ArticleLiterature Review

A Review of Strategies to Decrease the Duration of Indwelling Urethral Catehters and Potentially Reduce the Incidence of Catheter-Associated Urinary Tract Infections

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Abstract

The use of indwelling urinary catheters in hospitalized patients presents an increased risk of the development of complications, including catheter-associated urinary tract infection (CAUTI). With regard to the risk of developing a CAUTI, the greatest factor is the length of time the catheter is in situ. The aim of this article is to review the evidence on the prevention of CAUTI, particularly ways to ensure timely removal of indwelling catheters. Published studies evaluating interventions to reduce the duration of catheterization and CAUTI in hospitalized patients were retrieved. The research identified two types of strategies to reduce the duration of indwelling urinary catheters and the incidence of CAUTI: nurse-led interventions and informatics-led interventions, which included two subtypes: computerized interventions and chart reminders. Current evidence supports the use of nurse-led and informatics-led interventions to reduce the length of catheterizations and subsequently the incidence of CAUTI.

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... So-called reminders of the re-evaluation of indications for catheterisation are included in electronic patient health records [1,3,[12][13][14][15][16]. Another topic to consider is the introduction of schemata and suggestions regarding the relevant indications for catheterisation, and systems of reminders to re-evaluate indication for catheterisation. Bernard et al. (2012) state that it is expected that nursing personnel have correct knowledge of relevant indications, and further mentions that programmes for re-evaluation of catheterisation should be introduced as a matter of course [17]. In their studies, Underwood (2015) and Yatim et al. (2016) describe the implementation of the HOUDINY protocol (haematuria, obstruction, urological surgery/intervention, decubitus ulcer, input/output monitoring, nursing care, and immobility), which contains indications for catheterisation and principles of CAUTI [5,18] prevention. ...
... So-called reminders of the re-evaluation of indications for catheterisation are included in electronic patient health records [1,3,[12][13][14][15][16]. Another topic to consider is the introduction of schemata and suggestions regarding the relevant indications for catheterisation, and systems of reminders to re-evaluate indication for catheterisation. Bernard et al. (2012) state that it is expected that nursing personnel have correct knowledge of relevant indications, and further mentions that programmes for re-evaluation of catheterisation should be introduced as a matter of course [17]. In their studies, Underwood (2015) and Yatim et al. (2016) describe the implementation of the HOUDINY protocol (haematuria, obstruction, urological surgery/intervention, decubitus ulcer, input/output monitoring, nursing care, and immobility), which contains indications for catheterisation and principles of CAUTI [5,18] prevention. ...
... Catheterisation or indication for catheterisation for the "facilitation of nursing care" found little or no agreement in the case of 41% of nurses. In their review, Bernard et al. (2012) describe the topic of urinary bladder catheterisation without indication where the catheter is frequently introduced in the urgent admission ward and the indication is not further re-evaluated [17]. Education of competent healthcare workers is another measure in CAUTI prevention. ...
Article
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In the case of the prevention of catheter-associated urinary tract infections (CAUTI) related to healthcare provision, high-quality and comprehensively provided nursing care is essential. Implementation of preventive strategies is based on recommended procedures, and the introduction of whole sets of measures has been shown to be effective. The objective of this research is to find out whether the providers of acute bed care have implemented the steps of CAUTI prevention, and specifically which measures leading to improved quality of care in the area of urinary infections are already in place. To determine this, we carried out quantitative research. Data were collected using a questionnaire-based investigation; we used two non-standardised and one standardised questionnaire, and the respondents were general nurses in management positions (n = 186). The results revealed that result-related CAUTI indicators are monitored by only one-third of the respondents, and records of catheterisation indication are not kept by 17.3% of general nurses. The results of the research showed deficiencies in the monitoring of CAUTI outcome and process indicators, and a weakness of the implemented preventive measures is the maintenance of catheterisation documentation. Periodic CAUTI prevention training is not implemented as recommended. It is positive that there are well-working teams of HAI prevention experts in hospitals.
... Catheters should be used only for appropriate indications. Urinary catheters have been reported to be placed due to inappropriate indications (Al Mohajer and Darouiche, 2013 ;Bernard et al, 2012 ;Meddings et al, 2013 ;Titsworth et al, 2012 ). The first step in preventing CAUTIs is to eliminate the unnecessary use of catheters (Elpern et al, 2009 ;Fink et al, 2012 ;Gould et al, 2010 ;Lo et al, 2008 ;Meddings et al, 2013 ;Meddings and Saint, 2011 ;Pratt et al, 2007 ;Rothfeld and Stickley, 2010 ). ...
... The first step in preventing CAUTIs is to eliminate the unnecessary use of catheters (Elpern et al, 2009 ;Fink et al, 2012 ;Gould et al, 2010 ;Lo et al, 2008 ;Meddings et al, 2013 ;Meddings and Saint, 2011 ;Pratt et al, 2007 ;Rothfeld and Stickley, 2010 ). As reported in the literature, the right indications for catheter are (1) acute urinary retention, (2) bladder outlet obstruction, (3) healing assistance, (4) neurogenic bladder dysfunction, (5) prolonged immobilization, (6) accurate measurement of urinary output, (7) perioperative use for selected surgical procedures, (8) to improve comfort for end of life care, and (9) for postoperative management of surgical patients (Al Mohajer and Darouiche, 2013 ;Bernard et al, 2012 ;Chenoweth and Saint, 2013 ;Elpern et al, 2009 ;Geng et al, 2012 ;Gould et al, 2010 ;Lee et al, 2013 ;Lo et al, 2008 ;Meddings et al, 2013 ;Pratt et al, 2007 ;Rothfeld and Stickley, 2010 ;Titsworth et al, 2012 ;Tiwari et al, 2012 ). The decisions to catheterization should always be based upon the consideration of these indications. ...
... Catheter removal decisions must be evaluated routinely after the patient is catheterized (Huang et al, 2004 ;Lo et al, 2008 ). Catheter removal indications include (1) indications for keeping the catheter are no longer observed, (2) prolonged catheterization (>48 h), (3) a closed drainage system is compromised, (4) an obstructed urine flow is observed, and (5) an infection is observed (Al Mohajer and Darouiche, 2013 ;Bernard et al, 2012 ;Chenoweth and Saint, 2013 ;Elpern et al, 2009 ;Fink et al, 2012 ;Geng et al, 2012 ;Gould et al, 2010 ;Kennedy et al, 2013 ;Ksycki and Namias, 2009 ;Leblebicioglu et al, 2013 ;Lo et al, 2008 ;Meddings et al, 2010 ;Rebmann and Greene, 2010 ;Rothfeld and Stickley, 2010 ;Titsworth et al, 2012 ). ...
Article
In the United States about 100,000 people die annually from healthcare-associated infections (HAIs). Catheter-associated urinary tract infections (CAUTI) are the second most common type of HAI in the US, accounting for about 15% of HAIs. CAUTIs pose a significant treat to patients, which consequences could be as minor as an extra day in the hospital or as serious as death. Although studies show that implementing best practices and educating healthcare workers can help prevent HAIs, CAUTI prevention continues to pose a challenge to healthcare quality. Therefore, decreasing CAUTI rates has been targeted as one of the focus areas for several healthcare national initiatives. This survey paper considers research published from 2004 to 2015 on risk factors associated with CAUTIs and current preventive interventions. The goal of the survey is to provide a comprehensive taxonomy that aggregates and compare studies on CAUTIs and to identify future research opportunities for the development of system interventions that can be used to manage CAUTIs.
... The risk for developing a CAUTI is related directly to the time the catheter remains in situ. Therefore, limiting catheter use and duration are the most important measures to prevent CAUTIs [1,6]. Nevertheless, overuse of catheters is widespread, with many hospitalized patients receiving catheters without an appropriate indication and for a prolonged duration [7]. ...
... Many health care organizations, such as The Institute for Healthcare Improvement (IHI), are tackling the universal problem of CAUTIs and overuse of catheters [6], as reflected by the number of guidelines on catheter usage [8]. Diverse interventions that focus on limiting catheter use and on their prompt removal may significantly reduce CAUTIs [3, [9][10][11]. ...
... Diverse interventions that focus on limiting catheter use and on their prompt removal may significantly reduce CAUTIs [3, [9][10][11]. Education of nursing staff, electronic reminders aimed at reducing the duration of invasive devices [6,12], such as automatic stop orders [13], and the use of nurses specially trained to lead implementation projects (change champions) [12] have proved to be effective in changing practice and reducing CAUTIs [14]. ...
Article
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Objective To assess the effectiveness of implementation of evidence-based recommendations to reduce catheter-associated urinary tract infections (CAUTIs). Design Prospective cohort study, conducted in 2010–12, with a before and after design. Setting A major referral university hospital. Participants Data were collected before (n = 244) and 1 year after (n = 255) the intervention for patients who received urinary catheters. Intervention The intervention comprised two elements: (i) aligning doctors’ and nurses’ knowledge of indications for the use of catheters and (ii) an educational effort consisting of three 30- to 45-minute sessions on evidence-based practice regarding catheter usage for nursing personnel on 17 medical and surgical wards. Main Outcome Measures The main outcome measures were the proportion of (i) admitted patients receiving urinary catheters during hospitalization, (ii) catheters inserted without indication, (iii) inpatient days with catheter and (iv) the incidence of CAUTIs per 1000 catheter days. Secondary outcome measures were the proportion of (i) catheter days without appropriate indication and (ii) patients discharged with a catheter. Results There was a reduction in the proportion of inpatient days with a catheter, from 44% to 41% (P = 0.006). There was also a reduction in the proportion of catheter days without appropriate indication (P < 0.001) and patients discharged with a catheter (P = 0.029). The majority of catheters were inserted outside the study wards. Conclusions A short educational intervention was feasible and resulted in significant practice improvements in catheter usage but no reduction of CAUTIs. Other measures than CAUTI may be more sensitive to detecting important practice changes.
