scholarly journals National Trends of Incidence of Catheter-Associated Urinary Tract Infections in Acute-Care Hospitals

2020 ◽  
Vol 41 (S1) ◽  
pp. s327-s327
Author(s):  
Minn Soe ◽  
Qunna Li ◽  
Allan Nkwata ◽  
Margaret Dudeck ◽  
Jonathan Edwards
Keyword(s):  
Urinary Tract ◽  
Patient Care ◽  
Incidence Rate ◽  
Acute Care ◽  
Negative Binomial ◽  
Average Length ◽  
Acute Care Hospitals ◽  
Interrupted Time Series Analysis ◽  
Tract Infections ◽  
National Trends

Background: An indwelling urinary catheter is used in ~12%–16% of adult hospital inpatients during their hospitalization, which poses risks for acquiring a catheter-associated urinary tract infection (CAUTI). CAUTI data have been reported to the NHSN since 2005, and national benchmarks are annually reported in NHSN progress reports. Trends analyses in the incidence of CAUTI reported to the NHSN over long time have not been previously assessed. Objective: We investigated the national trends of CAUTI incidence separately for intensive care units (ICUs) and wards in acute-care hospitals (ACHs) from 2009 through 2018. Methods: We analyzed CAUTI data from ACHs reported to NHSN in 2009–2018. To evaluate trends of CAUTI incidence (per 1,000 catheter days), we conducted interrupted time-series analysis using negative-binomial mixed-effects modeling, separately for ICUs (nonneonatal ICUs) and wards. Due to the reporting requirement for adult and pediatric ICUs in 2012, and medical, surgical, and medical-surgical wards in 2015 by the CMS and the institution of the NHSN CAUTI definitional changes in 2015, calendar years 2012 and 2015 were treated as interruptions to the outcome in ICU models, and year 2015 was treated as a single interruption in the ward models. Regression models were assessed and adjusted, as appropriate, for patient care location type and facility-level characteristics such as hospital type, teaching status, bed size, number (and percentage) of ICU beds, and average length of inpatient stay. Random intercept and slope models were evaluated with covariance tests and were included to account for differential baseline incidence and trends among reporting hospitals. Results: The volume of patient care locations and hospitals reporting to the NHSN increased over time. Among the ICUs, the CAUTI incidence rate did not change in 2009–2012 and increased at an average of 5.6% per year in 2012–2014 (Fig. 1). CAUTI incidence rate dropped nearly 40% in 2015; thereafter, it decreased at an average of 8.9% per year. Among the wards, CAUTI incidence rate decreased at an average of 4.3% per year beginning 2009 (Fig. 2). The CAUTI incidence rate dropped almost 28% in 2015 and then decreased at an average of 4.3% per year. Conclusions: CAUTI incidence decreased substantially in 2015 among both ICUs and wards, which was partially attributable to CAUTI definitional change (see also Fig. 7 at https://www.cdc.gov/hai/data/archive/data-summary-assessing-progress.html). The significant decline of CAUTI incidence in both location types since 2015 is encouraging, and continued efforts in prevention of CAUTI are vital to sustaining this decline in the future.Funding: NoneDisclosures: None

scholarly journals 1162. An Evaluation of Metrics for Catheter-Associated Urinary Tract Infections (CAUTIs): A Statewide Comparison

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S415-S416
Author(s):  
Dana Pepe ◽  
Meghan Maloney ◽  
Vivian Leung ◽  
Adora Harizaj ◽  
David Banach ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
Healthcare Research ◽  
Hospital Data ◽  
Care Practices ◽  
Data Elements ◽  
Tract Infections ◽  
Facility Size ◽  
Catheter Care

