Feedback to nursing staff as an intervention to reduce catheter-associated urinary tract infections

doi:10.1016/S0196-6553(99)70005-2

American Journal of Infection Control

Volume 27, Issue 5, October 1999, Pages 402-404

https://doi.org/10.1016/S0196-6553(99)70005-2 Get rights and content

Abstract

Because of high incidence of catheter-related urinary tract infections (UTIs) in our Veterans Affairs medical center, we began providing nursing staff with unit-specific UTI rates. In our preintervention period, the first quarter of 1995, 38 infections occurred in 1186 catheter-patient-days or 32/1000 catheter-patient-days (95% CI, 22.9-43.7). Thereafter, nursing staff members were provided with a quarterly report with catheter-related UTI rates depicted graphically by unit. In the 18 months after this intervention, the mean UTI rate decreased to 17.4/1000 catheter-patient-days (95% CI, 14.6-20.6, P = .002). We estimated a cost savings of $403,000. We conclude that unit-specific feedback of nosocomial UTI rates to nursing staff is a highly effective method of reducing infection rates and reducing costs associated with nosocomial UTI. (AJIC Am J Infect Control 1999;27:402-4)

Section snippets

METHODS

The nursing staff of each medical-surgical ward identified patients with indwelling urinary catheters on the daily 24-hour report. Patients included those with urethral, suprapubic, and ureteral catheters. Patients receiving intermittent catherization or use of condom (external) catheters were not included, nor were patients in critical care units. The daily reports were sent to the Associate Chief of Nursing Service and forwarded to the infection control professional (ICP) weekly.

The first 3

Preintervention phase

During the calendar year 1994, we documented 203 nosocomial UTIs on 7 medical-surgical wards. We were unable to calculate a rate during this period because we did not have an accurate denominator of CPD. These wards were monitored from January 1, 1995, through September 1996. The preintervention phase (January through March 1995) showed 38 UTIs in 1186 CPD for a rate of 32/1000 CPD. The infection rates by ward ranged from 5.2/1000 CPD to 83.9/1000 CPD.

Postintervention phase

In the first postintervention quarter

DISCUSSION

Nosocomial catheter-related UTIs continue to be a major cause of morbidity, mortality, and excess cost. Despite nearly 4 decades of investigation, no consistently effective method of prevention, with the exception of closed drainage systems, has been identified. In a recent review of 45 randomized, controlled trials of intervention, Burke and Riley⁵ concluded that none of the individual strategies met rigorous criteria for efficacy.

We found that after an educational session of basic urinary

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Cited by (59)

