Intervention to improve the quality of antimicrobial prescribing for urinary tract infection: a cluster randomized trial

Abstract Introduction CAUTIs, or Catheter-associated Urinary Tract Infection, are one of the leading causes of healthcare associated infections. Since 2008, Centers for Medicare and Medicaid Services (CMS) stopped reimbursing hospital for the cost of CAUTIs, forcing hospitals to modify and improve care provided to patients with indwelling urinary catheters (IUC). They are reportable events to CMS, which can signify the quality of care provided at any medical institution. These infections also cause extra pain and suffering and can complicate any hospital stay. Treatment requires antibiotic use, which helps create and spread antibiotic-resistant organisms with excessive use. Methods BICU and BSC staff were evaluated for knowledge of IUC care, maintenance and policies using a quiz dispersed to RNs. This quiz identified knowledge gaps to help focus on specific topics for training. During Skills Day, all Burn RNs were given a mandatory training, including a PowerPoint presentation, hands-on training performing catheter care, and a handout with quick tips for maintenance. All technical partners (TP) were also trained, though they were not given the quiz. To assess effectiveness of training, RNs were encouraged to take a post-training quiz. Rates of CAUTI will also be closely monitored. Results For the pre-training quiz, average scores were 13.1 correct answers (out of 23 questions) or 56.5%. Post-training quiz scores were 18.5 correct answers (out of 23 questions) or 81%. Since the training in September 2018, no new CAUTIs have been recorded. Conclusions The training provided helped enhance burn staff skills to maintain and care for indwelling urinary catheters, as well as changed attitudes on the unit. Applicability of Research to Practice CAUTIs are a reflection of the quality of care an institution and unit provides its patients. It is also closely monitored and used to compare similar units across the nation. The training provided to the burn staff has shown to decrease the number of CAUTIs in the Burn ICU and Burn Special Care environments, thus decreasing costs, pain and suffering and antibiotic use.

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Effect of real-time feedback during cardiopulmonary resuscitation training on quality of performances: A prospective cluster-randomized trial

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907918825016 ◽

2019 ◽

Vol 27 (4) ◽

pp. 187-196

Author(s):

So Yeon Joyce Kong ◽

Kyoung Jun Song ◽

Sang Do Shin ◽

Young Sun Ro ◽

Helge Myklebust ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Randomized Trial ◽

Real Time ◽

Cluster Randomized Trial ◽

Group Model ◽

Feedback Group ◽

Resuscitation Training ◽

Objective Feedback ◽

Cluster Randomized

Background: The evidence supporting delivery of quality cardiopulmonary resuscitation is growing and significant attention has been focused on improving bystander cardiopulmonary resuscitation education for laypeople. The aim of this randomized trial was to assess the effectiveness of instructor’s real-time objective feedback during cardiopulmonary resuscitation training compared to conventional feedback in terms of trainee’s cardiopulmonary resuscitation quality. Methods: We performed a cluster-randomized trial of community cardiopulmonary resuscitation training classes at Nowon District Health Community Center in Seoul. Cardiopulmonary resuscitation training classes were randomized into either intervention (instructor’s objective real-time feedback based on the QCPR Classroom device) or control (conventional, instructor’s judgment-based feedback) group. The primary outcome was total cardiopulmonary resuscitation score, which is an overall measure of chest compression quality. Secondary outcomes were individual cardiopulmonary resuscitation performance parameters, including compression rate, depth, and release. Generalized linear mixed models were used to analyze the outcome data, accounting for both random and fixed effects. Results: A total of 149 training sessions (2613 trainees) were randomized into 70 intervention (1262 trainees) and 79 control (1351 trainees) groups. Trainees in the QCPR feedback group significantly increased overall cardiopulmonary resuscitation score performance compared with those in the conventional feedback group (model-based mean Δ increment from baseline to session 5: 11.2 (95% confidence interval 9.2–13.2) and 8.0 (6.0–9.9), respectively; p = 0.02). Individual parameters of compression depth and release also showed higher improvement among trainees in QCPR group with positive trends (p < 0.08 for both). Conclusion: This randomized trial suggests beneficial effect of instructor’s real-time objective feedback on the quality of layperson’s cardiopulmonary resuscitation performance.

