Using A Criteria-Based Reminder To Reduce Use Of Indwelling Urinary Catheters And Decrease Urinary Tract Infections

2013 ◽  
Vol 22 (2) ◽  
pp. 105-114 ◽  
Author(s):  
Yin-Yin Chen ◽  
Mei-Man Chi ◽  
Yu-Chih Chen ◽  
Yu-Jiun Chan ◽  
Shin-Shang Chou ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Relative Risk ◽  
Urinary Tract Infections ◽  
Intervention Group ◽  
Utilization Rate ◽  
Control Group ◽  
Urinary Catheterization ◽  
Urinary Catheters ◽  
Urinary Infections ◽  
Tract Infections

Background Duration of indwelling urinary catheterization is an important risk factor for urinary tract infection. Objectives To determine whether a reminder approach reduces the use of urinary catheters and the incidence of catheter-associated urinary tract infections. Methods A randomized control trial was performed in 2 respiratory intensive care units in a 2990-bed tertiary referral medical center. Patients who had urinary catheters in place for more than 2 days from April through November 2008 were randomly assigned to either the intervention group (use of a criteria-based reminder to remove the catheter) or the control group (no reminder). Results A total of 278 patients were recruited. Utilization rate of indwelling urinary catheters was decreased by 22% in the intervention group compared with the control group (relative risk, 0.78; 95% CI, 0.76-0.80; P < .001). The intervention significantly shortened the median duration of catheterization (7 days vs 11 days for the control group; P < .001). The success rate for removing the catheters in the intervention group by day 7 was 88%. The reminder intervention reduced the incidence of catheter-associated infections by 48% (relative risk, 0.52; 95% CI, 0.32-0.86; P = .009) in the intervention group compared with the control group. Conclusions Use of a criteria-based reminder to remove indwelling urinary catheters can diminish the use of urinary catheterization and reduce the likelihood of catheter-associated urinary infections. This reminder approach can prevent catheter-associated urinary infections, and its use should be strongly considered as a way to enhance the safety of patients. (American Journal of Critical Care. 2013;22:105–114)

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.

scholarly journals Effectiveness of a simple intervention for prevention of catheter-associated urinary tract infections on a medical hospital unit

2020 ◽  
Vol 21 (6) ◽  
pp. 221-227
Author(s):  
Anita G Au ◽  
Sabin Shurraw ◽  
Holly Hoang ◽  
Sukun Wang ◽  
Xiaoming Wang
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Statistical Significance ◽  
Control Group ◽  
Urinary Catheters ◽  
Indwelling Catheter ◽  
Tract Infections ◽  
Urinary Catheterisation ◽  
The Impact ◽  
Intervention Unit

Background: Urinary tract infections (UTI) are one of the most common hospital-acquired infections with 80% as a result of urinary catheterisation. Aim/Objective: This study examined the impact of a simple intervention consisting of a daily chart reminder in patients with indwelling urinary catheters (IUC) on the duration of catheter use and the incidence of catheter-associated UTIs (CAUTIs). Methods: The trial used a prospective pretest–post-test design with a control group over a six-month period conducted on two medical units of a community teaching hospital. We included all patients admitted to two medical units between 1 June and 30 November 2016 who had an IUC inserted at the study site. During the intervention phase, a sticker was placed in the charts of patients with urinary catheters reminding physicians to assess for catheter removal if not clinically necessary. Results: A total of 195 patients participated in this study (112 control unit, 83 intervention unit). There was a decrease in the duration of IUC use on the intervention unit from 11.7 days to 7.5 days ( P = 0.0028). There was a decrease in repeated catheterisation from 11.1% to 2.1% ( P = 0.0882), and CAUTIs from 17.5% to 4.6% ( P = 0.0552) but this did not reach statistical significance. Discussion: The implementation of a daily IUC reminder sticker in patient charts was associated with a significant reduction in the mean duration of indwelling catheter use with a trend towards a reduction in the frequency of repeated urinary catheterisation and rate of CAUTIs.

scholarly journals Quality Improvement Initiative: Foley Catheters in Patients Undergoing Pectus Deformity Repair

