University HealthSystem Consortium excellence in quality and safety award series: Prevention of nosocomial catheter-associated urinary tract infections through computerized feedback to physicians and a nurse-directed protocol

Yale-New Haven Hospital, New Haven, Connecticut, United States
American Journal of Medical Quality (Impact Factor: 1.25). 05/2005; 20(3):121-6. DOI: 10.1177/1062860605276074
Source: PubMed


Catheter-associated urinary tract infections (CAUTIs) represent the most common nosocomial infection. The authors' baseline rate of CAUTI for general medical service was elevated at 36 per 1000 catheter-days. The medical literature has consistently linked inappropriate catheter use with the development of CAUTI. The baseline data also revealed a high rate of inappropriate use of indwelling urinary catheters. Using the dual modalities of technology through prompts in the computerized order/entry system and handheld bladder scanners, as well as in combination with staff education and nurse empowerment, the authors were successful in reducing the use and duration of urinary catheters as well as the incidence of CAUTI. In subsequent data collection cycles over the following 2 years, 81% reduction in device use and a 73% reduction in the clinical end point of nosocomial CAUTI (36/1000 catheter-days to 11/1000 catheter-days; P < .001) was demonstrated.

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    • "These studies describe improvements in several aspects of patient care outcomes as a result of nurse-initiated care, including regulation of blood glucose [12–15], reduction in length of intubation [16, 17], reduction in the need for physical restraint [18], improved pain control [19, 20], improved outcome for myocardial infarction patients [21, 22], reduction in the number of catheter-associated urinary tract infections [23], and reduction in time to first treatment for asthmatic patients [24, 25]. For example, in their 2007 article, Wong et al. report “triage nurse-initiated pain relief has been evident as an effective measure for pain management” [26]. "
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    ABSTRACT: In an effort to improve the quality and flow of care provided to children presenting to the emergency department the implementation of nurse-initiated protocols is on the rise. We review the current literature on nurse-initiated protocols, validated emergency department clinical scoring systems, and the merging of the two to create Advanced Nursing Directives (ANDs). The process of developing a clinical pathway for children presenting to our pediatric emergency department (PED) with suspected appendicitis will be used to demonstrate the successful integration of validated clinical scoring systems into practice through the use of Advanced Nursing Directives. Finally, examples of 2 other Advanced Nursing Directives for common clinical PED presentations will be provided.
    06/2012; 2012(22):596393. DOI:10.1155/2012/596393
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    • "The results highlighted a significant reduction in CAUTI rates (from 21.3 to 12.4 per 1,000 catheter-days). 27 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. "
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    ABSTRACT: 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.
    American journal of infection control 05/2012; 40(8):692-5. DOI:10.1016/j.ajic.2012.01.021 · 2.21 Impact Factor
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    • "Physical reminder systems and virtual reminder systems have been implemented together (Saint, Kaufman, Thompson, et al, 2005; Topal, Conklin, Camp, et al, 2005). This approach has led to decreased rates of CAUTI, decreased duration of catheterization, decreased inappropriate use of urinary catheters, and decreased cost. "
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    ABSTRACT: Catheter-associated urinary tract infection (CAUTI) is a common and costly problem for hospitalized patients. Policymakers have taken notice of the importance of these infections, and changes to the prospective payment rules of Medicare, Medicaid, and many additional third-party payers have been implemented to hold hospitals accountable for the delivery of poor quality health care services. As key members of the health care team, nurses must be prepared to utilize evidence-based practices to prevent CAUTI in hospitalized patients. This article describes several variable-technology interventions to remind clinicians to remove unnecessary urinary catheters and proposes potential roles for nursing informatics in the prevention of CAUTI in hospitalized adults.
    Urologic nursing: official journal of the American Urological Association Allied 01/2009; 29(5):369-78; quiz 379.
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