Quality Gaps in Documenting Urinary Catheter Use and Infectious Outcomes

2013 ◽  
Vol 34 (8) ◽  
pp. 793-799 ◽  
Author(s):  
Barbara W. Trautner ◽  
Jan E. Patterson ◽  
Nancy J. Petersen ◽  
Sylvia Hysong ◽  
Deborah Horwitz ◽  
...  
Keyword(s):  
Infection Control ◽  
Urinary Catheter ◽  
Tertiary Care ◽  
Urinary Catheters ◽  
Indwelling Catheter ◽  
Term Care ◽  
Indwelling Catheters ◽  
Acute Medicine ◽  
Extended Care ◽  
Bed Days

Objective.To describe the frequency of use of all types of urinary catheters, including but not limited to indwelling catheters, as well as positive cultures associated with the various types. We also determined the accuracy of catheter-days reporting at our institution.Design.Prospective, observational trial based on patient-level review of the electronic medical record. Chart review was compared with standard methods of catheter surveillance and reporting by infection control personnel.Setting.Ten internal medicine and 5 long-term care wards in 2 tertiary care Veterans Affairs hospitals in Texas from July 2010 through June 2011.Participants.The study included 7,866 inpatients.Methods.Measurements included patient bed-days; days of use of indwelling, external, suprapubic, and intermittent urinary catheters; number of urine cultures obtained and culture results; and infection control reports of indwelling catheter-days.Results.We observed 7,866 inpatients with 128,267 bed-days on acute medicine and extended care wards during the study. A urinary catheter was used on 36.9% of the total bed-days observed. Acute medicine wards collected more urine cultures per 1,000 bed-days than did the extended care wards (75.9 and 10.4 cultures per 1,000 bed-days, respectively; P < .0001 ). Catheter-days were divided among indwelling-catheter-days (47.8%), external-catheter-days (48.4%), and other (intermittent- and suprapubic-catheter-days, 3.8%). External catheters contributed to 376 (37.3%) of the 1,009 catheter-associated positive urine cultures. Urinary-catheter-days reported to the infection control department missed 20.1% of the actual days of indwelling catheter use, whereas 12.0% of their reported catheter-days were false.Conclusions.Urinary catheter use was extremely common. External catheters accounted for a large portion of catheter-associated bacteriuria, and standard practices for tracking urinary-catheter-days were unreliable.Trial Registration.ClinicalTrials.gov identifier: NCT01052545.

scholarly journals Reducing the Use of Indwelling Urinary Catheters During Cesarean Deliveries

2017 ◽  
Vol 1 (2) ◽  
pp. 1-5
Author(s):  
Michelle Borland
Keyword(s):  
Urinary Tract ◽  
Needs Assessment ◽  
Cesarean Delivery ◽  
Small Community ◽  
Urinary Catheters ◽  
Indwelling Catheter ◽  
Indwelling Catheters ◽  
Cesarean Deliveries ◽  
Increased Risk ◽  
Tract Infections

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

Infected Urine as a Risk Factor for Postprostatectomy Wound Infection

1991 ◽  
Vol 12 (3) ◽  
pp. 147-149 ◽  
Author(s):  
Santiago Richter ◽  
Ruth Lang ◽  
Fruma Zur ◽  
Israel Nissenkorn
Keyword(s):  
Antibiotic Prophylaxis ◽  
Wound Infection ◽  
Urinary Catheter ◽  
Urinary Infection ◽  
Wound Infections ◽  
Open Prostatectomy ◽  
Indwelling Catheter ◽  
Indwelling Catheters ◽  
Infected Urine ◽  
Operation Wound