Abstract Background The Standardized Infection Ratio (SIR) is a metric used to gauge catheter-associated urinary tract infection (CAUTI) prevention, both locally and nationally. The device utilization ratio (DUR) is a process metric that captures catheter harm. More recently, the cumulative attributable difference (CAD) was introduced, which identifies the number of excess infections that need to be prevented to reach the desired goal. Our objective was to evaluate these metrics across all acute care hospitals in Connecticut (CT) by facility size. Methods A CAUTI Targeted Assessment for Prevention (TAP) Report for acute care hospitals across CT was generated from 1/1/2018 to December 31/2018, using the National Healthcare Safety Network (NHSN) database. CAUTI events, SIR, DUR, and CAD were compared across all hospitals. The SIR goal of 0.75 was used to calculate the CAD. Hospitals were stratified into large ( >425 beds), medium (250 to 424 beds), and small ( <249 beds) based on the Healthcare Cost and Utilization Project NIS Description of Data Elements, Agency for Healthcare Research and Quality for urban hospitals in the northeast region. Results A comparison of CAUTI metrics for 29 acute care hospitals across CT is shown in Table 1. Median SIR and DUR were 0.97, 1.02, 0.77, and 22%, 14%, 14.5% for large, medium and small hospitals, respectively. Of the 20 small hospitals, SIR could not be calculated for 5 hospitals, while 2 hospitals had an SIR = 0, as they had no reported infections. Median CAD for large, medium and small hospitals was 6.17, 1.3 and 0.25, respectively. Of note, 40% of small hospitals (J – CC, as in Table 1) had a negative CAD. Interestingly, 5 of these 8 hospitals with a negative CAD had a DUR higher than 16%. Conclusion Based on CT hospital data, metrics like CAD and SIR may be more suitable for larger hospitals or hospitals with higher CAUTI events, whereas DUR may be a more useful metric for smaller hospitals or hospitals with rare events. Hospitals with high SIR and low DUR may represent a population with high-risk catheter use, poor catheter care or higher rates of urine culturing. On the other hand, hospitals with high DUR and low SIR may represent low-risk populations, better catheter care practices or lower rates of urine culturing. Ultimately, we need a combination of metrics to measure preventable catheter harm. Disclosures Louise Dembry, MD, MS, MBA, ReadyDock: Consultant, Stock options.

Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals: 2014 Update

2014 ◽  
Vol 35 (5) ◽  
pp. 464-479 ◽  
Author(s):  
Evelyn Lo ◽  
Lindsay E. Nicolle ◽  
Susan E. Coffin ◽  
Carolyn Gould ◽  
Lisa L. Maragakis ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Acute Care ◽  
Urinary Tract Infections ◽  
Acute Care Hospitals ◽  
Guidance Document ◽  
American Hospital ◽  
American Hospital Association ◽  
Tract Infections ◽  
Healthcare Associated ◽  
Healthcare Epidemiology

Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their catheter-associated urinary tract infection (CAUTI) prevention efforts. This document updates “Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA). the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.

The Prevalence of Health Care–Associated Infection in Older People in Acute Care Hospitals

2011 ◽  
Vol 32 (8) ◽  
pp. 763-767 ◽  
Author(s):  
Shona Cairns ◽  
Jacqui Reilly ◽  
Sally Stewart ◽  
Debbie Tolson ◽  
Jon Godwin ◽  
...  
Keyword(s):  
Health Care ◽  
Urinary Tract ◽  
Older People ◽  
Acute Care ◽  
Hospital Care ◽  
Age Groups ◽  
Acute Care Hospitals ◽  
Gastrointestinal Infections ◽  
Health Care Associated Infection ◽  
Tract Infections

