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Available from: David A Pegues, Nov 10, 2014
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    • "On a more general nationwide scale to reduce CAUTIs, hospitals could provide further education and training to nurses and physicians on catheterization guidelines and protocols for insertion, maintenance, and removal of catheters to prevent CAUTIs [13]. Hospitals should also ensure that only properly trained staff-handle patients' urinary catheters and should also ensure that those staff use appropriate aseptic-techniques for catheter insertion [13]. Another staff related challenge in the effort to decrease HACs includes staff turnover and problems associated with short staffing [5]. "
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    ABSTRACT: The goal of this study was to evaluate the trend in urinary tract infections (UTIs) from 2005 to 2009 and determine the initial impact of Medicare's nonpayment policy on the rate of UTIs in acute care hospitals. October 2008 commenced Medicare's nonpayment policy for the additional care required as a result of hospital-acquired conditions, including catheter-associated urinary tract infections (CAUTIs). CAUTIs are the most common form of hospital-acquired infections. Rates of CAUTIs were analyzed by patient and hospital characteristics at the hospital level on a quarterly basis, yielding 20 observation points. October 2008 was used as the intervention point. A time series analysis was conducted using the 2005-2009 Nationwide Inpatient Sample datasets. A repeated measures Poisson regression growth curve model was used to analyze the rate of CAUTIs by hospital characteristics. The annual rate of CAUTIs continues to rise; however the annual rate of change is starting to decline. The change in rate of CAUTIs was not significantly different before and after the policy's payment change. The results of the adjusted time series analysis show that various hospital characteristics were associated with a significant decline in rate of CAUTIs in quarters 16-20 (after the policy implementation) compared to the rate in time 1-15 (before the policy implementation), while other characteristics were associated with a significant increase in CAUTIs. Medicare's nonpayment policy was not associated with a reduction in hospitals' CAUTI rates. The use of administrative data, improper coding of CAUTIs at the hospital level, and the short time period post-policy implementation were all limitations in this study.
    Health Policy 12/2013; 115(2-3). DOI:10.1016/j.healthpol.2013.11.013 · 1.91 Impact Factor
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    • "Johnson et al., in their systematic review also reported similar results.[40] Further, although several studies report reduced incidence of asymptomatic bacteriuria, use of anti-infective catheters has not been demonstrably associated with prevention of CAUTI, reduced incidence of bacteremia resulting out of urosepsis or decreased mortality rates therefrom, and hence their routine use in CCUs cannot at present be recommended.[41] However, use of anti-infective urinary catheters could be considered in patients deemed to be at high risk for development of CAUTI or if all other preventive measures fail to bring down CAUTI rates in a CCU. "
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    ABSTRACT: The use of indwelling catheters in the Critical Care Units (CCUs) has a major role in determining the incidence and the morbidity as well as mortality from hospital-acquired urinary tract infections (UTIs). Instituting evidence-based protocols can significantly reduce both the prevalence of indwelling catheterization as well as the incidence of hospital-acquired UTIs. The prevalence of catheter-associated urinary tract infections (CAUTIs) in the CCUs is directly linked to the widespread use of indwelling catheters in these settings. CAUTIs result in significant cost escalation for individual hospitals as well as the healthcare system as a whole. A UTI is an inflammatory response to colonization of the urinary tract, most commonly by bacteria or fungi. A UTI should be differentiated from the mere detection of bacteria in the urinary tract. This condition, referred to as asymptomatic bacteriuria, is common and does not require treatment, especially in the patient with an indwelling urinary catheter. A CAUTI occurs when a patient with an indwelling urinary catheter develops 2 or more signs or symptoms of a UTI such as hematuria, fever, suprapubic or flank pain, change in urine character, and altered mental status. CAUTI is classified as a complicated UTI. The current review highlights the important management issues in critical care patients having CAUTI. We performed a MEDLINE search using combinations of keywords such as urinary tract infection, critical care unit and indwelling urinary catheter. We reviewed the relevant publications with regard to CAUTI in patients in CCU.
    Indian Journal of Critical Care Medicine 03/2013; 17(6):370-374. DOI:10.4103/0972-5229.123451
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    • "Previous research has shown that inexperienced interns are responsible for most iatrogenic complications [6]. The majority of complications can be prevented using the proper UC technique, and for patient safety, only well-trained personnel are recommended to perform UC [7]. However, interns believe they receive inadequate training [6] and there is currently no standard for adequate training [8]. "
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    ABSTRACT: Inexperienced interns are responsible for most iatrogenic complications after urethral catheterization (UC). Although training on simulators is common, little is known about the transfer of learned skills to real clinical practice. This study aimed to evaluate the short- and long-term effects of UC simulated skills training on performance on real patients and to examine whether watching a video of the procedure immediately before assessment enhanced clinical performance. This was an experimental study of the effect of a UC simulation-based skills course on medical students' short-term (after one week) and long-term (after six weeks) performance. The additional effect of video instruction before performance testing on real patients was studied in a randomized trial. Sixty-four students participated in the study, which was preceded by a pilot study investigating the validity aspects of a UC assessment form. The pilot study demonstrated sufficient inter-rater reliability, intra-class correlation coefficient 0.86, and a significant ability to discriminate between trainee performances when using the assessment form, p= 0.001. In the main study, more than 90% of students demonstrated an acceptable performance or better when tested on real patients. There was no significant difference in the total score between the one-week and the six-week groups when tested on real patients and no significant difference between the video and the control groups. Medical students demonstrated good transfer of UC skills learned in the skills lab to real clinical situations up to six weeks after training. Simulated UC training should be the standard for all medical school curricula to reduce avoidable complications. However, this study did not demonstrate that an instructional video, as a supplement to simulated skills training, improved clinical UC performance. Current Controlled Trials ISRCTN:ISRCTN90745002.
    BMC Medical Education 02/2013; 13(1):29. DOI:10.1186/1472-6920-13-29 · 1.22 Impact Factor
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