... Di fatto, il 15-25% dei pazienti durante il ricovero viene sottoposto a cateterizzazione vescicale (Warren JW, 2001; ISS-ISTISAN, 2003;Parker D et al., 2009). Anche se gli individui interessati appartengono ad ogni fascia di età, quelli più a rischio sono le persone anziane (ISS-ISTISAN 2003;Bernard MS et al., 2012). Le IVU-CCV sono sempre più riconosciute come una significativa fonte di morbilità iatrogena evitabile (Powers CJ et al., 2012) e impongono un onere finanziario al sistema sanitario in termini di trattamento e durata del ricovero . ...
... Le IVU-CCV sono sempre più riconosciute come una significativa fonte di morbilità iatrogena evitabile (Powers CJ et al., 2012) e impongono un onere finanziario al sistema sanitario in termini di trattamento e durata del ricovero . Sebbene i tassi di mortalità diretta da IVU-CCV siano bassi (0,1%) rispetto alle altre infezioni nosocomiali, vi è un elevato rischio cumulativo di mortalità indiretta (0,7%) (Léone M et al., 2000;Bernard MS et al., 2012). La migliore forma di prevenzione sarebbe quella di evitare l'utilizzo del catetere vescicale per un paziente che non ne ha bisogno; nel caso si renda necessario il presidio, occorrerebbe rimuoverlo appena possibile (ISS-ISTISAN, 2003). ...
Article
Full-text available
INTRODUZIONE Si stima che tra il 5 e il 12 % dei pazienti ricoverati nelle strutture ospedaliere, nelle cliniche di lungodegenza o nelle case di riposo sia interessato da infezioni nosocomiali, fra cui quelle alle vie urinarie sono a maggiore incidenza (30-40%) (ISS-ISTISAN, 2003; Saint S et al., 2008; Winter M et al., 2009). Nel 60-80% dei casi si tratta di infezioni alle vie urinarie correlate al catetere vescicale (IVU-CCV) (ISS-ISTISAN, 2003; Parker D et al., 2009; Regione ER-ASSR, 2010). Di fatto, il 15-25% dei pazienti durante il ricovero viene sottoposto a cateterizzazione vescicale (Warren JW, 2001; ISS-ISTISAN, 2003; Parker D et al., 2009). Anche se gli individui interessati appartengono ad ogni fascia di età, quelli più a rischio sono le persone anziane (ISS-ISTISAN 2003; Bernard MS et al., 2012). Le IVU-CCV sono sempre più riconosciute come una significativa fonte di morbilità iatrogena evitabile (Powers CJ et al., 2012) e impongono un onere finanziario al sistema sanitario in termini di trattamento e durata del ricovero (Bernard MS et al., 2012). Sebbene i tassi di mortalità diretta da IVU-CCV siano bassi (0,1%) rispetto alle altre infezioni nosocomiali, vi è un elevato rischio cumulativo di mortalità indiretta (0,7%) (Léone M et al., 2000; Bernard MS et al., 2012). La migliore forma di prevenzione sarebbe quella di evitare l'utilizzo del catetere vescicale per un paziente che non ne ha bisogno; nel caso si renda necessario il presidio, occorrerebbe rimuoverlo appena possibile (ISS-ISTISAN, 2003). Ciò perchè i fattori di rischio più importanti per l'insorgenza di IVU-CCV sono dati dalla presenza stessa del catetere (Powers CJ et al., 2012) e dal tempo di permanenza (ISS-ISTISAN, 2003). Pur tuttavia, il tasso di cateterizzazione vescicale non necessaria è del 21-50% (Bernard MS et al., 2012). In un caso su tre il catetere vescicale è inserito senza ordine medico o in assenza di un valido e documentato razionale a supporto della procedura (Bernard MS et al., 2012) e spesso non si esegue una valutazione continua della necessità di mantenere in situ il presidio; questo determina una sua prolungata ed impropria permanenza con rischio infettivo aggiuntivo (Bernard MS et al., 2012). A prescindere dall'acclarata correlazione fra catetere vescicale ed infezioni alle vie urinarie, la ricerca ha sondato molti approcci d'intervento per prevenire le IVU-CCV. Sebbene siano numerosi gli studi che valutano altrettanto numerose strategie di prevenzione, l'applicazione degli interventi raccomandati varia considerevolmente (Saint S et al., 2008). Inoltre, nonostante gli infermieri siano responsabili dell'inserimento e gestione del catetere vescicale, in letteratura emergono ancora conoscenze poco aderenti agli esiti desunti dalla ricerca contemporanea sull'argomento (Makic MB et al., 2011); ciò confligge con la presa d'atto che gli interventi infermieristici andrebbero guidati, oltre che dal giudizio clinico del professionista, anche dalle prove di efficacia correnti. In quest'ottica, lo studio si propone di valutare l'efficacia degli interventi attualmente implementati per prevenire l'insorgenza delle IVU-CCV. MATERIALI E METODI E' stata condotta una overview di revisioni sistematiche al fine di sintetizzare le migliori prove di efficacia disponibili sull'argomento e definire le opportune decisioni clinico assistenziali (Cooper H et al., 2012). Per la ricerca dei
... Hemşireler üriner kateterizasyon ve kateter uygulanan hastaların bakımı ile ilgili bilgilerini hizmetiçi eğitimler ile güncellemelidir. Ancak, bu durumda hemşireler kateterizasyonun endikasyonlarını, komplikasyonlarını ve bakımda nelere dikkat etmesi gerektiklerini belirleyebilirler 23,30 . Literatüre baktığımızda hemşirelerin kateter ilişkili üriner sistem enfeksiyonlarını önlemeye yönelik bilgi ve tutumlarını değerlendirebilecek standart bir ölçüm aracının bulunmadığı, ancak verilen eğitim ve protokollerin etkinliğinin enfeksiyon hızlarıyla karşılaştırılarak değerlendirildiği görülmüştür [29][30][31][32] . ...
... Ancak, bu durumda hemşireler kateterizasyonun endikasyonlarını, komplikasyonlarını ve bakımda nelere dikkat etmesi gerektiklerini belirleyebilirler 23,30 . Literatüre baktığımızda hemşirelerin kateter ilişkili üriner sistem enfeksiyonlarını önlemeye yönelik bilgi ve tutumlarını değerlendirebilecek standart bir ölçüm aracının bulunmadığı, ancak verilen eğitim ve protokollerin etkinliğinin enfeksiyon hızlarıyla karşılaştırılarak değerlendirildiği görülmüştür [29][30][31][32] . Bu amaçla araştırmacılar tarafından geliştirilmiş olan bu ölçek ile standart bir değerlendirme yapılabileceği düşünülmektedir. ...
... Inserting the IUC procedure is performed under aseptic technique by qualified nursing staff (Urology Nursing Working Group, 2013). When invasive urinary catheterization is not appropriately maintained in hospitalized patients, serious adverse effects can occur, including CAUTI (Bernard et al., 2012). Other than the CAUTI, long-term use of an indwelling urethral catheter can be associated with many complications like bladder spasms, hematuria, urethral erosion, urethritis, periurethral abscess, unprescribed removal, pain, fistula formation, stones, obstruction secondary to encrustation, and leakage (De Silva, 2011). ...
... IUC insertion is a sterile and invasive procedure (Bernard et al., 2012). ...
... 3 Unfortunately, studies have found that prolonged catheter usage greatly increases a patient's risk for developing a urinary tract infection (UTI). 3,4 Not surprisingly, UTIs are among the most common health care-acquired infections (HAIs) and nearly 80% are catheter-associated (CAUTI). 5 While national and international guidelines for the prevention of CAUTI exist, the incidence continues to climb. ...
... 9 The evidence indicates most CAUTIs are preventable 10,11 and are largely a nursing responsibility as physicians are frequently unaware of the duration of catheterization among their hospitalized patients. 4 Thus, this study sought to determine how nurses might adopt a nurse-driven protocol to remove indwelling urinary catheterizations without waiting on a physician order. ...
Article
Hospitalized adult patients are at increased risk for adverse outcomes, particularly when undergoing invasive procedures that include indwelling urinary catheterization. This study identified factors associated with nurses' adoption of an evidence-based practice to reduce the duration of catheterization and potential for catheter-associated urinary tract infections in hospitalized adults.
... 246 Physical and psychological discomfort associated with insertion, removal and the catheter in situ are common. 247 Complications such as inÁ ammation, urethral strictures, mechanical trauma, bladder calculi and other infections of the renal system also occur. 237,[248][249][250] Urine retention after catheter removal is also a frequent occurrence. ...
... Der Einsatz von Harnwegkathetern ist auf das medizinisch vertretbare Minimum zu reduzieren und eine Katheterentfernung zum frühestmöglichen Zeitpunkt anzustreben. [5,8,9,11,16,22,29,39,66] ...