Objective.To determine the prevalence of health care-associated infection (HAI) in older people in acute care hospitals, detailing the specific types of HAI and specialties in which these are most prevalent.Design.Secondary analysis of the Scottish National Healthcare Associated Infection Prevalence Survey data set.Patients and Setting.All inpatients in acute care (n = 11,090) in all acute care hospitals in Scotland (n = 45).Results.The study found a linear relationship between prevalence of HAI and increasing age (P<.0001) in hospital inpatients in Scotland. Urinary tract infections and gastrointestinal infections represented the largest burden of HAI in the 75–84- and over-85-year age groups, and surgical-site infections represented the largest burden in inpatients under 75 years of age. The prevalence of urinary catheterization was higher in each of the over-65 age groups (P<.0001). Importantly, this study reveals that a high prevalence of HAI in inpatients over the age of 65 years is found across a range of specialties within acute hospital care. An increased prevalence of HAI was observed in medical, orthopedic, and surgical specialties.Conclusions.HAI is an important outcome indicator of acute inpatient hospital care, and our analysis demonstrates that HAI prevalence increases linearly with increasing age (P<.0001). Focusing interventions on preventing urinary tract infection and gastrointestinal infections would have the biggest public health benefit. To ensure patient safety, the importance of age as a risk factor for HAI cannot be overemphasized to those working in all areas of acute care.

Economic evaluation of quality improvement interventions to prevent catheter-associated urinary tract infections in the hospital setting: a systematic review

2021 ◽  
pp. bmjqs-2021-013839
Author(s):  
Sara G McCleskey ◽  
Lili Shek ◽  
Jonathan Grein ◽  
Hiroshi Gotanda ◽  
Laura Anderson ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Urinary Tract ◽  
Acute Care ◽  
Urinary Tract Infections ◽  
Grey Literature ◽  
Hospital Setting ◽  
Cost Savings ◽  
Acute Care Hospitals ◽  
Economic Evaluations ◽  
Tract Infections

BackgroundHospitals have implemented diverse quality improvement (QI) interventions to reduce rates of catheter-associated urinary tract infections (CAUTIs). The economic value of these QI interventions is uncertain.ObjectiveTo systematically review economic evaluations of QI interventions designed to prevent CAUTI in acute care hospitals.MethodsA search of Ovid MEDLINE, Econlit, Centre for Reviews & Dissemination, New York Academy of Medicine’s Grey Literature Report, WorldCat, IDWeek conference abstracts and prior systematic reviews was conducted from January 2000 to October 2020.We included English-language studies of any design that evaluated organisational or structural changes to prevent CAUTI in acute care hospitals, and reported programme and infection-related costs.Dual reviewers assessed study design, effectiveness, costs and study quality. For each eligible study, we performed a cost-consequences analysis from the hospital perspective, estimating the incidence rate ratio (IRR) and incremental net cost/savings per hospital over 3 years. Unadjusted weighted regression analyses tested predictors of these measures, weighted by catheter days per study.ResultsFifteen unique economic evaluations were eligible, encompassing 74 hospitals. Across 12 studies amenable to standardisation, QI interventions were associated with a 43% decline in infections (mean IRR 0.57, 95% CI 0.44 to 0.70) and wide ranges of net costs (mean US$52 000, 95% CI −$288 000 to $392 000), relative to usual care.ConclusionsQI interventions were associated with large declines in infection rates and net costs to hospitals that varied greatly but that, on average, were not significantly different from zero over 3 years. Future research should examine specific practices associated with cost-savings and clinical effectiveness, and examine whether or not more comprehensive interventions offer hospitals and patients the best value.

scholarly journals Incidence Trends of Central-Line–Associated Bloodstream Infections in Acute-Care Hospitals, NHSN, 2009–2018

2020 ◽  
Vol 41 (S1) ◽  
pp. s294-s295
Author(s):  
Allan Nkwata ◽  
Minn Soe ◽  
Qunna Li ◽  
Dominque Godfrey-Johnson ◽  
Jonathan Edwards ◽  
...  
Keyword(s):  
Acute Care ◽  
Negative Binomial ◽  
National Level ◽  
Bloodstream Infections ◽  
Acute Care Hospitals ◽  
The United States ◽  
Central Line ◽  
Incidence Trends ◽  
Tract Infections ◽  
Location Type

