Active training and surveillance: 2 good friends to reduce urinary catheterization rate

doi:10.1016/j.ajic.2012.01.021

American Journal of Infection Control

Volume 40, Issue 8, October 2012, Pages 692-695

https://doi.org/10.1016/j.ajic.2012.01.021 Get rights and content

Background

Because catheter-associated urinary tract infections (CAUTI) represent the most frequent health care-associated infection (HAI), we implemented an educational intervention on urinary catheter use to reduce the CAUTI rate.

Methods

The intervention was focused on correct management of catheterized patients. To assess the participants' knowledge, pre- and post-tests were performed. An active CAUTI surveillance program took place in a 900-bed teaching hospital in central Italy before and after the educational intervention. CAUTI definition, catheterization rate, and CAUTI rate were expressed according to the Centers for Disease and Prevention/National Healthcare Safety Network definitions. The level of significance was set at P ≤ .05.

Results

Two hundred ninety-six health care workers attended the educational intervention; the analysis of the pre- and post-tests highlighted a statistically significant improvement (P < .05). Before the intervention, mean catheterization rate was 18.5% (95% confidence interval [CI]:18.1-18.9); 46 cases of CAUTI were detected, with an incidence rate of 6.6/1,000 catheter-days (95% CI: 4.8-8.8). After the intervention, mean catheterization rate was 9.2% (95% CI: 8.9-9.5); 19 cases of CAUTI were detected, with an incidence rate of 5.8/1,000 catheter-days (95% CI: 3.5-9.0).

Conclusion

Through an active educational update and thanks to the implementation of a surveillance system, a successful reduction of catheterization rate was achieved. More efforts are needed to preserve this goal and to improve the CAUTI rate also.

Section snippets

Setting

The “Ospedali Riuniti” is a 900-bed teaching hospital in central Italy. The wards included in the study were grouped into medical (gastroenterology, nephrology, neurology, infectious diseases) and surgical (orthopedics, urology, neurosurgery, plastic and reconstructive surgery, thoracic surgery, vascular surgery).

Intervention

In November 2006, after the first surveillance period, a 2-days educational session involving all nurses and physicians of the hospital was performed. The educational intervention

Results

In Table 1 the comparison between the population baseline characteristics in the 2 surveillance period is shown.

Discussion

The above results show that an active educational intervention and the implementation of a surveillance system caused a successful reduction of catheterization rate. In fact, during the second CAUTI surveillance period, the catheterization rate dropped from 18.5% to 9.2%; lower levels were achieved also for the CAUTI incidence rate with a reduction from 6.6/1,000 catheter-days in period 1 to 5.8/1,000 catheter-days in period 2. At the start of the study period, the infection rates in specific

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Cited by (28)