... As evidenced throughout this project narrative, the need to effectively manage and reduce incidence of CAUTI is one of the most important issues related to reducing HAI .Whilst there are a number of guidelines to this end [10], and a variety of individual strategies targeting the achievement of this end including reminders [11], and education [12,13], when a strategic comprehensive facilitywide implementation was utilised, results were more effective at the management of CAUTI prevention programmes. However, guidelines fail to address the change management strategy required for a facilitywide implementation. ...
Article
Objective:To develop and implement an innovative change, in the form of a physical reminder sticker protocol, to mitigate the high incidence of CAUTI in the elderly home care patient population at GLTD. Methods: A comprehensive literature review was conducted that served to provide a robust evidence base to add assure the implementation programme was grounded in an evidence-based approach. Said literature review also added to steps identified for a facility-wide change implementation. Change management strategies were identified herein. A comprehensive implementation plan, developed in accord with the IHI Model for Improvement was presented. Evaluation: A variety of evaluation strategies and methodologies were identified to assess baseline data, interim data, and data results of a pilot implementation, short-term post-implementation results, and long-term postimplementation strategies. Discussion: Implications for the organisation and clinical setting were discussed. Recommendations for a robust Phase 2 were presented. Project strengths and weaknesses were discussed. Results: There were a total of 80 patients with catheter under HHCS in the beginning of the project. In the first three months on implementing the CAUTI program there was a significant decreases in the number of patients, from 80 it dropped to 60 a decrease of 25 %. The second phase saw a sharp decrease; the catheter was removed from 60 % of the patients. It was 10 percentage more than the anticipated by 50% by the end of March 2015.
... A study indicates Prolong urinary catheterization enhance the danger of catheter related infection. (Bernard et al., 2012).Accordingly, stop orders for the catheters are highly concern matter for nurses it empowers the nurses on the basis of frequent assessment for example every 24hrs, or in case of major and minor surgical procedure. A study conducted that large number of indwelling catheters are used in the hospital setting to provide treatment and management for specific problems and mostly indwelling catheters has no any orders or clear purpose of insertion indication. ...
Article
Full-text available
p>Nursing is an art science and an essential health care profession in which the skilled knowledgeable persons are committed to provide care to sick peoples and strive for the, protection and promotion of health and prevention against diseases and helps to minimize the risk and risk related injuries. Urinary tract infections are very common infection in the hospital settings almost responsible for 40% nosocomial infections. All the urinray tract infection is expected that approximately more than 70% infection reported because of indewelling cathters. Objectives : To assess the perceptions of nurses regarding indwelling urinary catheter and its care. To assess the practices of nurses to prevent the indwelling catheter related urinary tract infection. Methodology: Descriptive cross sectional design and data was collected through a five point Likert scale questioner. Study population was the nursing staff from the Jinnah hospital Lahore. Sample size was 184 nurses from all indoor departments of the Jinnah Hospital Lahore. Results : The findings show that the practice and perceptions scores of the registered nurses’ in the study group are insignificant with age, qualification and experience (i.e., p-value > 0.05) with the evidence-based guidelines for prevention of catheter associated urinary tract infection. Results of study indicated insignificant relationship between registered nurses’ practice and perceptions regarding the indwelling urinary catheter associated infection. Int. J. Appl. Sci. Biotechnol. Vol 5(2): 150-158 </p
... Bernard, Hunter, and Moore (2012) Integrative review, nine studies; assessment of studies' quality Lankshear et al. (2005) Systematic review; 20 studies; assessment of studies' quality Fuchs et al. (2011) Primary study; retrospective chart review Falls Indication of links between nurse staffing or nurse related interventions and the incidence of falls, but conflicting evidence; Clientele characteristics have a determining impact Seago (2001) Systematic review; 16 studies dealing with staffing-safety outcomes relationships; grading of studies' design and outcome measures Kurtzman (2010) Systematic review; 74 studies, including 15 systematic/literature reviews, five meta-syntheses or analyses, and 54 individual studies; assessment of studies' quality Oliver et al. (2007) Metaanalysis, with calculation of pooled effects for the outcomes of falls and fractures; 43 studies, including 28 RCTs; assessment of studies' quality ...
Article
Aims: A discussion of an optimal set of indicators that can be used on a priority basis to assess the performance of nursing care. Background: Recent advances in conceptualization of nursing care performance, exemplified by the Nursing Care Performance Framework, have revealed a broad universe of potentially nursing-sensitive indicators. Organizations now face the challenge of selecting, from this universe, a realistic subset of indicators that can form a balanced and common scorecard. Design: Discussion paper drawing on a systematic assessment of selected performance indicators. Data sources: Previous works, based on systematic reviews of the literature published between 1990 and 2014, have contributed to the development of the Nursing Care Performance Framework. These works confirmed a robust set of indicators that capture the universe of content currently supported by the scientific literature and cover all major areas of nursing care performance. Building on these previous works, this study consisted in gathering the specific evidence supporting 25 selected indicators, focusing on systematic syntheses, meta-analyses and integrative reviews. Implications for nursing: This study has identified a set of 12 indicators that have sufficient breadth and depth to capture the whole spectrum of nursing care and that could be implemented on a priority basis. Conclusions: This study sets the stage for new initiatives aiming at filling current gaps in operationalization of nursing care performance. The next milestone is to set up the infrastructure required to collect data on these indicators and make effective use of them. This article is protected by copyright. All rights reserved.
... During the past few years, many HAIs including CAUTIs, have come to be regarded as preventable complications rather than unavoidable outcomes of medical care [14,16,17,18,19]. This change in perspective has created an impetus to substantially reduce the incidence of CAUTIs, and multiple strategies have been explored to achieve this goal [20,21,22,23,24,25]. ...
Article
Full-text available
The most common type of healthcare-associated infection (HAI) is a urinary tract infection (UTI), and 80 percent of these are associated with the use of indwelling urinary catheters (IUCs). These are termed catheter-associated urinary tract infections (CAUTIs). It has been estimated that about 25 percent of all hospitalized patients have an IUC placed during their hospital stay. In addition to the morbidity and mortality that may be associated with a CAUTI, there are also financial consequences. This is particularly true since as of October 1, 2008, the Centers for Medicare and Medicaid Services stopped reimbursing hospitals for several types of infections acquired during a hospital stay, including CAUTIs. In United States (U.S.) the estimated annual cost of treating these CAUTIs is $350 million. It has been proposed that a large percentage of CAUTIs should be preventable. This article will discuss the diagnosis, treatment, and prevention of CAUTIs
... 56 Similar to other studies, we found that a comprehensive, nursing-led initiative eliminated postoperative, catheterassociated UTIs. 57,58 These results suggest that there is a need for institutions to develop standardized practices for addressing tumor-related and treatment-related complications affecting patients with glioma. ...
Article
Background Patients with glioma are at increased risk for tumor-related and treatment-related complications. Few guidelines exist to manage complications through supportive care. Our prior work suggests that a clinical care pathway can improve the care of patients with glioma. Methods We designed a quality improvement (QI) project to address the acute care needs of patients with gliomas. We formed a multidisciplinary team and selected 20 best-practice measures from the literature. Using a plan-do-study-act framework, we brainstormed and implemented various improvement strategies starting in October 2013. Statistical process control charts were used to assess progress. Results Retrospective data were available for 12 best practice measures. The baseline population consisted of 98 patients with glioma. Record review suggested wide variation in performance, with compliance ranging from 30% to 100%. The team hypothesized that lack of process standardization may contribute to less-than-ideal performance. After implementing improvement strategies, we reviewed the records of 63 consecutive patients with glioma. The proportion of patients meeting criteria for 12 practice measures modestly improved (65% pre-QI; 76% post-QI, P > .1). Unexpectedly, a higher proportion of patients were readmitted within 30 days of hospital discharge (pre-QI: 10%; post-QI: 17%, P > .1). Barriers to pathway development included difficulties with transforming manual measures into electronic data sets. Conclusions Creating evidence-based clinical care pathways for addressing the acute care needs of patients with glioma is feasible and important. There are many challenges, however, to developing sustainable systems for measuring and reporting performance outcomes overtime.
... Special approaches to prevent CAUTIs (Yokoe et al., 2014), such as protocol development for management of post-operative urinary retention, systematic reporting and analysis of IUC use and adverse effects, and implementation of an organization-wide program to identify and remove IUCs when no longer necessary, are also recommended. Nurse-directed interventions have been highlighted as an important component of comprehensive CAUTI prevention efforts (Bernard, Hunter, & Moore, 2012;Fink et al., 2012;Oman et al., 2012;Saint et al., 2009Saint et al., , 2013Underwood, 2015;Yokoe et al., 2014). ...
Article
Catheter-associated urinary tract infections (CAUTIs) are one of the most common hospital-acquired infections in the United States. Because of persistently high CAUTI rates despite evidence-based interventions, we designed and implemented a performance improvement nurse-driven removal protocol for indwelling urinary catheters. Post-implementation, both catheter utilization and CAUTIs decreased significantly at the one hospital with the highest baseline rates; at the two hospitals with low baseline rates, the impact of the protocol varied. This project highlights important steps in developing and implementing a nurse-driven removal protocol across a multi-hospital academic healthcare system.