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Jordan Crabtree ◽  
Troy Marke
Keyword(s):  
Quality Improvement ◽  
Urinary Tract ◽  
Urinary Retention ◽  
Urinary Tract Infections ◽  
Pectus Excavatum ◽  
Urinary Catheter ◽  
Intervention Group ◽  
Urinary Catheters ◽  
Post Intervention ◽  
Tract Infections

Background and Hypothesis: Pectus excavatum and carinatum are sternal deformities that often require surgeries with significant postoperative pain that can limit a patient’s ability to void. An indwelling urinary catheter is placed for the operation, but is often removed on the first postoperative day due to concerns of infection, which begs the necessity of these catheters in the first place. In this study, we hypothesized that there would be no increased risk of urinary retention or urinary tract infection irrespective of whether urinary catheters were utilized. Experimental Design: A pre/post quality improvement study was undertaken of patients undergoing pectus excavatum/carinatum repair between June 1, 2015 and May 31, 2022. The pre intervention group spanned from June 1, 2015 to May 31, 2021, where Foley catheters were placed intraoperatively and removed the first postoperative day. Pediatric surgery and anesthesia groups changed practice effective June 1, 2021 and decided to no longer utilize urinary catheters in pectus repairs. Pre-intervention patients were acquired through the surgery billing database. Post-intervention patients were acquired prospectively. Rates of urinary retention (any event requiring mechanical intervention for voiding) and urinary tract infections (UTI, >100,000 CFU bacteria/mL urine) were compiled into REDCap. Data are expressed as percent of the total cohort. Results:  Of 179 patients undergoing pectus repair (162 Excavatum, 17 Carinatum), 12 patients (6.7%) in the pre-intervention group experienced urinary retention. Of these, 9 received in/out catheterization, 1 had a Foley catheter replaced, and 2 underwent in/out catheterization and had a Foley replaced. There were no urinary tract infections recorded among the pre-intervention group. Conclusion and Potential Impacts: Urinary retention and UTI are rare in patients who have an indwelling urinary catheter. Data acquired over the next year from the post-intervention group will help determine the true necessity for these catheters in the perioperative pectus population. 

scholarly journals Participatory continuous nursing using the WeChat platform for patients with spinal cord injuries

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110161
Author(s):  
Jing Li ◽  
Qiao-Ping Li ◽  
Bi-Hong Yang
Keyword(s):  
Spinal Cord ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Muscle Atrophy ◽  
Spinal Cord Injuries ◽  
Control Group ◽  
Observation Group ◽  
Family Function ◽  
Tract Infections ◽  
Compliance Behaviour

Objective The study aim was to analyse the effect of participatory continuous nursing using the WeChat platform on the complications, family function and compliance of patients with spinal cord injuries. Methods This was a randomized controlled trial. Seventy-eight patients with stable disease treated by internal fixation were enrolled in the study from August 2017 to August 2019 and assigned equally to an observation group and a control group. The control group received regular care from the time of discharge. The observation group used the WeChat platform to participate in continuous care. Results Six months after discharge, the continuous nursing group had a significantly lower incidence of pressure ulcers, urinary tract infections, joint contractures and muscle atrophy than the control group. The continuous nursing group showed a significant improvement in family function level and compliance behaviour at 3 and 6 months after discharge. Conclusion A participation-based continuous nursing intervention using the WeChat platform can reduce the incidence of pressure ulcers, urinary tract infections, joint contracture and muscle atrophy; improve patient family function; and promote healthy compliance behaviour.

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

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

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.

Preventing Catheter-Associated Urinary Tract Infections in the Pediatric Intensive Care Unit

2020 ◽  
Vol 40 (1) ◽  
pp. e12-e17
Author(s):  
Megan D. Snyder ◽  
Margaret A. Priestley ◽  
Michelle Weiss ◽  
Cindy L. Hoegg ◽  
Natalie Plachter ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Urinary Tract Infections ◽  
Urinary Catheter ◽  
Pediatric Intensive Care ◽  
Urinary Catheters ◽  
Bundle Compliance ◽  
Tract Infections

