Antimicrobial catheters for reduction of symptomatic urinary tract infection in adults requiring short-term catheterisation in hospital : a multicentre randomised controlled trial

Copyright © 2012 Elsevier Ltd. All rights reserved. PMID: 23134837 [PubMed - indexed for MEDLINE]Peer reviewedPostprin

Epidemiology of Escherichia coli bacteraemia in England: results of an enhanced sentinel surveillance programme

Background: Escherichia coli causes over one third of the bacteraemia cases in England each year, and the incidence of these infections is increasing. Aim: To determine the underlying risk factors associated with E. coli bacteraemia. Methods: A three month enhanced sentinel surveillance study involving 35 National Health Service hospitals was undertaken in the winter of 2012/13 to collect risk factor information and further details on the underlying source of infection to augment data already collected by the English national surveillance programme. Antimicrobial susceptibility results for E. coli isolated from blood and urine were also collected. Findings: A total of 1,731 cases of E. coli bacteraemia were included. The urogenital tract was the most commonly reported source of infection (51.2% of cases) with prior treatment for a urinary tract infection being the largest independent effect associated with this infection source. Half of all patients had prior healthcare exposure in the month prior to the bacteraemia with antimicrobial therapy and urinary catheterisation being reported in one third and one fifth of these patients. Prior healthcare exposure was associated with a higher proportion of antibiotic non-susceptibility in the blood culture isolates (P=0.001). Conclusion: Analysis of risk factors suggests potential community and hospital-related interventions particularly better use of urinary catheters and improved antibiotic management of urinary tract infections. As part of the latter strategy, antibiotic resistance profiles need to be closely monitored to ensure treatment guidelines are up to date to limit inappropriate empiric therapy

Longitudinal Trends in All Healthcare-Associated Infections through Comprehensive Hospital-wide Surveillance and Infection Control Measures over the Past 12 Years: Substantial Burden of Healthcare-Associated Infections Outside of Intensive Care Units and “Other” Types of Infection

OBJECTIVE Targeted surveillance has focused on device-associated infections and surgical site infections (SSIs) and is often limited to healthcare-associated infections (HAIs) in high-risk areas. Longitudinal trends in all HAIs, including other types of HAIs, and HAIs outside of intensive care units (ICUs) remain unclear. We examined the incidences of all HAIs using comprehensive hospital-wide surveillance over a 12-year period (2001–2012). METHODS This retrospective observational study was conducted at the University of North Carolina (UNC) Hospitals, a tertiary care academic facility. All HAIs, including 5 major infections with 14 specific infection sites as defined using CDC criteria, were ascertained through comprehensive hospital-wide surveillance. Generalized linear models were used to examine the incidence rate difference by infection type over time. RESULTS A total of 16,579 HAIs included 6,397 cases in ICUs and 10,182 cases outside ICUs. The incidence of overall HAIs decreased significantly hospital-wide (−3.4 infections per 1,000 patient days), in ICUs (−8.4 infections per 1,000 patient days), and in non-ICU settings (−1.9 infections per 1,000 patient days). The incidences of bloodstream infection, urinary tract infection, and pneumonia in hospital-wide settings decreased significantly, but the incidences of SSI and lower respiratory tract infection remained unchanged. The incidence of Clostridium difficile infection (CDI) increased remarkably. The outcomes were estimated to include 700 overall HAIs prevented, 40 lives saved, and cost savings in excess of $10 million. CONCLUSIONS We demonstrated success in reducing overall HAIs over a 12-year period. Our data underscore the necessity for surveillance and infection prevention interventions outside of the ICUs, for non–device-associated HAIs, and for CDI. Infect Control Hosp Epidemiol 2015;36(10):1139–114