... Sağlık Bakım Araştırmaları ve Kalite Ajansı 2015 yılında, ameliyat sonrası dönemde klinik endikasyonu yoksa üriner kateterin 24 saat içinde çıkarılmasını önermiştir (15). Yapılan bir çalışmada, üriner kateter endikasyonu kontrol listesi kullanımının kateter uygulanmasını 5 yıl içinde yaklaşık %25 azalttığı (16), başka bir inceleme çalışmasında ise hemşirelerin üriner kateteri olan hastalarda kateter endikasyonunun günlük takibinin KİÜSE'yi azalttığı bulunmuştur (17). Çalışmalardan yola çıkılacak olursa, enfeksiyon etmenini ortadan kaldırmak için hastalarda kateter endikasyonu (üriner retansiyon, üriner inkontinans, perineal alanda açık yara ya da yakın üriner output takibi gibi) yakın takip edilerek kayıt tutulması ve endikasyon ortadan kalkınca kateterin çıkarılması gerekliliği görülmektedir. ...
Article
INTRODUCTION: Urinary tract infections are the most common healthcare-related infections, and about 60 to 80% of these infections occur related to the catheter. Precaution steps which can be taken to prevent these infections are known to reduce morbidity and mortality rates. This study aims to investigate the practices towards prevention catheter-related urinary tract infections (CRUTIs) for the nurses working in general surgery clinics. METHODS: This study was conducted in a tertiary setting with the participation of nurses who work in general surgery clinics. The data were collected by observation form consists of 25 evidence-based practices, named "Placement of Catheter (10-practice)", "Catheter Care (7-practice)" and "Usage of Urine Bag Application (8-practice)" towards prevention of CRUTIs. The data were collected using an interactive observation method; nurses were observed three times while practicing and scored once for each practice. Then, the mean score of each practice were calculated and after evaluation, this score was found between 0-75. RESULTS: The mean age of the nurses was 27,6+-7,1(19-40) years, and 81,2% of them were females. The mean scores of the nurses for catheter placement, catheter care, and usage of urine bag were 27,2+-1,4; 17.6+-2.6; 19.1+-2.6, respectively. In addition, the mean of total score for prevention of CRUTIs was 64,0+-4,6 (range: 54 to 72). DISCUSSION AND CONCLUSION: Although the scores of nurses were medium-good, practices towards prevention of infection should be taken as a whole. Thus, nurses should kept in mind that they are responsible from catheter placement to removal.
... [24,30] A recent review showed that interventions directed by nurses or implemented by computer systems help reduce the duration of urinary catheterizations and potential infections of the urinary tract. [31] To have a nurse providing written reminders has effectively and significantly reduced the number of catheterized inpatients. [32] Moreover, none of these interventions were followed by a greater need of recatheterizations after withdrawing the catheter. ...
Article
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Objective: To assess the effectiveness of a twice-weekly simple reminder intervention in shortening the duration of urinary catheterization and intravenous fluid therapy. Methods: Design: Parallel, controlled clinical trial. Setting: Two internal medicine wards. Patients: Patients admitted to the Internal Medicine Department since October 2010 and 3, 7 and 12 months later. Intervention: A twice-weekly simple reminder intervention during the meetings of the medical-nursing team in one ward (intervention group) and no intervention in the other (control group). Measurements: Age, sex, living at home or in a nursing residence, Barthel index, Norton scale, use and duration of urinary catheterization and intravenous fluid therapy, presence of pressure ulcers, onset of delirium, Major Diagnostic Category, and length of stay. Results: 747 patients were included. On 265 of them (35.4%) urinary catheterization was used. Patients in control group had urinary catheters inserted more frequently (39.1% vs. 31.7%; p = .03) and for a longer time [median (interquartile range) 5 (8) vs. 4 (6) days; p = .007]; also, the catheter was left in place at discharge more frequently (15.2% vs. 10.1%; p = .04). Intravenous fluid therapy was used on 519 (69%) patients. There were no differences in use between both groups, but it was for a longer period in control group [4 (5) vs. 3 (5) days; p = .001]. Conclusions: A simple face-to-face intervention during the meetings of the medical-nursing team with a twice a week reminder to withdraw unnecessary urinary catheters and intravenous fluid therapy efficiently reduces the duration of such treatments.
... When catheterization is performed during a cesarean delivery, reducing the length of time it is left in place was supported by the evidence with a reduction in UTIs, decreased pain, earlier first void, and ambulation times [13]. General guidelines for the use of indwelling catheters support the use of nursing interventions to reduce utilization of indwelling catheters [15,16]. ...
Article
One concern for medical professionals and women experiencing cesarean deliveries is the use of indwelling urinary catheters, which is associated with a delay in first void time, slower ambulation time, increased discomfort, longer hospital stays, and an increased risk for urinary tract infections. The purpose of this project was to determine if a practice change regarding the use of urinary catheters among pregnant women decreases the number of women receiving a catheter prior to having a cesarean section in a small community hospital. The knowledge to action and Rosswurm and Larabee’s models were used to guide this project, which was comprised of 2 phases. Phase 1 included a team of 10 experts that created the needs assessment that would establish hemodynamic stability using a 4-point scale. The items for inclusion in the needs assessment included primary cesarean, repeat cesarean, no urinary tract infection present, no fetal distress present, no systemic disorders present, no hypertensive disorders present, and no contraindications for anesthesia. Phase 2 was the implementation and evaluation of the needs assessment and new practice guidelines. Statistical analysis was performed using the Mann Whitney U test. There was 98% compliance (p < 0.001.) with the use of the assessment in women undergoing a cesarean delivery and a 64% reduction in the length of time an indwelling catheter was left in place. However, there was no significant change in the number of women receiving a catheter prior to cesarean delivery after a needs assessment was performed (p = 0.805). This project has potential implications that would support social change by reducing the use of indwelling catheters among hemodynamically stable women undergoing cesarean deliveries. Key words: Indwelling catheter, Urinary catheter, Foley, Cesarean, C-section
... During the past few years, many HAIs, including CAUTIs, have come to be regarded as preventable complications rather than unavoidable outcomes of medical care [11,[14][15][16][17]. This change in perspective has created an impetus to substantially reduce the incidence of CAUTIs, and multiple strategies have been explored to achieve this goal [18][19][20][21][22][23]. ...
... Urinary catheters may be the most common indwelling device inserted during surgical procedures. Because studies conclude that the duration of catheterization is the most important risk factor for developing infection, 48,49 The Joint Commission has added a core measure that requires the removal of the urinary catheter on postoperative day one or day two. Exceptions to this requirement include a physician-documented reason not to remove the catheter; all urological, gynecological, and perineal surgeries; a patient in intensive care; a patient receiving diuretics; and a patient with a documented infection before surgery. ...
Article
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Lack of careful attention to the increasing complexity of surgical procedures, instrument cleaning and processing, and the transition of surgical and other invasive procedures from the OR to areas outside the traditional hospital OR can contribute to surgical site infection (SSI) risk. Regardless of the location of an intervention, when basic infection prevention measures are applied reliably, even low infection rates can be reduced. To address infection prevention challenges, infection preventionists (IPs) must be well informed regarding infection risk and prevention during surgical and other invasive procedures and the effect a facility type may have on patients' infection risk. The IP must have a solid understanding of surgical asepsis, instrument disinfection, and sterilization to educate and support clinical teams in identifying opportunities for improvement relative to infection prevention. Copyright © 2015 AORN, Inc. Published by Elsevier Inc. All rights reserved.
... The two most common adverse outcomes in pediatric NSQIP are SSI and urinary tract infection (UTI), and both were identified as significant or near significant outliers for several individual specialties, and in aggregate. To guide our process improvement efforts, the NSQIP team undertook literature reviews seeking evidence-based best practice guidelines for prevention of UTI, as well as outcome studies that identified predictors of postoperative UTI [10][11][12][13]. The same exercise was undertaken for SSI [14][15][16][17][18][19][20][21][22]. ...
Article
Purpose The pediatric NSQIP program is in the early stages of facilitated surgical quality improvement for children. The objective of this study is to describe the initial experience of the first Canadian Children’s Hospital participant in this program. Method Randomly sampled surgical cases from the “included” case list were abstracted into the ACS-NSQIP database. These surgical procedure-specific data incorporate patient risk factors, intraoperative details, and 30 day outcomes to generate annual reports which provide hierarchical ranking of participant hospitals according to their risk-adjusted outcomes. Results Our first risk-adjusted report identified local improvement opportunities based on our rates of surgical site infection (SSI) and urinary tract infection (UTI). We developed and implemented an engagement strategy for our stakeholders, performed literature reviews to identify practice variation, and conducted case control studies to understand local risk factors for our SSI/UTI occurrences. We have begun quality improvement activities targeting reduction in rates of SSI and UTI with our general surgery division and ward nurses, respectively. Conclusions The NSQIP pediatric program provides high quality outcomes data that can be used in support of quality improvement. This process requires multidisciplinary teamwork, systematic stakeholder engagement, clinical research methods and process improvement through engagement and culture change.
... Starting from the aspects related to our study of the correspondence between infection, section and pathogen, it is recommended the rapid, vigilant and targeted application of HAI prevention and control strategies for reducing infections in intensive care units [30][31][32][33][34][35], of surgical infections in the pre-, intra-and post-operative phase [36][37][38], reduction of urinary catheter infections [39][40][41], reduction of intravascular catheter infections [42,43], respectively, reduction infections with Clostridioides difficile [44]. ...