AbstractObjective:To study the relation of preoperative infected urine and postprostatectomy wound infection in patients with and without indwelling bladder catheters.Design:Patients undergoing prostatectomy were evaluated for the presence of infected urine prior to prostatectomy and postoperative wound infection. They were further divided into patients with indwelling urinary catheter and catheter-free patients. All had received antibiotic prophylaxis.Patients: One hundred fifty consecutive patients undergoing open prostatectomy-mean age was 67 years; 100 patients with an indwelling catheter for a mean period of 50 days; 50 catheter-free patients.Results:Wound infection was found in 19 of 81 (23.5%) and in 6 of 69 (8.7%) patients with infected and sterile urine, respectively p = .028). In patients with indwelling catheters prior to operation, wound infection was 22.4% when urine was infected and 8.3% when it was not. In patients without catheters, infected urine was associated with 40% of wound infections, as compared with 8.9% of wound infections in patients with sterile urine. Organisms obtained from infected wound and urine were identical in 84% of cases. These results were obtained despite antibiotic prophylaxis.Conclusions:Wound infection has been demonstrated to be a postprostatectomy complication directly related to the presence of urinary infection at surgery; thus, elective prostatectomy should be deferred until urine becomes sterile.

scholarly journals 506. Urinary Catheters Are Associated with Progression from Bacteriuria to Invasive Infections in Patients with Carbapenem-Resistant Enterobacteriaceae, Metropolitan Atlanta, 2011–2017

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S245-S246
Author(s):  
Jessica Howard-Anderson ◽  
Chris W Bower ◽  
Gillian Smith ◽  
Mary Elizabeth Sexton ◽  
Sarah W Satola ◽  
...  
Keyword(s):  
Risk Factors ◽  
Urinary Catheter ◽  
Decubitus Ulcer ◽  
Invasive Infection ◽  
Urinary Catheters ◽  
Term Care ◽  
Carbapenem Resistant ◽  
Sterile Site ◽  
One Year ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Patients with carbapenem-resistant Enterobacteriaceae (CRE) bacteriuria have better outcomes than patients with an invasive CRE infection, but patients with bacteriuria may subsequently develop an invasive infection (“progression”). We sought to evaluate risk factors, particularly urinary catheters, for progression from CRE bacteriuria to an invasive CRE infection within one year. Methods We used population-based active surveillance data from the Georgia Emerging Infections Program to identify patients in metropolitan Atlanta with CRE in urine, but not in a concomitant or previous sterile site between August 1, 2011 and July 31, 2017. CRE was defined as an isolate resistant to tested third-generation cephalosporins and a minimum inhibitory concentration of ≥4 µg/mL for meropenem, doripenem or imipenem. We then assessed if these patients developed an invasive CRE infection (positive sterile site culture) with the same organism between one day and one year later. Demographics, culture site, comorbidities, and risk factors were obtained by chart review. Univariable analyses and multivariable logistic regression with progression as the outcome were performed in SAS 9.4. Results We identified 551 patients with CRE bacteriuria in 6 years, with an annual incidence of 1.1 cases/100,000 population. Many patients previously resided in long-term care facilities (48%), had a Charlson comorbidity index (CCI) >3 (38%), a central venous catheter (CVC, 34%) or a decubitus ulcer (27%, Table 1). Twenty-five patients (5%) progressed from CRE bacteriuria to an invasive CRE infection within one year (median 34 days). Predictors of progression in univariable analyses included the presence of a urinary catheter (OR 6.4 [95% CI: 1.9–21.6]), decubitus ulcer, CVC or other indwelling device, Klebsiella pneumoniae, black race, CCI >3, and ICU stay after urine culture was obtained (Table 2). In a multivariable analysis, urinary catheter (OR 4.6 [95% CI: 1.3–16.1]) predicted progression as well as K. pneumoniae, CCI >3 and CVC. Conclusion Progression from CRE bacteriuria to an invasive CRE infection is rare but clinically significant and is associated with urinary catheters. Future interventions should target urinary catheter removal, where possible, in patients with CRE bacteriuria. Disclosures All authors: No reported disclosures.

scholarly journals 253. Is Echocardiogram always indicated in Bacteremia?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S126-S126
Author(s):  
Sagy Grinberg ◽  
Sandhya Nagarakanti ◽  
Audai Ibrahim Ma’ayah ◽  
Yee Tchao ◽  
Eliahu Bishburg
Keyword(s):  
Tertiary Care ◽  
Blood Cultures ◽  
Streptococcus Viridans ◽  
Care Hospital ◽  
Indwelling Catheter ◽  
Indwelling Catheters ◽  
History Of ◽  
Unidentified Source ◽  
Staphylococcus Spp ◽  
Implanted Devices

