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- Title
A National Implementation Project to Prevent Catheter-Associated Urinary Tract Infection in Nursing Home Residents.
- Authors
Mody, Lona; Greene, M. Todd; Meddings, Jennifer; Krein, Sarah L.; McNamara, Sara E.; Trautner, Barbara W.; Ratz, David; Stone, Nimalie D.; Min, Lillian; Schweon, Steven J.; Rolle, Andrew J.; Olmsted, Russell N.; Burwen, Dale R.; Battles, James; Edson, Barbara; Saint, Sanjay
- Abstract
<bold>Importance: </bold>Catheter-associated urinary tract infection (UTI) in nursing home residents is a common cause of sepsis, hospital admission, and antimicrobial use leading to colonization with multidrug-resistant organisms.<bold>Objective: </bold>To develop, implement, and evaluate an intervention to reduce catheter-associated UTI.<bold>Design, Setting, and Participants: </bold>A large-scale prospective implementation project was conducted in community-based nursing homes participating in the Agency for Healthcare Research and Quality Safety Program for Long-Term Care. Nursing homes across 48 states, Washington DC, and Puerto Rico participated. Implementation of the project was conducted between March 1, 2014, and August 31, 2016.<bold>Interventions: </bold>The project was implemented over 12-month cohorts and included a technical bundle: catheter removal, aseptic insertion, using regular assessments, training for catheter care, and incontinence care planning, as well as a socioadaptive bundle emphasizing leadership, resident and family engagement, and effective communication.<bold>Main Outcomes and Measures: </bold>Urinary catheter use and catheter-associated UTI rates using National Healthcare Safety Network definitions were collected. Facility-level urine culture order rates were also obtained. Random-effects negative binomial regression models were used to examine changes in catheter-associated UTI, catheter utilization, and urine cultures and adjusted for covariates including ownership, bed size, provision of subacute care, 5-star rating, presence of an infection control committee, and an infection preventionist.<bold>Results: </bold>In 4 cohorts over 30 months, 568 community-based nursing homes were recruited; 404 met inclusion criteria for analysis. The unadjusted catheter-associated UTI rates decreased from 6.78 to 2.63 infections per 1000 catheter-days. With use of the regression model and adjustment for facility characteristics, the rates decreased from 6.42 to 3.33 (incidence rate ratio [IRR], 0.46; 95% CI, 0.36-0.58; P < .001). Catheter utilization was 4.5% at baseline and 4.9% at the end of the project. Catheter utilization remained unchanged (4.50 at baseline, 4.45 at conclusion of project; IRR, 0.95; 95% CI, 0.88-1.03; P = .26) in adjusted analyses. The number of urine cultures ordered for all residents decreased from 3.49 per 1000 resident-days to 3.08 per 1000 resident-days. Similarly, after adjustment, the rates were shown to decrease from 3.52 to 3.09 (IRR, 0.85; 95% CI, 0.77-0.94; P = .001).<bold>Conclusions and Relevance: </bold>In a large-scale, national implementation project involving community-based nursing homes, combined technical and socioadaptive catheter-associated UTI prevention interventions successfully reduced the incidence of catheter-associated UTIs.
- Subjects
UNITED States; ANTIBIOTICS; URINARY tract infection diagnosis; URINARY tract infection prevention; BACTERIOLOGY technique; PREVENTION of communicable diseases; COMPARATIVE studies; LONG-term health care; RESEARCH methodology; MEDICAL cooperation; NURSING care facilities; PREVENTIVE health services; RESEARCH; URINARY catheterization; URINARY tract infections; URINALYSIS; EVALUATION research; SENIOR housing; URINARY catheters; CATHETER-related infections; DIAGNOSIS; INFECTION prevention
- Publication
JAMA Internal Medicine, 2017, Vol 177, Issue 8, p1154
- ISSN
2168-6106
- Publication type
journal article
- DOI
10.1001/jamainternmed.2017.1689