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Implementing a National Program to Reduce Catheter-Associated Urinary Tract Infection: A Quality Improvement Collaboration of State Hospital Associations, Academic Medical Centers, Professional Societies, and Governmental Agencies

Published online by Cambridge University Press:  28 May 2015

Mohamad G. Fakih ,
Christine George ,
Barbara S. Edson ,
Christine A. Goeschel  and
Sanjay Saint
Mohamad G. Fakih
Affiliation:
St. John Hospital and Medical Center, Detroit, Michigan
Christine George
Affiliation:
Michigan Health and Hospital Association, Lansing, Michigan
Barbara S. Edson
Affiliation:
Health Research and Educational Trust, Chicago, Illinois
Christine A. Goeschel
Affiliation:
Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, Maryland
Sanjay Saint*
Affiliation:
Veterans Affairs Ann Arbor Healthcare System and University of Michigan School of Medicine, Ann Arbor, Michigan
*
University of Michigan Medical School, 2800 Plymouth Road, Building 16, Room 433W, Ann Arbor, MI 48109 (saint@med.umich.edu)
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Abstract

Catheter-associated urinary tract infection (CAUTI) represents a significant proportion of healthcare-associated infections (HAIs). The US Department of Health and Human Services issued a plan to reduce HAIs with a target 25% reduction of CAUTI by 2013. Michigan's successful collaborative to reduce unnecessary use of urinary catheters and CAUTI was based on a partnership between diverse hospitals, the state hospital association (SHA), and academic medical centers. Taking the lessons learned from Michigan, we are now spreading this work throughout the 50 states. This national spread leverages the expertise of different groups and organizations for the unified goal of reducing catheter-related harm. The key components of the project are (1) centralized coordination of the effort and dissemination of information to SHAs and hospitals, (2) data collection based on established definitions and approaches, (3) focused guidance on the technical practices that will prevent CAUTI, (4) emphasis on understanding the socioadaptive aspects (both the general, unit-wide issues and CAUTI-specific challenges), and (5) partnering with specialty organizations and governmental agencies who have expertise in the relevant subject area. The work may serve in the future as a model for other large improvement efforts to address other hospital-acquired conditions, such as venous thromboembolism and falls.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 10 , October 2013 , pp. 1048 - 1054
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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References