Abstract Background Echocardiography (ECHO) is a commonly used test; and is part of the Duke’s criteria for diagnosing endocarditis (IE). Our objectives were to analyze utilization and results of ECHO in pts with bacteremia growing organisms not typically associated with IE, and to evaluate whether ECHO contributed to a diagnosis of IE. Methods A retrospective review in a 680-bed tertiary care hospital from 2013–2019. Adult pts with bacteremia with at least 2 positive blood cultures for an organism not typically associated with IE such as Streptococcus viridans, Staphylococcus spp. and enterococcus, and who underwent ECHO were included. Data was collected on demographics, blood cultures, timing of ECHO and its’ findings. Modified Duke’s criteria was used to diagnose IE. Results Ninety four pts were included. Mean age 62 yrs. (range 23-91yrs). 50 (53%) were men. DM noted in 49(52%), CAD in 37(39%), CHF in 54 (57%), chronic kidney disease in 22(23%), hemodialysis in 19(20%), history of IE in 9 (10%). Transthoracic ECHO in 34 (36%), transesophageal ECHO in 28(30%), 32(34%) had both. Identifiable sources of bacteremia were urinary tract infection in 9 (10%), pneumonia 5 (5%), PICC line 5 (5%), wound/tissue infection 3 (3%).Clinicians did not specify the indication for ECHO in any of the cases. Unidentified source of bacteremia noted in 72(77%). Bacteremia was community acquired in 70(74%). Mean days of positive blood cultures 5.6 days (range 1–34 days). Gram (-) organism isolated in 44(47%), Gram (+) in 50(53%), of these, 50 (54%) had an implanted devices/indwelling catheter: 39 cardiac implantable device, 12 indwelling/tunneled catheter. The overall yield of ECHO in bacteremia was 11/94 (12%). ECHO in Gram (-) bacteremia had yield of 9% (4/44 pts) of them only 1 met possible IE by Duke’s criteria. Gram (+) bacteremia had an ECHO yield of 14% (7/50pts); of them 4 met possible IE Duke’s criteria. None of the cases met definite criteria for IE. Conclusion Yield of ECHO for the diagnosis of IE in pts with bacteremia with organisms other than Streptococcus viridans, staphylococci or enterococci was low even in the presence of implanted devices or indwelling catheters. Better criteria for ECHO utilization will reduce its use and potentially increase its yield. Disclosures All Authors: No reported disclosures

Infection Control in Pediatric Extended Care Facilities

2006 ◽  
Vol 27 (6) ◽  
pp. 598-603 ◽  
Author(s):  
Jo-Ann S. Harris
Keyword(s):  
Infection Control ◽  
Long Term Care ◽  
Term Care ◽  
Residential Care Facilities ◽  
Control Programs ◽  
Specialty Hospitals ◽  
Policies And Procedures ◽  
Extended Care ◽  
Care Facilities

Pediatric extended care facilities provide for the biopsychosocial needs of patients younger than 21 years of age who have sustained self-care deficits. These facilities include long-term and residential care facilities, chronic disease and specialty hospitals, and residential schools. Infection control policies and procedures developed for adult long-term care facilities, primarily nursing homes for elderly people, are not applicable to long-term care facilities that serve pediatric patients. This article reviews the characteristics of pediatric extended care facilities and their residents, and the epidemic and endemic nosocomial infections, infection control programs, and antimicrobial resistance profiles found in pediatric extended care facilities.

scholarly journals 10 Mechanical Complications Associated with Central Venous Catheters at a Canadian Tertiary Care Centre

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e4-e4
Author(s):  
Kieran Moore ◽  
Ketan Kulkarni ◽  
David Greencorn ◽  
Stefan Kuhle ◽  
Joanne Langley
Keyword(s):  
Tertiary Care ◽  
Central Venous Catheters ◽  
Mechanical Complication ◽  
Complication Rates ◽  
Central Venous ◽  
Term Care ◽  
Indwelling Catheters ◽  
Health Care Center ◽  
Mechanical Complications ◽  
Paediatric Patients