Article
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Background: Hospital-acquired infections (HAI) contribute to the emotional stress and functional disorders of the patient and in some cases, can lead to a state of disability that reduces quality of life. Often, HAI are one of the factors that lead to death. The purpose of this study was to analyze the cases of HAI identified in public hospitals at the county level, through case report sheets, as they are reported according to the Romanian legislation. Methods: We performed a cross sectional study design based on the case law of the data reported to the Mures Public Health Directorate, by all the public hospitals belonging to this county. We tracked hospital-acquired infections reported for 2017–2018, respectively, a number of 1024 cases, which implies a prevalence rate of 0.44%, 1024/228,782 cases discharged from these hospitals during the studied period. Results: The most frequent HAIs were reported by the intensive care units (48.4%), the most common infections being the following: bronchopneumonia (25.3%), enterocolitis with Clostridioides difficile (23.3%), sepsis, surgical wound infections and urinary tract infections. At the basis of HAI were 22 pathogens, but the five most common germs were Clostridioides difficile, Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus. Bronchopneumonia have been most frequently reported in intensive care units, the most common being identified the Acinetobacter baumannii agent. Sepsis and central catheter infections also appeared predominantly in intensive care units, more often with Klebsiella pneumoniae. The enterocolitis with Clostridioides difficile, were the apanage of the medical sections. Infections with Staphylococcus aureus have been identified predominantly in the surgical sections at the level of the surgical wounds. Urinary infections had a similar distribution in the intensive care units, the medical and surgical sections, with Klebsiella pneumoniae being the most commonly incriminated agent. Conclusions: We showed a clear correspondence between the medical units and the type of HAI: what recommends the rapid, vigilant and oriented application of the prevention and control strategies of the HAI.
... Nurses are a key role in patient"s outcomes, so a need to provide evidence -based knowledge needed for patients and implement best guidelines in their practice (Bernard, and Moore, 2012). Because care is often delivered in a pressurized and fast-moving environment, involving a vast array of technology, daily decisions and judgments by health-care professional staff. ...
Article
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The aim of the study was to assess the effect of nursing education intervention on time management for nurses in dialysis unit. Hypothesis: After the nursing education intervention: 1-the knowledge of nurses about renal failure, hemodialysis and time management will increase, 2-The perception of nurses about importance of time management in improving their performance and the perception about their ability to control time wasters will increase. 3-The performance of nurses will improve after receiving the educational intervention. Design: Quasi-experimental design used. Setting: dialysis unit at Benha university hospitals and health insurance hospital used to conduct study. Tools: two tools were designed; I): Interview questionnaire sheet: It consists of four parts (I): It consisted of personal identification and demographic characteristics of the studied nurses. Part (II): to assess nurses' general knowledge about renal failure and hemodialysis. Part III: Time management perception questionnaire. Part IV: Time waters' perception questionnaire. Tool (II): Observational Checklist for nurses' performance with workload at dialysis unit. Results: The results of the study revealed that (58.3%) of nurses were working at Benha University Hospital and having experience at dialysis unit more than 5 years. more than half (55%) their age above 30 years, The majority of them 76.7% were working as a bedside nurse, (60.6%) have not any training program in time management. The results showed that there are statistically significant improvement regarding to total level of general knowledge about renal failure and time management, total level of perception about importance of time management and perception about ability to control time wasters after 1 month and at follow up among studied nurses. Conclusion: the nursing educational intervention had a significant effect on improvement of the nurses' knowledge related to renal failure, hemodialysis, time management and performance. Also, it improved the perception of nurses about importance of time management in their performance and their ability to control time wasters. Recommendations: Orientation program for newly staff and continuous education for nurses in dialysis unit about time management and time waster with periodic evaluation of knowledge and practices for the nurses working at dialysis to assess what needs and appraisals. In addition to application of protocol or Schedule of care for patient with chronic renal failure CRF written in Arabic language to improve factor that reinforce time waster.
... 246 Physical and psychological discomfort associated with insertion, removal and the catheter in situ are common. 247 Complications such as inÁ ammation, urethral strictures, mechanical trauma, bladder calculi and other infections of the renal system also occur. 237,[248][249][250] Urine retention after catheter removal is also a frequent occurrence. ...
Article
The Department of Health commissioned a review of new evidence and we have updated the evidence base for making infection prevention and control recommendations. A critical assessment of the updated evidence indicated that the epic2 guidelines published in 2007 remain robust, relevant and appropriate, but some guideline recommendations required adjustments to enhance clarity and a number of new recommendations were required. These have been clearly identified in the text. In addition, the synopses of evidence underpinning the guideline recommendations have been updated.
Article
Urinary tract infections account for about 40% of hospital-acquired (nosocomial) infections, and about 80% of urinary tract infections acquired in hospital are associated with urinary catheters. To determine if certain antibiotic prophylaxes are better than others in terms of prevention of urinary tract infections, complications, quality of life and cost-effectiveness in short-term catheterisation in adults. We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and MEDLINE in Process, and handsearching of journals and conference proceedings (searched 31st October 2012). Additionally, we examined all reference lists of identified trials. All randomised and quasi-randomised trials comparing antibiotic prophylaxis for short-term (up to and including 14 days) catheterisation in adults. Data were independently extracted by all review authors and compared. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook for Systemtic Reviews of Interventions. Where data had not been fully reported, clarification was sought directly from the authors of the trial. Six parallel-group randomised controlled trials with 789 participants met the inclusion criteria. All six trials compared antibiotic prophylaxis versus no prophylaxis. Studies presented a low to unclear risk of bias with similar interventions and measured outcomes.The primary outcome of bacteriuria was less common in the prophylaxis group amongst surgical patients with asymptomatic bacteriuria (I(2) = 0; risk ratio (RR) 0.20; 95% confidence interval (CI) 0.13 to 0.31) . Two non-surgical studies could not be combined in a meta-analysis due to heterogeneity and only one showed significantly fewer cases of bacteriuria (RR 0.19; 95% CI 0.09 to 0.37).Two trials of surgical patients with asymptomatic bacteriuria only (255 participants) compared one type of antibiotic prophylaxis with another and neither study showed a significant difference in cases of bacteriuria.One study (78 participants) compared antibiotic prophylaxis in patients at catheterisation only versus antibiotic prophylaxis throughout catheterisation period with asymptomatic bacteriuria. Antibiotics at catheterisation only, resulted in significantly fewer cases of bacteriuria than giving prophylaxis throughout the catheterisation period (RR 0.29 95% CI 0.09 to 0.91).Secondary data of pyuria were provided by two surgical studies (255 participants). When studies were pooled, pyuria occurred in significantly fewer cases in the prophylactic antibiotic group (RR 0.23, 95% CI 0.13 to 0.42). The number of gram-negative isolates in patients' urine just before catheter removal in one study (RR 0.05, 95% CI 0.00 to 0.79) and six weeks after hospital discharge (RR 0.36, 95% CI 0.23 to 0.56) were significantly lower. There were no events in the treatment group before catheter removal. When pooled data from two studies showed significantly reduced febrile morbidity in those receiving antibiotic prophylaxis (RR 0.53 95% CI 0.31 to 0.89).Although all studies assessed micro-organisms isolated from the urine specimens the data were too heterogenous to pool in a meta-analysis and have been provided in a narrative form. Further secondary data such as economic analysis, length of stay and quality of life were not covered in detail. The limited evidence indicated that receiving prophylactic antibiotics reduced the rate of bacteriuria and other signs of infection, such as pyuria, febrile morbidity and gram-negative isolates in patients' urine, in surgical patients who undergo bladder drainage for at least 24 hours postoperatively. There was also limited evidence that prophylactic antibiotics reduced bacteriuria in non-surgical patients.
Chapter
Harnwegsinfektionen (HWI) gehören in Krankenhäusern mit einem Anteil von 22,4 % neben den postoperativen Wundinfektionen (24,7 %), Pneumonien (21,5 %), Infektionen mit Clostridium difficile (6,6 %) und der primären Sepsis (6 %) zu den häufigsten nosokomialen Infektionen. In 80 % der Fälle sind nosokomiale Harnwegsinfektionen mit einem Katheter assoziiert, wobei zwischen 12–16 % aller Krankenhauspatienten und bis zu 81,8 % aller Patienten auf Intensivstationen im Verlauf ihres stationären Aufenthaltes einen Blasenverweilkatheter erhalten. Fundierte Kenntnisse über die Grundlagen Harnwegskatheter-assoziierter Infektionen (HWKaI) und den sachgerechten Umgang mit Harnwegskathetern haben deshalb nicht nur eine große individuelle, sondern auch sozioökonomische Bedeutung. Es wird davon ausgegangen, dass bis zu 70 % aller HWKaI durch geeignete Präventionsmaßnahmen verhindert werden können.
Chapter
The purpose of this chapter is to assist nurse practitioners, particularly those specializing in urology, on how to recognize and manage urinary tract infections. Unfortunately, the lack of knowledge in assessing both a urine specimen correctly and the inability to correlate this information with a patient’s presenting signs and symptoms is cause for frequent misdiagnosis of urinary tract infections. In addition, the misuse and overuse of antibiotics in today’s society has made treating urinary tract infections more complicated. This chapter will review the different types of infections, the diagnostic testing required, as well as population-specific guidelines for proper management.
