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

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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

References (14)

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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.

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