Background Catheter-associated urinary tract infections are common health care–associated infections and have been associated with increased mortality, morbidity, length of stay, and cost. Prevention strategies are grouped into bundles focused on reducing unnecessary catheter use and promptly removing urinary catheters. Before intervention in the study institution, no urinary catheters were unnecessarily used and compliance with the catheter-associated urinary tract infection bundle was 84%. Objective To increase bundle compliance by using targeted rounds specifically focused on eliminating dependent loops in drainage tubing and ensuring appropriate catheter use to reduce the incidence of catheter-associated urinary tract infections. Methods A multidisciplinary team was formed to identify misperceptions, highlight best practices, and eliminate barriers to success over 1 year in a single pediatric intensive care unit. The team completed a quality improvement project of daily targeted rounding for patients with an indwelling urinary catheter. The goals were to assess appropriateness of catheterization, increase bundle compliance, and decrease catheter-associated urinary tract infection risk. Targeted rounds were conducted in addition to the medical team rounds. Results Bundle compliance supported by targeted rounding increased from 84% to 93% and helped reduce the overall catheter-associated urinary tract infection rate from 2.7 infections per 1000 catheter-days at baseline to 0. This change was sustained for 1 year. Conclusion Targeted rounding for pediatric patients with an indwelling urinary catheter is an effective and sustainable strategy to reduce catheter-associated urinary tract infections. The ease of implementation for this intervention lends itself to generalizability to other patient populations.

scholarly journals PREVALÊNCIA DE INFECÇÃO URINÁRIA E DE Actinomyces suis EM PORCAS GESTANTES E SUA CORRELAÇÃO COM ALGUNS PARÂMETROS FÍSICOS E QUÍMICOS DA URINA

2000 ◽  
Vol 5 (1) ◽  
Author(s):  
G.C. ALBERTON ◽  
P.R. WERNER ◽  
J. SOBESTIANSKY ◽  
O.D. COSTA ◽  
W. BARIONI JÚNIOR
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Urinary Infection ◽  
Urine Samples ◽  
Chemical Parameters ◽  
Presumptive Diagnosis ◽  
Urinary Infections ◽  
Physical And Chemical Parameters ◽  
Tract Infections ◽  
Physical And Chemical

O presente trabalho teve como objetivo determinar a prevalência de infecção urinária e da bactéria Actinomyces suis na urina de 1745 porcas gestantes da região Sul do Brasil e correlacionar essa prevalência com parâmetros físicos e químicos da urina. A prevalência de infecção urinária e de A. suis foi de 28,31% e 20,63%, respectivamente. Observou-se correlação negativa entre infecção urinária e A. suis, ou seja, as porcas que apresentaram infecção urinária tinham menor prevalência de A. suis (13,67%) do que as que não a apresentaram (23,12%). Da mesma forma, as porcas portadoras de A. suis, tinham menor prevalência de infecção urinária (17,43%) do que as não portadoras (28,62%). Apenas 3,60% das porcas examinadas eram positivas para infecção urinária e A. suis simultaneamente. A cor predominante da urina foi a amarelo claro, tanto para as porcas portadoras ou não portadoras de infecção urinária ou de A. suis. Constatou-se a presença de turbidez em 83,15% das amostras, sendo que em 96,18% das amostras turvas observou-se a presença de cristais. Finalmente, a cor, aspecto, densidade, pH e presença de cristais, foram considerados como parâmetros sem valor para o diagnóstico presuntivo de infecção urinária em porcas gestantes. Prevalence of urinary tract infections and of Actinomyces suis in urine from pregnant sows. Correlation with some urine’s physical and chemical parameters Abstract A survey has been carried out in urine samples from 1745 pregnant sows from Southern Brazil, in regard to the prevalence of urinary infections and of Actinomyces suis and its correlation with some of the urine physical and chemical parameters. Prevalence of urinary infections was of 28.31% and that of A. suis, 20.63%. However, a negative correlation has been found between the incidence of urinary infection and the presence of A. suis, the prevalence of the latter being lower in sows which are positive for urinary infections (13.67%) than in those without urinary infection (23.12%). At the same time, sows positive for A. suis display a lesser number of urinary infection (17.43%) than those negative for the bacteria (28.62%). Only in 3.60% of the sows, urinary infection and A. suis occurred simultaneously. Due to the presence of crystals, turbidity was frequently observed in sow’s urine (83.15%). Crystals were present in 96.18% of sow’s turbid urine samples. Furthermore, color, turbidity, density, pH and the presence of crystals were not considered of value for the presumptive diagnosis of urinary tract infections in pregnant sows.

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