Conference Paper
Purpose: To identify factors associated with Registered Nurses' adoption of an evidence-based practice to reduce the duration of indwelling urinary catheterization in hospitalized adults. Background/Significance: Critical to health care reform is the demand for high-quality, cost-effective, and safe health care. Inclusion of evidence-based practice (EBP) related to patient safety is vital for healthcare organizations, and nurses play a pivotal role in translating evidence into practice. Despite long-standing indwelling urinary catheter protocols, catheter-associated urinary tract infections (CAUTI) continue to rise and constitute the most common type of healthcare acquired infections. Methods: Pilot study using mixed methods and a two-group pre/post study design. Instruments used included the Evidence-Based Practice Questionnaire (EBPQ) and the Adoption of the Early Catheter Discontinuation Protocol Questionnaire (AECDPQ). Qualitative data were collected via focus groups. Additionally, quantitative data were collected on the incidence and duration of urinary catheterization among patients on both units pre/post intervention of a nurse-driven protocol. Descriptive statistics and analysis of variance were used. Results: The change in mean total scores on the EBPQ from pre to post intervention was statistically significant between the two groups (F = 6.15, p = 0.018). Additionally, the results for the practice (F = 7.74, p = 0.009) and attitude (F = 9.85, p = 0.004) subscales were also statistically significant. The mean score for responses to the AECDPQ was 5.82 (SD = 0.83), well above the mean score of 4.0 (neutral), t(19) = 9.76, p < 0.001. The difference in mean change for duration of catheterization between the groups was statistically significant, F(1,251) = 5.83, P = 0.016. Conclusions and Implications for Practice: Results indicated that learning about and implementing a nurse-driven protocol was a factor in the intervention group nurses' perceptions of practice and attitudes related to EBP. The focus group responses indicated motivation to adopt changes in practice when the rationale was understood.
Article
Healthcare-associated infections (HAIs) are a major threat to patient safety, and are associated with mortality rates varying from 5% to 35%. Important risk factors associated with HAIs are the use of invasive medical devices (e.g. central lines, urinary catheters and mechanical ventilators), and poor staff adherence to infection prevention practices during insertion and care for the devices when in place. There are specific risk profiles for each device, but in general, the breakdown of aseptic technique during insertion and care for the device, as well as the duration of device use, are important factors for the development of these serious and costly infections. To assess the effectiveness of different interventions, alone or in combination, which target healthcare professionals or healthcare organisations to improve professional adherence to infection control guidelines on device-related infection rates and measures of adherence. We searched the following electronic databases for primary studies up to June 2012: the Cochrane Effective Paractice and Organisation of Care (EPOC) Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and CINAHL. We searched reference lists and contacted authors of included studies. We also searched the Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effectiveness (DARE) for related reviews. We included randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after (CBA) studies and interrupted time series (ITS) studies that complied with the Cochrane EPOC Group methodological criteria, and that evaluated interventions to improve professional adherence to guidelines for the prevention of device-related infections. Two review authors independently extracted data and assessed the risk of bias of each included study using the Cochrane EPOC 'Risk of bias' tool. We contacted authors of original papers to obtain missing information. We included 13 studies: one cluster randomised controlled trial (CRCT) and 12 ITS studies, involving 40 hospitals, 51 intensive care units (ICUs), 27 wards, and more than 3504 patients and 1406 healthcare professionals. Six of the included studies targeted adherence to guidelines to prevent central line-associated blood stream infections (CLABSIs); another six studies targeted adherence to guidelines to prevent ventilator-associated pneumonia (VAP), and one study focused on interventions to improve urinary catheter practices. We judged all included studies to be at moderate or high risk of bias.The largest median effect on rates of VAP was found at nine months follow-up with a decrease of 7.36 (-10.82 to 3.14) cases per 1000 ventilator days (five studies and 15 sites). The one included cluster randomised controlled trial (CRCT) observed, improved urinary catheter practices five weeks after the intervention (absolute difference 12.2 percentage points), however, the statistical significance of this is unknown given a unit of analysis error. It is worth noting that N = 6 interventions that did result in significantly decreased infection rates involved more than one active intervention, which in some cases, was repeatedly administered over time, and further, that one intervention involving specialised oral care personnel showed the largest step change (-22.9 cases per 1000 ventilator days (standard error (SE) 4.0), and also the largest slope change (-6.45 cases per 1000 ventilator days (SE 1.42, P = 0.002)) among the included studies. We attempted to combine the results for studies targeting the same indwelling medical device (central line catheters or mechanical ventilators) and reporting the same outcomes (CLABSI and VAP rate) in two separate meta-analyses, but due to very high statistical heterogeneity among included studies (I(2) up to 97%), we did not retain these analyses. Six of the included studies reported post-intervention adherence scores ranging from 14% to 98%. The effect on rates of infection were mixed and the effect sizes were small, with the largest median effect for the change in level (interquartile range (IQR)) for the six CLABSI studies being observed at three months follow-up was a decrease of 0.6 (-2.74 to 0.28) cases per 1000 central line days (six studies and 36 sites). This change was not sustained over longer follow-up times. The low to very low quality of the evidence of studies included in this review provides insufficient evidence to determine with certainty which interventions are most effective in changing professional behaviour and in what contexts. However, interventions that may be worth further study are educational interventions involving more than one active element and that are repeatedly administered over time, and interventions employing specialised personnel, who are focused on an aspect of care that is supported by evidence e.g. dentists/dental auxiliaries performing oral care for VAP prevention.
Chapter
Catheter-associated urinary tract infection (CAUTI) is common, costly, and is associated with significant patient morbidity, particularly with chronic indwelling urinary catheters. There has been an increased focus on the prevention of CAUTI since the Centers for Medicare and Medicaid Services instituted nonreimbursement for CAUTI. Interpretation of many studies of CAUTI is impeded by the failure to distinguish between symptomatic and asymptomatic bacteriuria. Consensus guidelines for the diagnosis, prevention, and treatment of CAUTI have been published by multiple organizations. However, a single, evidence-based approach to the diagnosis of urinary tract infection does not exist. Biofilms play a unique role in the pathogenesis of CAUTI and are associated with pathogens with a high propensity toward multidrug resistant organisms. Duration of urinary catheterization is the most important risk factor for CAUTI. Avoiding placement of indwelling catheters and promoting early removal of the catheter when appropriate are the most effective interventions to prevent CAUTI. Many aspects of the management of CAUTI merit further study. Practical strategies are needed to ensure effective use of proven infection prevention and ameliorate the burden of disease associated with indwelling urinary catheterization.
Chapter
Harnwegsinfektionen (HWI) gehören in Krankenhäusern mit einem Anteil von 22,4 % neben den postoperativen Wundinfektionen (24,7 %), Pneumonien (21,5 %), Infektionen mit Clostridium difficile (6,6 %) und der primären Sepsis (6 %) zu den häufigsten nosokomialen Infektionen. In 80 % der Fälle sind nosokomiale Harnwegsinfektionen mit einem Katheter assoziiert, wobei zwischen 12–16 % aller Krankenhauspatienten und bis zu 81,8 % aller Patienten auf Intensivstationen im Verlauf ihres stationären Aufenthaltes einen Blasenverweilkatheter erhalten. Fundierte Kenntnisse über die Grundlagen Harnwegskatheter-assoziierter Infektionen (HWKaI) und den sachgerechten Umgang mit Harnwegskathetern haben deshalb nicht nur eine große individuelle, sondern auch sozioökonomische Bedeutung. Es wird davon ausgegangen, dass bis zu 70 % aller HWKaI durch geeignete Präventionsmaßnahmen verhindert werden können.
Article
Background: The purpose of this study is to examine the incidence, risk factors, and morbidity of postoperative urinary tract infections (UTI) in pediatric surgical patients. Methods: All patients in the 2012-2016 American College of Surgeons National Surgical Quality Improvement Program Pediatric database were included. Demographics, comorbidities, and 30-day outcomes were assessed. Multivariable logistic regression was used to estimate the independent effects of patient and procedure characteristics on the risk for UTI and to estimate the effects of UTI on the risk for readmission and reoperation. Results: Of 369,176 patients, 1964 (0.5%) developed a postoperative UTI. Those undergoing urological and neurosurgical procedures were at greatest risk. Diabetes, ventilator dependence, and dependence on nutritional support each increased the odds of developing a UTI by more than 60% (P < 0.01). On multivariable analysis, UTI was an independent risk factor for unplanned readmission (OR, 4.93; 95% CI, 4.39-5.54; P < 0.001) and reoperation (OR, 1.21; 95% CI, 1.01-1.45; P = 0.041). Conclusion: Urinary tract infection is an uncommon but not inconsequential complication following surgery in the pediatric population and is associated with increased risk of readmission and reoperation. The identification of risk factors for postoperative UTI provides the opportunity for targeted surveillance and patient-specific interventions to prevent UTIs in children at greatest risk. Level of evidence: Level III, retrospective comparative study.
