ◽  
pp. 367-374
Author(s):  
Sarah P. Carter ◽  
Brooke A. Ammerman ◽  
Heather M. Gebhardt ◽  
Jonathan Buchholz ◽  
Mark A. Reger
Keyword(s):  
Medical Records ◽  
Research Study ◽  
Small Sample Size ◽  
Psychiatric Inpatient ◽  
Small Sample ◽  
Inpatient Unit ◽  
Online Laboratory ◽  
Psychiatric Inpatient Unit ◽  
Before And After ◽  
Participant Reactions

Abstract. Background: Concerns exist regarding the perceived risks of conducting suicide-focused research among an acutely distressed population. Aims: The current study assessed changes in participant distress before and after participation in a suicide-focused research study conducted on a psychiatric inpatient unit. Method: Participants included 37 veterans who were receiving treatment on a psychiatric inpatient unit and completed a survey-based research study focused on suicide-related behaviors and experiences. Results: Participants reported no significant changes in self-reported distress. The majority of participants reported unchanged or decreased distress. Reviews of electronic medical records revealed no behavioral dysregulation and minimal use of as-needed medications or changes in mood following participation. Limitations: The study's small sample size and veteran population may limit generalizability. Conclusion: Findings add to research conducted across a variety of settings (i.e., outpatient, online, laboratory), indicating that participating in suicide-focused research is not significantly associated with increased distress or suicide risk.

Testing the health literacy of twenty Bangladeshi patients before and 5 months after they begin to access their GP electronic record

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697133
Author(s):  
Richard Fitton ◽  
Amir Hannan ◽  
Ingrid Brindle ◽  
Shafia Begum ◽  
Sarwar Shah
Keyword(s):  
Health Literacy ◽  
Health Outcomes ◽  
Medical History ◽  
Medical Records ◽  
Practice Nurse ◽  
Electronic Record ◽  
Phone Calls ◽  
Before And After ◽  
Medical Histories ◽  
Memory Knowledge

BackgroundPatients with higher health literacy enjoy better health outcomes and are more compliant with treatment. Health literacy is a product of memory, reason and imagination. Patients who can access their records have potentially more memory (knowledge) and make less phone calls to and have less consultations with their GP, practice nurse, HCA and other professionals.AimThe study aims to measure the knowledge that twenty Bangladeshi patients with poor English have of their medical history before and after access to their electronic record.Method55% of patients at Thornley House have access to their medical records. A simple questionnaire was given to 20 Bangladeshi patients before and 5 months after access to their electronic record. The questionnaires recorded the patients’ knowledge of their medical histories. The scores of the completed before and after questionnaires were compared to see if record access had increased patients’ knowledge.ResultsFive patients completed before and after questionnaires. Each achieved a higher score after record access. The differences in scores for the five patients were 2, 5, 1, 10, and 1, respectively.ConclusionHealth literacy for patients is similar to medical literacy for doctors. It requires knowledge, skills and attitudes. We will see whether record access can increase knowledge. Further studies might measure whether that increased knowledge improves skills and attitudes.

Sign in / Sign up

Export Citation Format

Share Document