Effectiveness of behavioural interventions to reduce urinary tract infections and Escherichia coli bacteraemia for older adults across all care settings: a systematic review
2019, Journal of Hospital Infection
Citation Excerpt :
One community study examined a catheter self-management intervention [43]; another hospital study used a CAUTI rate feedback intervention [44], and one used a bacterial interference intervention in a LTCF [45]. Eleven studies reported CAUTI rates as the primary outcome [27–32,34,35,37,41], nine reported UTI rates [25,26,33,36,38,40,42,44,45], and one study reported E. coli in blood or urine [39]. Five studies used an RCT-based design [26,37,40,43,45], 15 studies used a before-and-after design [25,27–36,39,41,42,44], and one study used a cross-sectional design [38].
Escherichia coli bacteraemia rates in the UK have risen; rates are highest among older adults. Previous urinary tract infections (UTIs) and catheterization are risk factors.
To examine effectiveness of behavioural interventions to reduce E. coli bacteraemia and/or symptomatic UTIs for older adults.
Sixteen databases, grey literature, and reference lists were searched. Titles and/or abstracts were scanned and selected papers were read fully to confirm suitability. Quality was assessed using Critical Appraisal Skills Programme guidelines and Scottish Intercollegiate Guidelines Network grading.
Twenty-one studies were reviewed, and all lacked methodological quality. Six multi-faceted hospital interventions including education, with audit and feedback or reminders reduced UTIs but only three supplied statements of significance. One study reported decreasing catheter-associated UTI (CAUTI) by 88% (F (1,20) = 7.25). Another study reported reductions in CAUTI from 11.17 to 10.53 during Phase I and by 0.39 during Phase II (χ² = 254). A third study reported fewer UTIs per patient week (risk ratio = 0.39). Two hospital studies of online training and catheter insertion and care simulations decreased CAUTIs from 33 to 14 and from 10.40 to 0. Increasing nursing staff, community continence nurses, and catheter removal reminder stickers reduced infection. There were no studies examining prevention of E. coli bacteraemias.
The heterogeneity of studies means that one effective intervention cannot be recommended. We suggest that feedback should be considered because it facilitated reductions in UTI when used alone or in multi-faceted interventions including education, audit or catheter removal protocols. Multi-faceted education is likely to be effective. Catheter removal protocols, increased staffing, and patient education require further evaluation.
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.
Nosocomial Urinary Tract Infections
2014, Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases
Evaluating the impact of pluridisciplinary training on proper glove use in hospital
2014, Medecine et Maladies Infectieuses
The authors of this randomized study had for aim to evaluate the impact of training on proper glove use by comparing compliance to glove use recommendations between trained and untrained healthcare personnel according to healthcare professional groups.
A random selection of trained and untrained nurses, nurse aids, and hospital housekeepers was performed in a French University hospital, using a listing of healthcare personnel. The audits were conducted by two infection control nurses, in series of 10 observations, with a maximum time limit of two hours. The evaluation criteria were compliance or non-compliance of glove-wearing practices with internal hospital recommendations, disclosed to professionals during training.
Overall, 111 professionals were audited and 794 acts were observed. Hand hygiene was significantly better in trained vs. untrained healthcare professionals (P < 0.01). Proper glove use practices were similar between trained and untrained nurses (85% of compliance), whereas the difference was statistically significant in favor of trained healthcare personnel for the other categories (P < 0.001 for nurse aids and P = 0.02 for housekeepers).
We demonstrated the impact of pluridisciplinary training on proper glove use practices in hospital settings, but with different benefits found according to professional groups. The lower the initial training level, the greater the overall benefit appeared to be.
Cette étude randomisée visait à évaluer l’impact de la formation sur le bon usage des gants, en comparant la conformité des pratiques d’utilisation des gants entre personnels formés et non formés selon les différents groupes de professionnels de santé.
Dans un hôpital universitaire français, en utilisant la liste des personnels de santé paramédicaux, une sélection aléatoire d’infirmières, d’aides-soignantes et d’agents de service de l’hôpital, formés et non formés, a été effectuée. Les audits ont été effectués par deux infirmières hygiénistes par série de 10 observations, d’un délai maximum de 2 heures. Les critères d’évaluation étaient la conformité ou la non-conformité des pratiques de gantage par rapport au référentiel interne de l’hôpital présenté aux professionnels lors de la formation.