Background: Central-line–associated bloodstream infections (CLABSIs) are an important cause of healthcare-associated morbidity and mortality in the United States. CLABSI surveillance in the CDC NHSN began in 2005 and has been propelled by state CLABSI reporting requirements, first introduced in 2005, and subsequently by the CMS requirements for intensive care units (ICUs) in 2011 and select ward locations in 2015. Although trend analyses were previously reported, no recent assessment of the NHSN CLABSI incidence rate changes has been performed. In this analysis, we evaluated trends in CLABSI rates in nonneonatal ICUs and all wards reported from acute-care hospitals. Methods: CLABSI rates, including blood stream infections attributed to mucosal barrier injury reported to the NHSN from 2009 to 2018, were analyzed. To evaluate trends in CLABSI incidence and to account for the potential impact of definitional changes in catheter-associated urinary tract infections (CAUTIs) that indirectly impacted CLABSI rates, as well as the CMS mandate for select wards, we conducted an interrupted time-series analysis using negative binomial random-effects modeling with an interruption in 2015. ICUs and ward locations were analyzed separately. Models were adjusted for patient care location type and hospital-level characteristics: hospital type, medical affiliation, teaching status, bed size, number of ICU beds, and average length of inpatient stay. Random intercept and slope models were used to account for differential baseline incidence and trends among reporting hospitals. Results: The overall crude incidence of CLABSI per 1,000 central-line days decreased from 1.6 infections in 2009 to 0.9 infections in 2018, except for an increase in 2015. Similar trends were observed by location type. Among the ICUs, adjusted CLABSI incidence decreased by 10% annually in 2009–2014, increased nearly 29% in 2015, and thereafter decreased at an average of 6.8% per year. Among the wards, adjusted CLABSI incidence decreased at an average of 7.9% annually, except for a 29.3% increase in 2015. Conclusions: Substantial progress has been made in reducing CLABSIs in both ICUs and wards over the last 10 years. Indirect effects of CAUTI definitional changes may explain the immediate increase in ICUs, whereas the CMS mandate may explain the similar increase in wards in 2015. Despite this increase, these findings suggest that policies and practices aimed at prevention of CLABSI have likely been effective on a national level.Funding: NoneDisclosures: None

Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals

2008 ◽  
Vol 29 (S1) ◽  
pp. S41-S50 ◽  
Author(s):  
Evelyn Lo ◽  
Lindsay Nicolle ◽  
David Classen ◽  
Kathleen M. Arias ◽  
Kelly Podgorny ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Acute Care ◽  
Urinary Catheter ◽  
Acute Care Hospitals ◽  
Urethral Catheter ◽  
Healthcare Associated Infections ◽  
Tract Infections ◽  
Healthcare Associated

Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections. The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their catheter-associated urinary tract infection (CAUTI) prevention efforts. Refer to the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America “Compendium of Strategies to Prevent Healthcare-Associated Infections” Executive Summary and Introduction and accompanying editorial for additional discussion.1. Burden of CAUTIsa. Urinary tract infection is the most common hospital-acquired infection; 80% of these infections are attributable to an indwelling urethral catheter.b. Twelve to sixteen percent of hospital inpatients will have a urinary catheter at some time during their hospital stay.c. The daily risk of acquisition of urinary infection varies from 3% to 7% when an indwelling urethral catheter remains in situ.2. Outcomes associated with CAUTIa. Urinary tract infection is the most important adverse outcome of urinary catheter use. Bacteremia and sepsis may occur in a small proportion of infected patients.b. Morbidity attributable to any single episode of catheterization is limited, but the high frequency of catheter use in hospitalized patients means that the cumulative burden of CAUTI is substantial.c. Catheter use is also associated with negative outcomes other than infection, including nonbacterial urethral inflammation, urethral strictures, and mechanical trauma.

scholarly journals Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals: 2014 Update

2014 ◽  
Vol 35 (S2) ◽  
pp. S32-S47 ◽  
Author(s):  
Evelyn Lo ◽  
Lindsay E. Nicolle ◽  
Susan E. Coffin ◽  
Carolyn Gould ◽  
Lisa L. Maragakis ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Acute Care ◽  
Urinary Tract Infections ◽  
Acute Care Hospitals ◽  
Guidance Document ◽  
American Hospital ◽  
American Hospital Association ◽  
Tract Infections ◽  
Healthcare Associated ◽  
Healthcare Epidemiology

Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their catheter-associated urinary tract infection (CAUTI) prevention efforts. This document updates “Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.

Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals: 2014 Update

2014 ◽  
Vol 35 (S2) ◽  
pp. S32-S47 ◽  
Author(s):  
Evelyn Lo ◽  
Lindsay E. Nicolle ◽  
Susan E. Coffin ◽  
Carolyn Gould ◽  
Lisa L. Maragakis ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Acute Care ◽  
Urinary Tract Infections ◽  
Acute Care Hospitals ◽  
Guidance Document ◽  
American Hospital ◽  
American Hospital Association ◽  
Tract Infections ◽  
Healthcare Associated ◽  
Healthcare Epidemiology

Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their catheter-associated urinary tract infection (CAUTI) prevention efforts. This document updates “Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.

Quality improvement in hospitals: barriers and facilitators

2017 ◽  
Vol 30 (1) ◽  
pp. 16-24 ◽  
Author(s):  
Dick E. Zoutman ◽  
B. Douglas Ford
Keyword(s):  
Patient Safety ◽  
Quality Improvement ◽  
Patient Care ◽  
Acute Care ◽  
Medical Staff ◽  
Acute Care Hospitals ◽  
Content Type ◽  
Active Involvement ◽  
Staff Engagement ◽  
Positive Impacts

Purpose The purpose of this paper is to examine quality improvement (QI) initiatives in acute care hospitals, the factors associated with success, and the impacts on patient care and safety. Design/methodology/approach An extensive online survey was completed by senior managers responsible for QI. The survey assessed QI project types, QI methods, staff engagement, and barriers and factors in the success of QI initiatives. Findings The response rate was 37 percent, 46 surveys were completed from 125 acute care hospitals. QI initiatives had positive impacts on patient safety and care. Staff in all hospitals reported conducting past or present hand-hygiene QI projects and C. difficile and surgical site infection were the next most frequent foci. Hospital staff not having time and problems with staff prioritizing QI with other duties were identified as important QI barriers. All respondents reported hospital leadership support, data utilization and internal champions as important QI facilitators. Multiple regression models identified nurses’ active involvement and medical staff engagement in QI with improved patient care and physicians’ active involvement and medical staff engagement with greater patient safety. Practical implications There is the need to study how best to support and encourage physicians and nurses to become more engaged in QI. Originality/value QI initiatives were shown to have positive impacts on patient safety and patient care and barriers and facilitating factors were identified. The results indicated patient care and safety would benefit from increased physician and nurse engagement in QI initiatives.

Enterococcal Infections: An Increasing Problem in Hospitalized Patients

1988 ◽  
Vol 9 (10) ◽  
pp. 457-461 ◽  
Author(s):  
Margaret S. Terpenning ◽  
Marcus J. Zervos ◽  
Dennis R. Schaberg ◽  
Carol A. Kauffman
Keyword(s):  
Nursing Home ◽  
Urinary Tract ◽  
Soft Tissue ◽  
Home Care ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
Older Men ◽  
Hospitalized Patients ◽  
Nursing Home Care ◽  
Overall Mortality

AbstractWe studied 157 episodes of infection or colonization with enterococci in 122 patients over a six-month period. One hundred twelve episodes (71.3%) occurred in patients over age 60 years. The most common sites for isolation of enterococci were the urinary tract, and bone and soft tissue. Nosocomial acquisition of enterococci occurred in 74.7% of all infections, and an additional 21% of episodes occurred in patients who had been transferred from another hospital or were regularly seen in the clinic. The overall mortality was 19.6%; 71.4% of those with bacteremia died. Enterococci appear to be significant pathogens, especially in older men in veterans' acute care hospitals and nursing home care units.

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