1.Klevens, RM, Edwards, JR, Richards, CL Jret al.Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep 2007;122:160–166.CrossRefGoogle ScholarPubMed
2.Saint, S, Meddings, JA, Calfee, D, Kowalski, CP, Krein, SL. Catheter-associated urinary tract infection and the Medicare rule changes. Ann Intern Med 2009;150:877–884.CrossRefGoogle ScholarPubMed
3.Fakih, MG, Dueweke, C, Meisner, S, et al.Effect of nurse-led multidisciplinary rounds on reducing the unnecessary use of urinary catheterization in hospitalized patients. Infect Control Hosp Epidemiol 2008;29:815–819.CrossRefGoogle ScholarPubMed
4.Fakih, MG, Watson, SR, Greene, MT, et al.Reducing inappropriate urinary catheter use: a statewide effort. Arch Intern Med 2012;172:255–260.CrossRefGoogle ScholarPubMed
5.Saint, S, Greene, MT, Kowalski, C, Watson, S, Hofer, T, Krein, S. Preventing catheter-associated urinary tract infection in the United States: a national comparative study. JAMA Intern Med 2013:874–879.Google Scholar
6.Gould, CV, Umscheid, CA, Agarwal, RK, Kuntz, G, Pegues, DA. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol 2010;31:319–326.CrossRefGoogle ScholarPubMed
7.Fakih, MG, Shemes, SP, Pena, ME, et al.Urinary catheters in the emergency department: very elderly women are at high risk for unnecessary utilization. Am J Infect Control 2010;38:683–688.CrossRefGoogle ScholarPubMed
8.Hazelett, SE, Tsai, M, Gareri, M, Allen, K. The association between indwelling urinary catheter use in the elderly and urinary tract infection in acute care. BMC Geriatr 2006;6:15.CrossRefGoogle ScholarPubMed
9.Gokula, RR, Hickner, JA, Smith, MA. Inappropriate use of urinary catheters in elderly patients at a midwestern community teaching hospital. Am J Infect Control 2004;32:196–199.CrossRefGoogle Scholar
10.Jain, P, Parada, JP, David, A, Smith, LG. Overuse of the indwelling urinary tract catheter in hospitalized medical patients. Arch Intern Med 1995;155:1425–1429.CrossRefGoogle ScholarPubMed
11.Wald, HL, Epstein, AM, Radcliff, TA, Kramer, AM. Extended use of urinary catheters in older surgical patients: a patient safety problem? Infect Control Hosp Epidemiol 2008;29:116–124.CrossRefGoogle ScholarPubMed
12.Saint, S, Lipsky, BA, Goold, SD. Indwelling urinary catheters: a one-point restraint? Ann Intern Med 2002;137:125–127.CrossRefGoogle ScholarPubMed
13.Aaronson, DS, Wu, AK, Blaschko, SD, McAninch, JW, Garcia, M. National incidence and impact of noninfectious urethral catheter related complications on the surgical care improvement project. J Urol 2011;185:1756–1760.CrossRefGoogle ScholarPubMed
14.Meddings, J, Rogers, MA, Macy, M, Saint, S, Systematic review and meta-analysis: reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalized patients. Clin Infect Dis 2010;51:550–560.CrossRefGoogle ScholarPubMed
15.Garibaldi, RA, Burke, JP, Dickman, ML, Smith, CB. Factors pre-disposing to bacteriuria during indwelling urethral catheterization. N Engl J Med 1974;291:215–219.CrossRefGoogle Scholar
16.Tambyah, PA, Maki, DG. Catheter-associated urinary tract infection is rarely symptomatic: a prospective study of 1,497 catheterized patients. Arch Intern Med 2000;160:678–682.Google Scholar
17.Maki, DG, Tambyah, PA. Engineering out the risk for infection with urinary catheters. Emerg Infect Dis 2001;7:342–347.CrossRefGoogle ScholarPubMed
18.Meddings, J, Saint, S. Disrupting the life cycle of the urinary catheter. Clin Infect Dis 2011;52:1291–293.CrossRefGoogle ScholarPubMed
19.Saint, S, Olmsted, RN, Fakih, MG, et al.Translating health care-associated urinary tract infection prevention research into practice via the bladder bundle. Jt Comm J Qual Patient Saf 2009;35:449–455.Google ScholarPubMed
20.Knoll, BM, Wright, D, Ellingson, L, et al.Reduction of inappropriate urinary catheter use at a Veterans Affairs hospital through a multifaceted quality improvement project. Clin Infect Dis 2011;52:1283–1290.CrossRefGoogle Scholar
21.Gokula, RM, Smith, MA, Hickner, J. Emergency room staff education and use of a urinary catheter indication sheet improves appropriate use of foley catheters. Am J Infect Control 2007;35:589–593.CrossRefGoogle ScholarPubMed
22.Fakih, MG, Pena, ME, Shemes, S, et al.Effect of establishing guidelines on appropriate urinary catheter placement. Acad Emerg Med 2010;17:337–340.CrossRefGoogle ScholarPubMed
23.Fakih, M, Rey, J, Pena, M, Szpunar, S, Saravolatz, L. Sustained reductions in urinary catheter use over 5 years: bedside nurses view themselves responsible for evaluation of catheter necessity. Am J Infect Control 2012;236–239.Google ScholarPubMed
24.Pronovost, PJ, Berenholtz, SM, Needham, DM. Translating evidence into practice: a model for large scale knowledge translation. BMJ 2008;337:a1714.CrossRefGoogle Scholar
25.Pronovost, P, Weast, B, Rosenstein, B, et al.Implementing and validating a comprehensive unit-based safety program. J Patient Saf 2005;1:33–40.CrossRefGoogle Scholar
26.Saint, S, Howell, JD, Krein, SL. Implementation science: how to jump-start infection prevention. Infect Control Hosp Epidemiol 2010;31(suppl 1):S14–S17.CrossRefGoogle ScholarPubMed
27.Saint, S, Kowalski, CP, Banaszak-Holl, J, Forman, J, Damschroder, L, Krein, SL. How active resisters and organizational constipators affect health care-acquired infection prevention efforts. Jt Comm J Qual Patient Saf 2009;35:239–46.Google ScholarPubMed
28.Saint, S, Kowalski, CP, Forman, J, et al.A multicenter qualitative study on preventing hospital-acquired urinary tract infection in US hospitals. Infect Control Hosp Epidemiol 2008;29:333–341.CrossRefGoogle ScholarPubMed
29.Saint, S, Kowalski, CP, Banaszak-Holl, J, Forman, J, Damschroder, L, Krein, SL. The importance of leadership in preventing health-care-associated infection: results of a multisite qualitative study. Infect Control Hosp Epidemiol 2010;31:901–907.CrossRefGoogle ScholarPubMed
30.Damschroder, LJ, Banaszak-Holl, J, Kowalski, CP, Forman, J, Saint, S, Krein, SL. The role of the champion in infection prevention: results from a multisite qualitative study. Qual Saf Health Care 2009;18:434–440.CrossRefGoogle ScholarPubMed
31.Saint, S, Wiese, J, Amory, JK, et al.Are physicians aware of which of their patients have indwelling urinary catheters? Am J Med 2000;109:476–480.CrossRefGoogle ScholarPubMed
32.Lo, E, Nicolle, L, Classen, D, et al.Strategies to prevent catheter-associated urinary tract infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29(suppl 1):S41–S50.CrossRefGoogle ScholarPubMed
33. Centers for Disease Control and Prevention. National Health-care Safety Network (NHSN) Patient Safety Component Manual. http://www.cdc.gov/nhsn/TOC_PSCManual.html. Accessed January 30, 2013.Google Scholar
34.Fakih, MG, Greene, MT, Kennedy, EH, et al.Introducing a population-based outcome measure to evaluate the effect of interventions to reduce catheter-associated urinary tract infection. Am J Infect Control 2012;40:359–364.CrossRefGoogle ScholarPubMed
35.Saint, S, Greene, MT, Kowalski, CP, Watson, SR, Hofer, TP, Krein, SL. Preventing catheter-associated urinary tract infection in the United States: a national comparative study. JAMA Intern Med 2013;173:874–879.CrossRefGoogle ScholarPubMed
36.Krein, SL, Kowalski, CP, Harrod, M, Forman, J, Saint, S. Barriers to reducing urinary catheter use: a qualitative assessment of a statewide initiative. JAMA Intern Med 2013;173:881–886.CrossRefGoogle ScholarPubMed