Abstract Background The administration of life-saving treatment through central venous catheters (CVC) has significantly improved the quality of life and outcomes for patients, especially for those requiring long-term care. While CVC-associated bacteremia is a standard patient outcome measure, little is known about the incidence of mechanical complications in children. Although common, large data on mechanical complications are scarce and generally limited to specific paediatric populations from modest single center series. Objectives To determine the incidence of mechanical complications among paediatric patients with CVCs. Design/Methods In this retrospective study we analyzed data from all paediatric patients (0-19 years) who required a CVC between 2001 and 2016 at our health care center, which services patients from regional hospitals in a shared care model. Details on CVC insertions and daily records of catheter function while in hospital have been collected prospectively and stored in a dedicated database. Patient demographics, catheter characteristics, and complications were abstracted from the database. Complications were defined through clinician documentation of CVC mechanical failures such as disconnect, leakage, fracture, and blockage. Complication rates were expressed per 1,000 line days. Results A total of 8,747 CVCs were placed in 5,743 patients during the study period for a total of 780,448 line days. Neonatal patients required the most CVC insertions and made up 41% of the cohort studied. Total mechanical complication rates were the highest over the 15-year period in 2001 (12 per 1,000 line days) and lowest in 2013 (3.8 per 1,000 line days). Peripherally inserted central catheters were used in the majority of patients (56%), while port-a-caths made up the vast majority of line days (78%). Mechanical complications occurred more frequently in non-tunneled catheters and were least likely to occur in port-a-caths (43 and 3.1 per 1,000 line days, respectively). Tunneled catheters failed mechanically at a rate of 8.0 per 1,000 line days and the peripherally inserted central catheter complication rate was 17 per 1,000 line days. Conclusion We provide a novel description of the incidence of mechanical complications in the setting of commonly used CVCs in a large paediatric cohort. Our findings help convey the true frequency of mechanical failures and create a benchmark for mechanical CVC complications in children. Recognizing the mechanical limitations of indwelling catheters will assist clinicians in optimizing catheter choice. Future study is planned to identify risk factors associated with CVC complications.

The Chronic Indwelling Catheter and Urinary Infection in Long-Term–Care Facility Residents

2001 ◽  
Vol 22 (5) ◽  
pp. 316-321 ◽  
Author(s):  
Philip W. Smith ◽  
Lindsay E. Nicolle
Keyword(s):  
Antimicrobial Therapy ◽  
Long Term Care ◽  
Urinary Infection ◽  
Indwelling Catheter ◽  
Term Care ◽  
Substantial Impact ◽  
Indwelling Catheters ◽  
The Impact ◽  
Catheter Care

AbstractFrom 5% to 10% of residents of long-term–care facilities have urinary drainage managed with chronic indwelling catheters. These residents are always bacteriuric, usually with a complex microbiological flora of two to five organisms and a biofilm on the catheter that may contribute to obstruction. Residents with chronic indwelling catheters have increased morbidity from urinary infection compared to bacteriuric residents without chronic catheters. The most effective means to prevent infection is limitation of chronic indwelling catheter use. While appropriate catheter care and infection control precautions are recommended in managing these patients, the impact of these practices on the occurrence of urinary infection or prevention of symptomatic episodes has not been evaluated. Symptomatic infection can likely be prevented by attention to catheter care, including early recognition and replacement of obstructed catheters and prevention of catheter trauma. Appropriate use of prophylactic antimicrobial therapy prior to invasive genitourinary procedures is also necessary. Asymptomatic bacteriuria should not be treated. When symptomatic episodes occur, patients should be evaluated clinically and microbiologically and treated with appropriate antimicrobial therapy. Further technological advances in catheter material and urine drainage will be needed to have a substantial impact on the frequency of urinary infection with chronic catheter use.