Patient engagement to counter catheter-associated urinary tract infections with an app (PECCA): a multicentre, prospective, interrupted time-series and before-and-after study
2024, Journal of Hospital Infection
The risk of urinary tract infections (UTIs) is increased by unnecessary placement and prolonged use of urinary catheters.
To assess whether inappropriate use of catheters and catheter-associated UTI were reduced through patient participation.
In this multicentre, interrupted time-series and before-and-after study, we implemented a patient-centred app which provides catheter advice for patients, together with clinical lessons, feedback via e-mails and support rounds for staff members. Data on catheter use and infections were collected during a six-month baseline and a six-month intervention period on 13 wards in four hospitals in the Netherlands. Dutch Trial Register: NL7178.
Between June 25^th, 2018 and August 1^st, 2019, 6556 patients were included in 24 point-prevalence surveys, 3285 (50%) at baseline and 3271 (50%) during the intervention. During the intervention 249 app users and a median of seven new app users per week were registered (interquartile range: 5.5–13.0). At baseline, inappropriate catheter use was registered for 175 (21.9%) out of 798 catheters, compared to 55 (7.0%) out of 786 during the intervention. Time-series analysis showed a non-significant decrease of inappropriate use of 5.8% (95% confidence interval: –3.76 to 15.45; P = 0.219), with an odds ratio of 0.27 (0.19–0.37; P < 0.001). Catheter-associated UTI decreased by 3.0% (1.3–4.6; P = 0.001), with odds ratio 0.541 (0.408–0.716; P < 0.001).
Although UTI significantly decreased after the implementation, patient participation did not significantly reduce the prevalence of inappropriate urinary catheter use. However, the inappropriate catheter reduction of 5.8% and an odds ratio of 0.27 suggest a positive trend. Patient participation appears to reduce CAUTI and could reduce other healthcare-associated infections.
Successful strategy to decrease indwelling catheter utilization rates in an academic medical intensive care unit
2017, American Journal of Infection Control
Duration of indwelling urinary catheterization is an important risk factor for urinary tract infections. We devised a strategy to decrease the utilization of indwelling urinary catheters (IUCs). We also highlight the challenges of managing critically ill patients without IUCs and demonstrate some of the initiatives that we undertook to overcome these challenges.
A retrospective observational outcomes review was performed in an adult medical intensive care unit (ICU) between January 2012 and December 2016. This period included a baseline and series of intervals, whereby different aspects of the strategies were implemented. IUC utilization ratio and catheter-associated urinary tract infection (CAUTI) rates were calculated.
Our IUC utilization ratio had a statistically significant decrease from 0.92 (baseline) to 0.28 (after 3 interventions) (P < .0001). Similarly, CAUTI rates had a statistically significant decrease from 5.47 (baseline) to 1.08 (after 3 intervention) (P = .0134). These rates sustained a statistically significant difference over the 2-year follow-up period from the last intervention. Incontinence-associated dermatitis (IAD) was identified as a potential complication of not using an IUC. There was no statistically significant change in the IAD rates during 2013-2016.
Our interventions demonstrated that aggressive and comprehensive IUC restriction protocol and provider training can lead to a successful decrease in IUC use, leading to a lower IUC utilization ratio and CAUTI rate in a large complex academic ICU setting.
Implementing clinical guidelines to prevent catheter-associated urinary tract infections and improve catheter care in nursing homes: Systematic review
2017, American Journal of Infection Control
Catheter-associated urinary tract infection is the most common health care–associated infection, is considered avoidable, and has cost implications for health services. Prevalence is high in nursing homes, but little research has been undertaken to establish whether implementing clinical guidelines can reduce infection rates in long-term care or improve quality of urinary catheter care.
Systematic search and critical appraisal of the literature.
Three studies evaluated the impact of implementing a complete clinical guideline. Five additional studies evaluated the impact of implementing individual elements of a clinical guideline.
Prevention of catheter-associated urinary tract infection in nursing homes has received little clinical or research attention. Studies concerned with whole guideline implementation emerged as methodologically poor using recognized criteria for critically appraising epidemiologic studies concerned with infection prevention. Research evaluating the impact of single elements of clinical guidelines is more robust, and their findings could be implemented to prevent urinary infections in nursing homes.
Urinary catheters prevalence study in a university hospital
2017, Progres en Urologie
Le sondage vésical est le principal facteur d’infection urinaire nosocomiale. Nous avons évalué, au sein de notre institution, les pratiques liées au sondage vésical (SV).
Nous avons effectué une enquête transversale du SV pendant une semaine en septembre 2014 dans tous les services adultes de notre institution. Nous avons relevé la prévalence de patients sondés, les indications, la durée, la gestion du SV et les infections urinaires symptomatiques.
Sur 1046 patients audités, 125 (12 %) étaient sondés. L’âge moyen était de 72 ans (64,8–79,2). La prévalence du SV était plus fréquente en réanimation chirurgicale (88 %), réanimation médicale (87 %), urologie (50 %), gériatrie (18 %) et soins de suite (18 %). La durée moyenne de SV était de 7,8 jours (3,8–11,8). Elle était plus courte en chirurgie qu’en médecine (3,6 vs 9,7 jours ; p < 0,001). Le SV était présent depuis plus de 4 jours dans 60 % des cas. La rétention aiguë d’urine était l’indication la plus fréquente (59 %), significativement plus en service médical que chirurgical (75 % vs 26 %). Les autres motifs étaient le périopératoire (17 %), la quantification de diurèse (12 %), l’immobilisation stricte (4 %) et les indications non reconnues ou pose pour confort du personnel (4 %). Une infection urinaire symptomatique était présente dans 10 % des cas, majoritairement en médecine (30 % vs 8 %).
