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2113. Process Change Implementation to Decrease Catheter-Associated Urinary Tract Infections

BACKGROUND: More than 50% of catheter-associated urinary tract infections (CAUTI) occur within 5 days of urinary catheter (UC) insertion suggesting poor insertion technique. Breaks in sterile technique and inappropriate UC kit use were observed resulting in increased insertion-associated CAUTI (iCAU...

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Autores principales: Reese, Sara, Knepper, Bryan, Kurtz, Jennifer, Miller, Amber, Young, Heather
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254085/
http://dx.doi.org/10.1093/ofid/ofy210.1769
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author Reese, Sara
Knepper, Bryan
Kurtz, Jennifer
Miller, Amber
Young, Heather
author_facet Reese, Sara
Knepper, Bryan
Kurtz, Jennifer
Miller, Amber
Young, Heather
author_sort Reese, Sara
collection PubMed
description BACKGROUND: More than 50% of catheter-associated urinary tract infections (CAUTI) occur within 5 days of urinary catheter (UC) insertion suggesting poor insertion technique. Breaks in sterile technique and inappropriate UC kit use were observed resulting in increased insertion-associated CAUTI (iCAUTI, CAUTI occurring ≤5 days post-UC insertion). Specific challenges with UC insertion were identified in the emergency department (ED, high patient flow) and critical care units (CCU, high acuity). The objective of the study was to change the UC insertion process in the ED and CCU to reduce iCAUTI. METHODS: The study included pre-intervention (August 2016–May 2017), implementation (June–December 2017) and post-intervention (January–March 2018) periods. The interventions were use of a buddy system for UC insertions and the reduction of UC insertions in the ED. The buddy system involved critical care nurses inserting UC catheters with another healthcare worker present to ensure correct process and identify breaches in sterile technique. The ED was notified of the patients who (1) received a UC within 24 hours of admission and (2) received the UC in the ED resulting in raised awareness and joint effort between ED and CCU. An iCAUTI rate was calculated for each of the three periods. The proportion of UCs inserted using the buddy system and the proportion of admitted patients with UCs inserted in the ED were calculated. RESULTS: The iCAUTI rate decreased by 75.8% between pre-intervention (0.33 iCAUTI/100 UCs inserted) and implementation period (0.08) and increased slightly in post-intervention period (0.16). The ED demonstrated the largest decrease in iCAUTI rate between pre-intervention (0.40) and post-intervention (0.0). Buddy system adherence was 47.3% for the implementation and 58.2% for the post-implementation period. Patients who had UCs inserted in the ED decreased from 59.8% in pre-intervention, to 42.4% in implementation to 35.1% in the post-intervention period. CONCLUSION: A decrease in iCAUTI was observed with the implementation of a buddy system and reduction of UC insertions in the ED. Sustainability of the iCAUTI reduction program will be successful with the use of tools such as electronic medical records as well as culture change and staff buy in. Future directions will include expanding the program to acute care floors. DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-62540852018-11-28 2113. Process Change Implementation to Decrease Catheter-Associated Urinary Tract Infections Reese, Sara Knepper, Bryan Kurtz, Jennifer Miller, Amber Young, Heather Open Forum Infect Dis Abstracts BACKGROUND: More than 50% of catheter-associated urinary tract infections (CAUTI) occur within 5 days of urinary catheter (UC) insertion suggesting poor insertion technique. Breaks in sterile technique and inappropriate UC kit use were observed resulting in increased insertion-associated CAUTI (iCAUTI, CAUTI occurring ≤5 days post-UC insertion). Specific challenges with UC insertion were identified in the emergency department (ED, high patient flow) and critical care units (CCU, high acuity). The objective of the study was to change the UC insertion process in the ED and CCU to reduce iCAUTI. METHODS: The study included pre-intervention (August 2016–May 2017), implementation (June–December 2017) and post-intervention (January–March 2018) periods. The interventions were use of a buddy system for UC insertions and the reduction of UC insertions in the ED. The buddy system involved critical care nurses inserting UC catheters with another healthcare worker present to ensure correct process and identify breaches in sterile technique. The ED was notified of the patients who (1) received a UC within 24 hours of admission and (2) received the UC in the ED resulting in raised awareness and joint effort between ED and CCU. An iCAUTI rate was calculated for each of the three periods. The proportion of UCs inserted using the buddy system and the proportion of admitted patients with UCs inserted in the ED were calculated. RESULTS: The iCAUTI rate decreased by 75.8% between pre-intervention (0.33 iCAUTI/100 UCs inserted) and implementation period (0.08) and increased slightly in post-intervention period (0.16). The ED demonstrated the largest decrease in iCAUTI rate between pre-intervention (0.40) and post-intervention (0.0). Buddy system adherence was 47.3% for the implementation and 58.2% for the post-implementation period. Patients who had UCs inserted in the ED decreased from 59.8% in pre-intervention, to 42.4% in implementation to 35.1% in the post-intervention period. CONCLUSION: A decrease in iCAUTI was observed with the implementation of a buddy system and reduction of UC insertions in the ED. Sustainability of the iCAUTI reduction program will be successful with the use of tools such as electronic medical records as well as culture change and staff buy in. Future directions will include expanding the program to acute care floors. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2018-11-26 /pmc/articles/PMC6254085/ http://dx.doi.org/10.1093/ofid/ofy210.1769 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Reese, Sara
Knepper, Bryan
Kurtz, Jennifer
Miller, Amber
Young, Heather
2113. Process Change Implementation to Decrease Catheter-Associated Urinary Tract Infections
title 2113. Process Change Implementation to Decrease Catheter-Associated Urinary Tract Infections
title_full 2113. Process Change Implementation to Decrease Catheter-Associated Urinary Tract Infections
title_fullStr 2113. Process Change Implementation to Decrease Catheter-Associated Urinary Tract Infections
title_full_unstemmed 2113. Process Change Implementation to Decrease Catheter-Associated Urinary Tract Infections
title_short 2113. Process Change Implementation to Decrease Catheter-Associated Urinary Tract Infections
title_sort 2113. process change implementation to decrease catheter-associated urinary tract infections
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254085/
http://dx.doi.org/10.1093/ofid/ofy210.1769
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