Carbapenem-resistant Enterobacterales bacteriuria and subsequent bacteremia: A population-based study

2020 ◽  
pp. 1-6
Author(s):  
Jessica R. Howard-Anderson ◽  
Chris W. Bower ◽  
Gillian Smith ◽  
Mary Elizabeth Sexton ◽  
Monica M. Farley ◽  
...  
Keyword(s):  
Risk Factors ◽  
Urine Culture ◽  
Urinary Catheter ◽  
Multivariable Analysis ◽  
Venous Catheter ◽  
Decubitus Ulcer ◽  
Population Based ◽  
Urinary Catheters ◽  
Term Care ◽  
Carbapenem Resistant

Abstract Objective: To describe the epidemiology of carbapenem-resistant Enterobacterales (CRE) bacteriuria and to determine whether urinary catheters increase the risk of subsequent CRE bacteremia. Design: Using active population- and laboratory-based surveillance we described a cohort of patients with incident CRE bacteriuria and identified risk factors for developing CRE bacteremia within 1 year. Setting: The study was conducted among the 8 counties of Georgia Health District 3 (HD3) in Atlanta, Georgia. Patients: Residents of HD3 with CRE first identified in urine between 2012 and 2017. Results: We identified 464 patients with CRE bacteriuria (mean yearly incidence, 1.96 cases per 100,000 population). Of 425 with chart review, most had a urinary catheter (56%), and many resided in long-term care facilities (48%), had a Charlson comorbidity index >3 (38%) or a decubitus ulcer (37%). 21 patients (5%) developed CRE bacteremia with the same organism within 1 year. Risk factors for subsequent bacteremia included presence of a urinary catheter (odds ratio [OR], 8.0; 95% confidence interval [CI], 1.8–34.9), central venous catheter (OR, 4.3; 95% CI, 1.7–10.6) or another indwelling device (OR, 4.3; 95% CI, 1.6–11.4), urine culture obtained as an inpatient (OR, 5.7; 95% CI, 1.3–25.9), and being in the ICU in the week prior to urine culture (OR, 2.9; 95% CI, 1.1–7.8). In a multivariable analysis, urinary catheter increased the risk of CRE bacteremia (OR, 5.3; 95% CI, 1.2–23.6). Conclusions: In patients with CRE bacteriuria, urinary catheters increase the risk of CRE bacteremia. Future interventions should aim to reduce inappropriate insertion and early removal of urinary catheters.

“Music First”

GeroPsych ◽  
2018 ◽  
Vol 31 (1) ◽  
pp. 17-30 ◽  
Author(s):  
Dane L. Shiltz ◽  
Tara T. Lineweaver ◽  
Tim Brimmer ◽  
Alex C. Cairns ◽  
Danielle S. Halcomb ◽  
...  
Keyword(s):  
Usual Care ◽  
Psychological Symptoms ◽  
Care Facility ◽  
Care Group ◽  
Music Listening ◽  
Term Care ◽  
Antipsychotic Medications ◽  
Risk Of Death ◽  
Extended Care ◽  
Individualized Music

Abstract. Existing research has primarily evaluated music therapy (MT) as a means of reducing the negative affect, behavioral, and/or cognitive symptoms of dementia. Music listening (ML), on the other hand, offers a less-explored, potentially equivalent alternative to MT and may further reduce exposure to potentially harmful psychotropic medications traditionally used to manage negative behavioral and psychological symptoms of dementia (BPSD). This 5-month prospective, naturalistic, interprofessional, single-center extended care facility study compared usual care (45 residents) and usual care combined with at least thrice weekly personalized ML sessions (47 residents) to determine the influence of ML. Agitation decreased for all participants (p < .001), and the ML residents receiving antipsychotic medications at baseline experienced agitation levels similar to both the usual care group and the ML patients who were not prescribed antipsychotics (p < .05 for medication × ML interaction). No significant changes in psychotropic medication exposure occurred. This experimental study supports ML as an adjunct to pharmacological approaches to treating agitation in older adults with dementia living in long-term care facilities. It also highlights the need for additional research focused on how individualized music programs affect doses and frequencies of antipsychotic medications and their associated risk of death and cerebrovascular events in this population.

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