Major article
Indwelling urinary catheter management and catheter-associated urinary tract infection prevention practices in Nurses Improving Care for Healthsystem Elders hospitals

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Background

Indwelling urinary catheters (IUCs) are commonly used in hospitalized patients, especially elders. Catheter-associated urinary tract infections (CAUTIs) account for 34% of all health care associated infections in the United States, associated with excess morbidity and health care costs. Adherence to CAUTI prevention practices has not been well described.

Methods

This study used an electronic survey to examine IUC care practices for CAUTI prevention in 3 areas—(1) equipment and alternatives and insertion and maintenance techniques; (2) personnel, policies, training, and education; and (3) documentation, surveillance, and removal reminders—at 75 acute care hospitals in the Nurses Improving the Care of Healthsystem Elders (NICHE) system.

Results

CAUTI prevention practices commonly followed included wearing gloves (97%), handwashing (89%), maintaining a sterile barrier (81%), and using a no-touch insertion technique (73%). Silver-coated catheters were used to varying degrees in 59% of the hospitals; 4% reported never using a catheter-securing device. Urethral meatal care was provided daily by 43% of hospitals and more frequently that that by 41% of hospitals. Nurses were the most frequently reported IUC inserters. Training in aseptic technique and CAUTI prevention at the time of initial nursing hire was provided by 64% of hospitals; however, only 47% annually validated competency in IUC insertion. Systems for IUC removal were implemented in 56% of hospitals. IUC documentation and routine CAUTI surveillance practices varied widely.

Conclusions

Although many CAUTI prevention practices at NICHE hospitals are in alignment with evidence-based guidelines, there is room for improvement. Further research is needed to identify the effect of enhanced compliance with CAUTI prevention practices on the prevalence of CAUTI in NICHE hospitals.

Section snippets

Design, data collection, and sample

A descriptive design was used to survey NICHE hospital nurse coordinators about IUC practices. NICHE, a national program of the Hartford Institute for Geriatric Nursing, provides resources and technical support to enhance hospitals’ systemic capacity to embed evidence-based geriatric knowledge into practice. NICHE is a membership program that requires an organizational commitment, including participation of senior personnel in a NICHE Leadership Training Program and ongoing demonstration of

Results

Out of the 255 NICHE hospitals, 75 acute care hospitals (mean number of beds, 391) from 29 states and Canada responded, for a 34% response rate. Table 1 summarizes the characteristics of participating hospitals. There were no differences between responding and nonresponding hospitals in terms of bed size, urban setting, and magnet or teaching status. Responding hospitals were less than likely nonresponding hospitals to be government-owned (P = .039). Table 2 summarizes the CDC’s recommended

Discussion

We have described in detail the CAUTI prevention practices in a sample of NICHE hospitals. Although many practices at these hospitals are in alignment with evidence-based guidelines, there is considerable heterogeneity of practice in nearly all areas assessed (Table 2), leaving considerable room for standardization and improvement.

Our survey is complementary to the earlier survey of Saint et al,11 which queried a nationally representative sample of infection preventionists about selected CAUTI

Acknowledgments

The authors thank the participating NICHE hospital coordinators, Nina Shabbat, PhD, and Brian Bandle, for assistance with data management, and Karis May for help with formatting the manuscript.

References (20)

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This work was funded by the Agency for Healthcare Research and Quality (Grant AHRQ R18HSO18377). Dr Wald is the recipient of a Paul Beeson Career Development Award in Aging (NIA K23 AG034544) from the National Institute on Aging, the John A. Hartford Foundation, the STARR Foundation, and an anonymous donor.

Conflict of interest:None to report.

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