Article
Full-text available
Aims: To identify indicators of nursing care performance by identifying structures, processes, and outcomes that are relevant, feasible and have the potential for benchmarking in Swiss acute hospitals. Design: A modified Delphi-Consensus Technique. Methods: We examined 19 indicators based on the current evidence and that were pre-selected by nursing scientists. Between August-October 2019, a consortium of experts (representatives of different cantons, hospitals, and healthcare roles in Switzerland) determined the relevance, feasibility, and suitability for benchmarking these indicators in two-round modus of digital survey. Consensus was defined a priori by at least 75% agreement on the highest level of a 3-point Likert-type scale. Results: The response rate was 70.4% in the first and 68.4% in the second round. In round one consensus was reached for three indicators on relevance but for none of the indicators regarding feasibility or potential for benchmarking. For round two, the experts suggested two additional indicators (new total of 21 indicators). Of 21 indicators, consensus was reached on twelve regarding relevance, seven regarding feasibility, and two regarding the potential for benchmarking. Conclusion: A national expert consortium defined 12 of 21 nursing care indicators as relevant. Feasibility, however, was estimated only among seven indicators and a consensus on suitability for benchmarking was reached for two nursing-sensitive indicators. Impact: The results show how the indicators to evaluate nursing care performance, which have been identified as priority by Canadian nursing scientists, are assessed in a different setting. There are many overlaps, but also some differences in the assessment of the indicators between the different settings. Different health systems prioritize the indicators to evaluate nursing care performance differently, which is why national surveys are important for the compilation of their own (priority) indicator sets.
Article
Full-text available
INTRODUZIONE Il tessuto sociale del nostro Paese negli ultimi decenni ha acquistato spiccati caratteri di multiculturalità: secondo le stime più recenti (1° gennaio 2018), in Italia sono presenti circa 6,11 milioni di stranieri (10% della popolazione totale) (PoliS Lombardia-ORIM, 2018). In ragione di ciò è sempre più frequente prendersi cura di persone con diversa estrazione culturale, il che incide sulla gestione del sintomo doloroso (Weber SE, 1996; Ramer L et al., 1999; Peacock S et al., 2008; Narayan MC, 2010) ed esercita un'influenza sugli atteggiamenti e i comportamenti degli operatori sanitari. Secondo i dati di letteratura, ad esempio, gli infermieri gestiscono in modo subottimale il dolore di malati di cultura differente dalla loro (Weissman D et al., 2004). Il problema è destinato ad aumentare di rilevanza negli anni a venire e non più eludibile da un punto di vista clinico, assistenziale ed etico. L'obiettivo del presente studio è dunque di illustrare un approccio culturalmente sensibile alla persona con dolore. MATERIALI E METODI Per rispondere a tale obiettivo è stata condotta una revisione della letteratura. Il reperimento dei record utili è avvenuto interrogando i database biomedici PubMed, CINAHL, EMBASE, PsycINFO, Web of Science e Scopus con l'utilizzo delle seguenti parole chiave: pain, culture, nursing, nurse, "transcultural nursing", "culture (anthropological)", "cultural anthropology", "nurse attitude". Una prima selezione dei record ottenuti è avvenuta per pertinenza all'argomento e rilevanza di titolo e/o abstract; successivamente si è proceduto ad un ulteriore processo di screening in base a pertinenza e/o rilevanza dopo lettura integrale dei full text dei documenti eleggibili. Da ultimo, quelli da includere nella revisione sono stati sottoposti ad analisi e sintesi narrativa. RISULTATI La strategia di ricerca è stata implementata il 26 febbraio 2020. I record individuati sono stati complessivamente sessantadue. Al termine del processo di selezione sono stati ritenuti pertinenti e rilevanti per l'obiettivo dello studio e quindi inclusi ventuno documenti.
Chapter
The purpose of this chapter is to assist advanced practice providers, particularly those specializing in urology, on how to recognize and manage urinary tract infections. Unfortunately, the lack of knowledge in assessing both a urine specimen correctly and the inability to correlate this information with a patient’s presenting signs and symptoms is cause for frequent misdiagnosis of urinary tract infections. In addition, the misuse and overuse of antibiotics in today’s society has made treating urinary tract infections more complicated and contributed to a need for proper antibiotic stewardship. This chapter will review the different types of infections, the diagnostic testing required, as well as population-specific guidelines for proper management.
Article
Catheterisation is often a necessary measure for those in care homes, but it is an invasive procedure that must be performed carefully and with due diligence. Barry Hill and Aby Mitchell provide guidance on catheter insertion and management
Research Proposal
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Urinary tract infections (UTIs) are among the most common infectious diseases of humans, with Escherichia coli being responsible for >80% of all cases. The study was conducted to isolate and determine the antibiotic resistance in E. coli from urinary tract infections from AL-Yarmouk Teaching Hospital in Baghdad. Widespread use of antibiotics has led to the emergence of resistant bacteria. As the antibiotic sensitivity profile of the bacteria is frequently changing, this retrospective analysis was designed to assess the recent antibiotic sensitivity among urinary catheter and non-catheter Escherichia coli isolates. A total of 129 clinical urine specimens were collected from patients suffering from urinary tract infection 92 from hospital urinary catheterized patients and 37 non-catheterized patients. The sensitivity pattern of E. coli isolates to antibiotics in UTI were amoxicillin/clavulanic acid (65.11%), cefotaxime (69.76%), ceftazidime (62.79%), ceftriaxone (72.09%), ciprofloxacin (60.46%), gentamicin (46.51%), imipenem (0%), meropenem (0%) and nitrofurantion (0%) hence E. coli considered as a multidrug resistant organism.However, the percentage of antibiotics resistant isolates was statistically significant difference in urinary catheter compared to non-catheter Escherichia coli isolates.
Article
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The aim of the study was to assess the effect of nursing education intervention on time management for nurses in dialysis unit. Hypothesis: After the nursing education intervention: 1- the knowledge of nurses about renal failure, hemodialysis and time management will increase, 2- The perception of nurses about importance of time management in improving their performance and the perception about their ability to control time wasters will increase. 3- The performance of nurses will improve after receiving the educational intervention. Design: Quasi-experimental design used. Setting: dialysis unit at Benha university hospitals and health insurance hospital used to conduct study. Tools: two tools were designed; I): Interview questionnaire sheet: It consists of four parts (I): It consisted of personal identification and demographic characteristics of the studied nurses. Part (II): to assess nurses' general knowledge about renal failure and hemodialysis. Part III: Time management perception questionnaire. Part IV: Time waters' perception questionnaire. Tool (II): Observational Checklist for nurses' performance with workload at dialysis unit. Results: The results of the study revealed that (58.3%) of nurses were working at Benha University Hospital and having experience at dialysis unit more than 5 years. more than half (55%) their age above 30 years, The majority of them 76.7% were working as a bedside nurse, (60.6%) have not any training program in time management. The results showed that there are statistically significant improvement regarding to total level of general knowledge about renal failure and time management, total level of perception about importance of time management and perception about ability to control time wasters after 1 month and at follow up among studied nurses. Conclusion: the nursing educational intervention had a significant effect on improvement of the nurses' knowledge related to renal failure, hemodialysis, time management and performance. Also, it improved the perception of nurses about importance of time management in their performance and their ability to control time wasters. Recommendations: Orientation program for newly staff and continuous education for nurses in dialysis unit about time management and time waster with periodic evaluation of knowledge and practices for the nurses working at dialysis to assess what needs and appraisals. In addition to application of protocol or Schedule of care for patient with chronic renal failure CRF written in Arabic language to improve factor that reinforce time waster. Keywords: Dialysis, Workload, Time management, time waster.
Article
Objective: The objective of this evidence based implementation project was to promote evidence based practice in the prevention of catheter-associated urinary tract infection (CAUTI) in the neurology and neurosurgery units of a Taipei hospital. Introduction: Catheter-associated urinary tract infection has been associated with increased morbidity, mortality, hospital costs and length of stay. Urinary drainage systems are often reservoirs of infection in patients, thus effective prevention of CAUTI requires an evidence-based approach. The CAUTI incidence in the neurosurgery units of the hospital was 1.86-2.69% urinary catheter days, which ranked as medium when compared to the entire hospital. Method: A clinical audit was undertaken using the Joanna Briggs Institute Practical Application of Clinical Evidence System tool, based on eight audit criteria that represented best practice recommendations for CAUTI. A baseline audit of the neurology and neurosurgery units was performed, followed by the implementation of multiple strategies throughout a 20-week period. A follow-up audit was undertaken after this to assess changes in practice. Results: The post strategy implementation audit results indicated that compliance with clinical guideline recommendations improved considerably. Proper utilization of an appropriate closed drainage system and training of persons maintaining catheters achieved 100% compliance. The guideline recommendation that catheter and drainage bags be changed only when clinically indicated reached 94% compliance. Catheters removed within 24 hours postoperatively improved by more than 50% compliance. Compliance with systemic antimicrobials being clinically indicated and their use justified improved by 25% and documentation on a clinically appropriate indication for ongoing urinary catheterization improved by almost 33.3%. Conclusions: The implementation project was successful in improving nurses' knowledge and skills related to the prevention of CAUTI. A variety of strategies, such as an education program, simple and clear instruments, collaboration with physicians in caring for patients with a high risk of CAUTI, and multiple educational materials can facilitate implementation of evidence based procedures in clinical practice.