Post Foley Removal Guideline Process and Outcome Evaluation

When patients are admitted to a hospital patient safety should be a priority in all aspects of the care they receive. Preventing patients from acquiring hospital infections (HAIs) is one example of patient safety. All hospital employees have the responsibility to ensure that standard workflow and processes are in place to ensure this safety. The purposes of this Practice Inquiry Project (PIP) were to examine and develop interventions to decrease the risk of catheter associated urinary tract infections (CAUTIs), incorporate an effective process and standard workflow to implement evidence practice practices (EBP), and to evaluate the effectiveness of implementing the Post Foley Removal Guideline (PFRG) to prevent reinsertion of the indwelling catheter for urinary retention, and thereby decreasing the risk of developing a CAUTI. The clinical and fiscal impact of CAUTIs are quite significant as well as are the challenges to ensure best practices are implemented enterprise-wide to reduce these risks. The first manuscript is a literature review of the impact of CAUTIs and prevention strategies to decrease the risk. The purpose of this literature review is to examine the most effective strategies/interventions to prevent hospital acquired CAUTIs. Studies have noted that a majority of these infections are preventable, with insertion and duration of use being the two principle preventable risk factors (Alexis’s 2014; APIC 2009; Umscheid, 2011; US-HHS, 2014). The second manuscript in this series details the development of an organization structure and workflow that would provide a vehicle to identify risk factors and implement best practices hospital-wide. Through evaluation by senior nursing leadership, the Quality Improvement Project (QIP) was developed to create an organization structure that would be effective in implementing enterprise-wide evidence based practice (EBP) and ensure standard of care was being given in all areas to make an effective impact on lowering CAUTI rates. The final manuscript is a pre and post-retrospective analysis of the impact the Post Foley Removal Guideline (PFRG) had on the CAUTI rates, device days, hospital length of stay, re-insertion rates and compliance. The study noted a significant decrease in CAUTIs, with only partial compliance to the PFRG and no significant difference in device days. This indicates multiple factors are present when implementing a new protocol. This PI was instrumental in helping me develop knowledge and skills to evaluate the extent of a patient safety issue, develop leadership skills to facilitate changes within a large hospital system, translate EBP to the clinical units, and evaluate outcomes

A Point Prevalence Cross-Sectional Study of Healthcare-Associated Urinary Tract Infections in Six Australian Hospitals

Objectives: Urinary tract infections (UTIs) account for over 30% of healthcare-associated infections. The aim of this study was to determine healthcare-associated UTI (HAUTI) and catheter-associated UTI (CAUTI) point prevalence in six Australian hospitals to inform a national point prevalence process and compare two internationally accepted HAUTI definitions. We also described the level and comprehensiveness of clinical record documentation, microbiology laboratory and coding data at identifying HAUTIs and CAUTIs. Setting: Data were collected from three public and three private Australian hospitals over the first 6 months of 2013. Participants A total of 1109 patients were surveyed. Records of patients of all ages, hospitalised on the day of the point prevalence at the study sites, were eligible for inclusion. Outpatients, patients in adult mental health units, patients categorised as maintenance care type (ie, patients waiting to be transferred to a long-term care facility) and those in the emergency department during the duration of the survey were excluded. Outcome measures: The primary outcome measures were the HAUTI and CAUTI point prevalence. Results: Overall HAUTI and CAUTI prevalence was 1.4% (15/1109) and 0.9% (10/1109), respectively. Staphylococcus aureus and Candida species were the most common pathogens. One-quarter (26.3%) of patients had a urinary catheter and fewer than half had appropriate documentation. Eight of the 15 patients ascertained to have a HAUTI based on clinical records (6 being CAUTI) were coded by the medical records department with an International Classification of Diseases (ICD)-10 code for UTI diagnosis. The Health Protection Agency Surveillance definition had a positive predictive value of 91.67% (CI 64.61 to 98.51) compared against the Centers for Disease Control and Prevention definition. Conclusions: These study results provide a foundation for a national Australian point prevalence study and inform the development and implementation of targeted healthcare-associated infection surveillance more broadly

A point prevalence cross-sectional study of healthcare-associated urinary tract infections in six Australian hospitals

OBJECTIVES: Urinary tract infections (UTIs) account for over 30% of healthcare-associated infections. The aim of this study was to determine healthcare-associated UTI (HAUTI) and catheter-associated UTI (CAUTI) point prevalence in six Australian hospitals to inform a national point prevalence process and compare two internationally accepted HAUTI definitions. We also described the level and comprehensiveness of clinical record documentation, microbiology laboratory and coding data at identifying HAUTIs and CAUTIs. SETTING: Data were collected from three public and three private Australian hospitals over the first 6 months of 2013. PARTICIPANTS: A total of 1109 patients were surveyed. Records of patients of all ages, hospitalised on the day of the point prevalence at the study sites, were eligible for inclusion. Outpatients, patients in adult mental health units, patients categorised as maintenance care type (ie, patients waiting to be transferred to a long-term care facility) and those in the emergency department during the duration of the survey were excluded. OUTCOME MEASURES: The primary outcome measures were the HAUTI and CAUTI point prevalence. RESULTS: Overall HAUTI and CAUTI prevalence was 1.4% (15/1109) and 0.9% (10/1109), respectively. Staphylococcus aureus and Candida species were the most common pathogens. One-quarter (26.3%) of patients had a urinary catheter and fewer than half had appropriate documentation. Eight of the 15 patients ascertained to have a HAUTI based on clinical records (6 being CAUTI) were coded by the medical records department with an International Classification of Diseases (ICD)-10 code for UTI diagnosis. The Health Protection Agency Surveillance definition had a positive predictive value of 91.67% (CI 64.61 to 98.51) compared against the Centers for Disease Control and Prevention definition. CONCLUSIONS: These study results provide a foundation for a national Australian point prevalence study and inform the development and implementation of targeted healthcare-associated infection surveillance more broadly