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583 OnabotulinumtoxinA reduces urinary incontinence and improves quality of life in overactive bladder patients regardless of use of clean intermittent catheterisation or the presence of urinary tract infection

European Urology Supplements ◽

10.1016/s1569-9056(14)60573-x ◽

2014 ◽

Vol 13 (1) ◽

pp. e583 ◽

Cited By ~ 1

Author(s):

K. Everaert ◽

J. Gruenenfelder ◽

H. Schulte-Baukloh ◽

S. Guard ◽

Y. Zheng ◽

...

Keyword(s):

Quality Of Life ◽

Urinary Tract Infection ◽

Urinary Incontinence ◽

Urinary Tract ◽

Tract Infection ◽

Overactive Bladder ◽

Intermittent Catheterisation ◽

Clean Intermittent Catheterisation

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Uncontrolled allergic rhinitis during treatment and its impact on quality of life: A cluster randomized trial

Journal of Allergy and Clinical Immunology ◽

10.1016/j.jaci.2010.06.034 ◽

2010 ◽

Vol 126 (3) ◽

pp. 666-668.e5 ◽

Cited By ~ 56

Author(s):

Philippe J. Bousquet ◽

Claus Bachert ◽

Giorgo W. Canonica ◽

Thomas B. Casale ◽

Joaquim Mullol ◽

...

Keyword(s):

Quality Of Life ◽

Allergic Rhinitis ◽

Randomized Trial ◽

Cluster Randomized Trial ◽

Cluster Randomized

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Maintenance of indwelling urinary catheters with a novel polyhexanide-based solution: user experience

British Journal of Nursing ◽

10.12968/bjon.2020.29.18.s18 ◽

2020 ◽

Vol 29 (18) ◽

pp. S18-S28

Author(s):

Litti Andersen ◽

Marianne Bertelsen ◽

Vicki Buitenhuis ◽

Annette Carstensen ◽

Jane Hannibalsen ◽

...

Keyword(s):

Quality Of Life ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Healthcare Costs ◽

Product Evaluation ◽

Improve Quality ◽

Urinary Catheters ◽

User Experiences

Background: Catheter-associated urinary tract infection (CAUTI) can significantly affect patients' quality of life and increase healthcare costs. Aims: This study aimed to capture patients' and nurses' experience of catheter maintenance using a polyhexanide-based solution (PS) in everyday practice. Methods: Retrospective analysis of data was collected for a product evaluation. PS was used twice a week for five weeks. Findings: The study included 42 patients, 30 (71%) men and 12 women (29%). After five weeks of rinsing catheters with PS, nine patients reported no or decreased frequency of CAUTI, eight a better quality of life, eight reduced blockage, seven a decrease in odour and five fewer catheter changes. Three patients reported no benefit from PS use. Nurses reported that fewer visits were needed and consumption of disposables was lower. Conclusions: User experiences suggest that, as a novel means of catheter maintenance, PS has the potential to reduce catheter-associated complications such as CAUTI, improve quality of life and reduce healthcare costs.

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Supporting patients with long-term catheterisation to reduce risk of catheter-associated urinary tract infection

British Journal of Nursing ◽

10.12968/bjon.2019.28.9.s4 ◽

2019 ◽

Vol 28 (9) ◽

pp. S4-S17 ◽

Cited By ~ 1

Author(s):

Anna Waskiewicz ◽

Obrey Alexis ◽

Deborah Cross

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Fluid Intake ◽

Adult Population ◽

Personal Hygiene ◽

Reduce Risk ◽

The Uk

More than 90 000 of the UK adult population are estimated to have a urinary catheter, with 24% likely to develop symptoms of catheter-associated urinary tract infection (CAUTI). The consequences of having a CAUTI are reduced quality of life, risk of hospitalisation and increased mortality. The authors undertook a literature review of primary research studies to identify how nurses could support patients to maintain effective catheter care to reduce the risk of CAUTI. Four themes emerged: education, knowledge, empowerment and communication. The authors therefore conclude that consistent knowledge, clear communication and treating patients as partners in the decision-making process can help build trust and allow empower patients. This will enable patients to make safe and healthy decisions about their catheter, particularly with regard to personal hygiene and optimal fluid intake, to reducing the risk of CAUTI.

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