Article
Harnwegsinfektionen (HWI) haben als eine der häufigsten bakteriellen Infektionen in der Humanmedizin eine große Bedeutung. Wegen der steigenden Prävalenz multiresistenter Erreger sollte zur Diagnostik stets eine Urinkultur angelegt werden, um den ungezielten Einsatz von Antibiotika zu vermeiden. Zur Prophylaxe rezidivierender HWI der Frau stehen nach dem Ausschluss prädisponierender Faktoren heute eine Vielzahl verhaltenstherapeutischer, medikamentöser und supportiver Behandlungsoptionen zur Verfügung. Dabei haben Vakzinen, Probiotika (Laktobazillen) und standardisierte Phytopharmaka vor dem Hintergrund der Antibiotikaresistenzentwicklung einen wachsenden Stellenwert. Nosokomiale HWI sind zu 80 % mit einem Harnwegskatheter assoziiert. Es wird davon ausgegangen, dass bis zu 70 % dieser Infektionen durch geeignete Präventionsmaßnahmen verhindert werden können. Fundierte Kenntnisse der Grundlagen harnwegskatheterassoziierter Infektionen (HKI) und der korrekte Umgang mit Harnwegskathetern haben deshalb nicht nur eine große individuelle sondern auch sozioökonomische Bedeutung.
Research
Full-text available
Urinary tract infections (UTIs) are among the most common infectious diseases of humans, with Escherichia coli being responsible for >80% of all cases. The study was conducted to isolate and determine the antibiotic resistance in E. coli from urinary tract infections from AL-Yarmouk Teaching Hospital in Baghdad. Widespread use of antibiotics has led to the emergence of resistant bacteria. As the antibiotic sensitivity profile of the bacteria is frequently changing, this retrospective analysis was designed to assess the recent antibiotic sensitivity among urinary catheter and non-catheter Escherichia coli isolates. A total of 129 clinical urine specimens were collected from patients suffering from urinary tract infection 92 from hospital urinary catheterized patients and 37 non-catheterized patients. The sensitivity pattern of E. coli isolates to antibiotics in UTI were amoxicillin/clavulanic acid (65.11%), cefotaxime (69.76%), ceftazidime (62.79%), ceftriaxone (72.09%), ciprofloxacin (60.46%), gentamicin (46.51%), imipenem (0%), meropenem (0%) and nitrofurantion (0%) hence E. coli considered as a multidrug resistant organism.However, the percentage of antibiotics resistant isolates was statistically significant difference in urinary catheter compared to non-catheter Escherichia coli isolates.
Preprint
Full-text available
Urinary tract infections (UTIs) are among the most common infectious diseases of humans, with Escherichia coli being responsible for >80% of all cases. The study was conducted to isolate and determine the antibiotic resistance in E. coli from urinary tract infections from AL-Yarmouk Teaching Hospital in Baghdad. Widespread use of antibiotics has led to the emergence of resistant bacteria. As the antibiotic sensitivity profile of the bacteria is frequently changing, this retrospective analysis was designed to assess the recent antibiotic sensitivity among urinary catheter and non-catheter Escherichia coli isolates. A total of 129 clinical urine specimens were collected from patients suffering from urinary tract infection 92 from hospital urinary catheterized patients and 37 non-catheterized patients. The sensitivity pattern of E. coli isolates to antibiotics in UTI were amoxicillin/clavulanic acid (65.11%), cefotaxime (69.76%), ceftazidime (62.79%), ceftriaxone (72.09%), ciprofloxacin (60.46%), gentamicin (46.51%), imipenem (0%), meropenem (0%) and nitrofurantion (0%) hence E. coli considered as a multidrug resistant organism.However, the percentage of antibiotics resistant isolates was statistically significant difference in urinary catheter compared to non-catheter Escherichia coli isolates.
Chapter
Management of conservative bladder dysfunction and urinary incontinence is usually the domain of nurses. For successful treatment and management, the knowledge and skill of appliances that are available and teaching patients and carers how to use the products are keys to success. In this chapter a latest comprehensive overview is given of absorbent products, intermittent catheterisation and dilatation, the male external catheter and indwelling catheterisation (urethral and suprapubic). Also included are catheter materials, types of catheters, Charrière or French gauge and catheter management is described. For each subject nursing interventions like patient assessment, education, explanation, training, documentation, solutions for challenges with appliances and follow-up care will be discussed. Photos and flowcharts are used to explain products, conservative management or trouble shooting. Scientific data such as the latest literature and evidence-based (nursing) guidelines have been used to justify objective description of the subject of this chapter.
Article
Aims and objectives: The aim of the study is to investigate the effect of educating nurses on preventing catheter-associated urinary tract infections in patients who undergo hip fracture surgery. Background: Urinary tract infections after hip fracture surgery are observed at a rate of 12% to 61%, and the most important risk factor associated with urinary tract infection is considered to be the presence of urinary catheters. Nurse education about the use and management of urinary catheters is important to decrease the risk of urinary tract infections. Design: The study was semi-experimental. Methods: The study was conducted in an orthopedics and traumatology clinic of a training hospital between January 2014 and December 2015. After a power analysis was performed, a total of 60 patients fulfilled the criteria to be included in the study, with n=30 in the pre-education group and n=30 in the post-education group. Nurses who worked in the orthopedics and traumatology clinic of the military hospital were the target population, and 18 nurses who consented to join the study constituted the sample. The "Patient Monitoring Form", "Nurse Information Form" and "Daily Urinary Catheter Assessment Tool" were used as data collection tools. Results: The mean pre-education knowledge score of the nurses was found to be 68.05±10.69, while the mean post-education score was 95.13±6.27. The mean catheter duration decreased from 11.06±6.34 days to 3.83±0.95 days after the education. The catheter-associated urinary tract infection rate decreased by 9.37 per thousand. Conclusion: Educating nurses on preventing catheter-associated urinary tract infections in patients who underwent hip fracture surgery significantly decreased the rate of catheter-associated urinary tract infections and the duration of catheterization. This article is protected by copyright. All rights reserved.
Article
Background: Reducing the incidence of indwelling urinary catheter (IUC) use and early removal of the devices that are inserted are appropriate priorities for quality patient care. Just like symptomatic bacteriuria, failed catheter removal as a complication of IUC use is associated with considerable morbidity. In the ideal setting, patients that need IUCs have them, and patients that do not need them will have them safely removed, with the goal of reducing medical complications and facilitating the rehabilitation phase of care. Objective: To determine the incidence of failed removal of indwelling urethral catheters (IUCs) and the factors associated with failed removal in persons hospitalized with acute stroke. Design: Retrospective review of medical records and associated clinical data collection platforms. Setting: Comprehensive stroke center at a tertiary care hospital PATIENTS: The study cohort included 175 stroke patients admitted to the hospital and managed with IUCs. Mean age was 66.1 years (Standard Deviation = 15), 55% were female. Methods: Univariable and multiple logistic regression analyses were performed. Variables assessed included age, gender, race, duration of hospital stay, stroke subtype, National Institutes of Health Stroke Scale and 6-Clicks Scale, which is a measure of functional status. Main outcome measurements: The dependent variable was occurrence of a failed attempt at removal of an IUC - defined as removal followed by a catheter reinsertion. Results: Over the study period, 175 of 432 patients with acute hospital admission for new stroke had an IUC removal event. Of these patients, 46 (26%) experienced a failed catheter removal. On univariate analysis, factors significantly associated with failed removal included presence of a hemorrhagic stroke (p = .005), lower level of physical function (by 6-Clicks and NIHSS scores), hospital length of stay (p < .001) and discharge location (p = .005). Bedside bladder ultrasound testing by nursing staff was more frequently utilized in the group of patients who had failed IUC removals (95% confidence interval: 4.561 - 21.669, p<.001). Length of stay (p < .001), white race (p = .001), and hemorrhagic stroke (p = .009) were independently associated with failed catheter removal after adjustment for other clinical variables CONCLUSIONS: This single site study identified a high incidence of failed urinary catheter removal in stroke patients, along with factors associated with failed removal. This is the first step in developing a predictive model that could reduce the incidence of this adverse event. Policies, penalties and protocols designed to reduce catheter days must be sensitive to the special situations where IUCs are medically necessary and equal consideration given to identifying the patients for which catheter removal poses a greater risk than continued catheter use.
Article
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Objective. To identify nursing actions in the perioperative period and in preparing prostatectomy patients for discharge. Methodology. Cross-sectional, retrospective study. Data were collected from medical record of patients who underwent partial or total prostatectomy between August 2009 and August 2010 at hospitals in Divinopolis, Minas Gerais, Brazil. Results. A total of 121 patients were identified; the mean age was 67 years. The most frequent diagnosis was prostate cancer (70%). Main preoperative activities were measuring vital signs (55%), administering drugs (52%), educating patients about fasting (50%), and managing edema (45%). After surgery, the most frequent tasks were measuring vital signs (100%), measuring urine and emptying the urinary bag (100% for each), facilitating the healing of surgical wounds (77%), and evaluating Penrose drain discharge (48%). Among the 25 types of care observed, the activity that nurses performed most often for patients about to be discharged was providing education about urinary catheter manipulation (16%). Conclusion. This study identified weaknesses in care delivery for prostatectomy patients, particularly regarding home care education.
Article
National evidence-based guidelines for preventing healthcare-associated infections (HCAI) in National Health Service (NHS) hospitals in England were commissioned by the Department of Health (DH) and developed during 1998-2000 by a nurse-led multi-professional team of researchers and specialist clinicians. Following extensive consultation, they were published in January 2001.1 These guidelines describe the precautions healthcare workers should take in three areas: standard principles for preventing HCAI, which include hospital environmental hygiene, hand hygiene, the use of personal protective equipment, and the safe use and disposal of sharps; preventing infections associated with the use of short-term indwelling urethral catheters; and preventing infections associated with central venous catheters.
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