A 2-year point-prevalence surveillance of healthcare-associated infections and antimicrobial use in Ferrara University Hospital, Italy

Background: Healthcare-Associated Infections (HAIs) represent one of the leading issues to patient safety as well as a significant economic burden. Similarly, Antimicrobial Use (AMU) and Resistance (AMR) represent a growing threat to global public health and the sustainability of healthcare services. Methods: A Point Prevalence Survey (PPS) following the 2016 ECDC protocol for HAI prevalence and AMU was conducted at Ferrara University Hospital (FUH). Data were collected by a team of trained independent surveyors in 2016 and 2018. Risk factors independently associated with HAI were assessed by a multivariate logistic regression model. Results: Of the 1102 patients surveyed, 115 (10.4%) had an active HAI and 487 (44.2%) were on at least 1 systemic antimicrobial agent. Factors independently associated with increased HAI risk were a "Rapidly Fatal" McCabe score (expected fatal outcome within 1 year), presence of medical devices (PVC, CVC, indwelling urinary catheter or mechanically assisted ventilation) and a length of hospital stay of at least 1 week. The most frequent types of HAI were pneumonia, bloodstream infections, and urinary tract infections. Antimicrobial resistance to third-generation cephalosporins was observed in about 60% of Enterobacteriaceae. Conclusions: The survey reports a high prevalence of HAI and AMU in FUH. Repeated PPSs are useful to control HAIs and AMU in large acute-care hospitals, highlighting the main problematic factors and allowing planning for improvement actions

The Impact of a Nurse-Driven Foley Catheter Removal Protocol on Catheter Associated Urinary Tract Rates in Critical Care Areas

Background: Indwelling urinary catheters serve a purpose in critical care; however, they can also pose a risk for patients. With increased catheter use, there is an increased risk of developing a catheter associated urinary tract infection (CAUTI). CAUTIs lead to longer length of stay for patients, antibiotic treatment, and have a financial burden to the institution. The objective of this study was to determine if a nurse driven catheter removal protocol could reduce CAUTIs in critical care units. Methods: Retrospective review of CAUTI data from the National Healthcare Safety Network (NHSN) was observed three months prior to the protocol implementation and three months post implementation. Results: There were seven CAUTIs reported prior to the protocol implementation and five post implementation. There was also an increase noted in catheter days post implantation. There was a 29% reduction in CAUTI rate (p = 0.5736). Discussion: While the rate reduction from pre to post protocol implementation was not statistically significant, we propose that given the reduction in CAUTIs, it is clinically significant. Conclusion: Implementation of catheter removal protocols could be a useful tool in CAUTI reduction. Further research would be beneficial in determining the association between the tool and CAUTI rate reduction

Education Program for Critical Care Nurses on Preventing Catheter-Associated Urinary Tract Infections

Catheter-associated urinary tract infections (CAUTIs) are the most frequently reported hospital-acquired condition, affecting more than 560,000 patients each year. CAUTIs prolong hospital stays and increase health care costs, and they can result in patient morbidity and mortality. Nurses can be empowered by receiving education and knowledge to manage and identify urinary catheters that are not clinically indicated. The purpose of this project was to develop an education program on CAUTI prevention for critical care nurses using the teach-back method. The conceptual framework that guided this project was Knowles\u27s adult learning theory. The theoretical model was based on 4 fundamental assumptions of self-concept development. A total of 32 critical care unit nurses participated in the evaluation of the teach-back method. Demographic data were collected from these 32 participants, and the results of a frequency analysis were obtained. Deidentified CAUTI data were provided by the organization prior to the educational intervention. The postintervention CAUTI rate and increase in nurses\u27 knowledge level were evaluated 1 month after the educational intervention using a 1-sample t test. The finding was statistically significant (p \u3c .001). The incidence of CAUTI was followed, and the outcomes indicated that the overall incidence of CAUTI in these patients was decreased. The education program was effective in improving critical care unit nurses\u27 knowledge of evidence-based practices to prevent CAUTIs. Improving nurses\u27 knowledge to decrease CAUTI rates is a strategy that may be effective in many healthcare settings. This educational intervention may create social change by improving the health of patients and serving as an educational resource for nurses