La prévalence de notre centre est supérieure à la prévalence nationale (8,1 %), restant cependant en-dessous de la moyenne européenne (17,2 %). La maîtrise du risque d’infection passe par le respect des indications de pose et la réduction des durées de sondage.
4.
Urinary tract infection is the most common healthcare-association infection, especially because of urinary catheter. We evaluated our practices concerning catheter insertion and management in our institution.
We conducted a single-centre descriptive cross-sectional study during 1 week in September 2014 in all adult departments. We noted prevalence, indications, length, management of urinary catheter (UC) and symptomatic catheter-associated urinary tract infections (SCAUTI).
Amongst 1046 patients audited, 125 (12%) had UC. The mean age was 72 years (64.8–79.2). UC prevalence was higher in surgical (88%) and medical (87%) intensive care, urology (50%), geriatrics (18%) and long-term care (18%) departments. The average catheterisation length was 7.8 days (3.8–11.8); it was shorter in surgery than in medicine departments (3.6 vs 9.7 days, P < 0.001). Catheters were present for more than 4 days in 60% of the cases. Acute urinary retention was the most frequent indication (59%), significantly more in medical than surgical departments (75% vs 26%). Others indications were perioperative (17%), diuresis monitoring (12%), strict immobilization (4%) and unnecessary indications or staff comfort (4%). A SCAUTI was present in 10% of cases, mostly in medicine department (30% vs 8%).
The prevalence of our institution is higher than the national prevalence (8.1%), but still below the European average (17.2%). Control of the risk of CAUTI requires compliance with UC appropriate indications, UC management, and prompt removal of unnecessary UC.
4.
New Nursing Graduates' Self-Efficacy Ratings and Urinary Catheterization Skills in a High-Fidelity Simulation Scenario
2017, Clinical Simulation in Nursing
Transition to practice is a major concern for nurse educators, health care executives, and new nursing graduates. The disparity of nurse educators' and leaders' perceptions regarding new graduates' abilities to perform procedural skills may lead to patient harm. Pay for performance, quality indicators, and decreased reimbursement related to catheter-associated urinary tract infections have increased the need for competency validation.
A quantitative method with a descriptive correlational design provided information about the relationship of self-efficacy of the new nursing graduate and competency in urinary catheterization. Following a self-efficacy inquiry, a high-fidelity simulation was conducted for individual evaluation of the psychomotor skill of urinary catheterization.
Analysis with nonparametric statistics for correlation indicated a lack of statistical significance (p > .05) between self-efficacy and competency in the psychomotor skill of urinary catheterization.
This study indicates that there is a need for validating competency in psychomotor skills within the context of a simulated patient care situation. The appropriate use of high-fidelity simulation may include incorporating self-efficacy measurements with an objective evaluation of psychomotor abilities to improve patient outcomes while increasing the accountability of the nurse.
Assessment of a multi-modal intervention for the prevention of catheter-associated urinary tract infections
2016, Journal of Hospital Infection
Citation Excerpt :
Interestingly, a significant fall in the in-hospital length of stay during P2 was observed. This effect had also been previously reported as a result of interventions of this type.2 However, we cannot draw further conclusions due to a lack of adjustment for variables related to in-hospital length of stay such as severity of illness in the included patients.
Catheter-associated urinary tract infections (CAUTIs) represent an important healthcare burden.
To assess the effectiveness of an evidence-based multi-modal, multi-disciplinary intervention intended to improve outcomes by reducing the use of urinary catheters (UCs) and minimizing the incidence of CAUTIs in the internal medicine department of a university hospital.
A multi-modal intervention was developed, including training sessions, urinary catheterization reminders, surveillance systems, and mechanisms for staff feedback of results. The frequency of UC use and incidence of CAUTIs were recorded in three-month periods before (P1) and during the intervention (P2).
The catheterization rate decreased significantly during P2 [27.8% vs 16.9%; relative risk (RR): 0.61; 95% confidence interval (CI): 0.57–0.65]. We also observed a reduction in CAUTI risk (18.3 vs 9.8%; RR: 0.53; 95% CI: 0.30–0.93), a reduction in the CAUTI rate per 1000 patient-days [5.5 vs 2.8; incidence ratio (IR): 0.52; 95% CI: 0.28–0.94], and a non-significant decrease in the CAUTI rate per 1000 catheter-days (19.3 vs 16.9; IR: 0.85; 95% CI: 0.46–1.55).
The multi-modal intervention was effective in reducing the catheterization rate and the frequency of CAUTIs.

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: Conflicts of interest: None to report.

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Major articleActive training and surveillance: 2 good friends to reduce urinary catheterization rate

Background

Methods

Results

Conclusion

Section snippets

Setting

Intervention

Results

Discussion

Int J Antimicrob Agents

Jt Comm J Qual Patient Saf

Am J Infect Control

Am J Infect Control

J Hosp Infect

Am J Infect Control

Indian J Med Microbiol

J Hosp Infect

J Hosp Infect

J Hosp Infect

Eur Urol

Am J Infect Control

J Hosp Infect

Am J Infect Control

Management of catheter-associated urinary tract infection (CAUTI)

Curr Opin Infect Dis

Major article
Active training and surveillance: 2 good friends to reduce urinary catheterization rate