Globalement, 111 professionnels ont été audités, avec 794 actes observés. L’hygiène des mains était significativement meilleure chez les formés comparativement aux professionnels non formés (p < 0,01). En ce qui concerne la bonne utilisation des gants, les pratiques étaient similaires entre les infirmières et infirmiers formés et non formés (85 % de conformité), alors que la différence était statistiquement significative en faveur du personnel formé pour les autres catégories (p < 0,001 pour les aides-soignantes et p = 0,02 pour les agents de service hospitalier).
Cette étude démontre l’impact d’une action de formation multidisciplinaire sur la bonne utilisation des gants à l’hôpital, mais avec des bénéfices différents selon les catégories de professionnels de santé. Le bénéfice semble d’autant plus grand que le niveau initial de formation est modeste.
Improvement in urinary tract infections rates in a department of internal medicine
2013, Revista de Calidad Asistencial
Valorar el impacto de una intervención desarrollada en el servicio de Medicina Interna del Hospital Universitario Insular de Gran Canaria para prevenir las infecciones del tracto urinario asociadas a sondaje vesical (ITU-SV).
El proyecto se desarrolló en 3 fases de vigilancia prospectivas de 2 meses de duración cada una entre 2009 y 2011. Durante las fases 1 y 2 se siguieron los criterios diagnósticos de los Centers for Disease Control and Prevention (CDC) de 2004 para la clasificación de las infecciones y se obtuvieron los indicadores de resultado. En la fase 3 se emplearon los criterios de los CDC de 2009 y se obtuvieron tanto indicadores de resultado como de proceso. Se comparó la incidencia acumulada de ITU-SV de las 3 fases mediante el test de tendencia ji-cuadrado.
El número total de días de sondaje vesical (SV) disminuyó desde la primera a la tercera fase, así como la incidencia acumulada de ITU-SV. Sin embargo, en la segunda fase la media de días de SV aumentó, volviendo a disminuir en la tercera fase. Se realizó una intervención con envío de recordatorios a través de la historia clínica electrónica durante la tercera fase, en la que se logró disminuir las tasas de ITU-SV y reducir la duración media de SV.
Las tasas de ITU-SV podrían ser minimizadas mediante un enfoque multidisciplinar que incluya tanto formación a los sanitarios implicados como vigilancia, retroalimentación y uso específico de recordatorios electrónicos.
To evaluate the impact on the urinary tract infections (UTI) rates of an intervention implemented in the Department of Internal Medicine of the Hospital Universitario Insular de Gran Canaria.
Infection control practitioners implemented a three phase project, each lasting two months, focusing on surveillance and feed-back, between 2009 and 2011. During phases 1 and 2, the 2004 Centers for Disease Control and Prevention (CDC)–diagnostic criteria for nosocomial infections were followed, and only rates of infections were calculated. For phase 3, the criteria published in 2009 were used, and rates of infections plus processes rates were obtained. The cumulative incidence of UTI in the three periods was compared using a chi-square for trends test.
The total number of catheter days, as well as the cumulative incidence of UTI dropped from phase 1 to 3. Nevertheless, in phase 2 the mean urinary catheter days increased. We detected a decrease in the UTI rates and urinary catheter days mean after introducing an electronic reminder in the patient electronic charts.
A multidisciplinary approach, including surveillance, reminders, and feed-back, has proved useful in controlling UTI rates in our hospital.
Active training and surveillance: 2 good friends to reduce urinary catheterization rate
2012, American Journal of Infection Control
Citation Excerpt :
An important result has been reported by Topal et al,28 in 2005, with 81% reduction in device use, and a 73% reduction in CAUTI rate (from 36 per 1,000 catheter-days to 11 per 1,000 catheter-days; P < .001) was demonstrated. Similarly, in a previous study, a decrease in CAUTI rate from 32/1,000 catheter-days to 17/1,000 catheter-days was achieved with the use of periodic feedback to nursing staff regarding rates of urinary catheter-associated infections.29 In a recent published study, the authors reported the reduction of postoperative urinary catheter duration after an educational session specifically devoted to nurses.
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.
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.
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).
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.

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^☆: From the VA Pittsburgh Health Care System and the University of Pittsburgh School of Medicine.

^☆☆: Reprint requests: Robert R. Muder, MD, VA Medical Center, University Drive C, Pittsburgh, PA 15240.

^★: 0196-6553/99/$8.00 + 0 17/46/96689

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Feedback to nursing staff as an intervention to reduce catheter-associated urinary tract infections☆,☆☆,★

Abstract

Section snippets

METHODS

Preintervention phase

Postintervention phase

DISCUSSION

J Urol

AJIC Am J Infect Control

Estimating the effects of nosocomial infections on the length of hospitalization

J Infect Dis

Incidence and nature of endemic and epidemic nosocomial infections

Nosocomial bacteriuria: estimating the potential for prevention by closed sterile urinary drainage

Infect Control Hosp Epidemiol

Nosocomial urinary tract infection

CDC definitions for nosocomial infection

AJIC Am J Infect Control