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Sanjay Saint - One of the best experts on this subject based on the ideXlab platform.
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michigan appropriate perioperative map criteria for Urinary Catheter use in common general and orthopaedic surgeries results obtained using the rand ucla appropriateness method
BMJ Quality & Safety, 2019Co-Authors: Jennifer Meddings, Ted A Skolarus, Karen E Fowler, Steven J Bernstein, Justin B Dimick, Jason Mann, Sanjay SaintAbstract:Background Indwelling Urinary Catheters are commonly used for patients undergoing general and orthopaedic surgery. Despite infectious and non-infectious harms of Urinary Catheters, there is limited guidance available to surgery teams regarding appropriate perioperative Catheter use. Objective Using the RAND Corporation/University of California Los Angeles (RAND/UCLA) Appropriateness Method, we assessed the appropriateness of indwelling Urinary Catheter placement and different timings of Catheter removal for routine general and orthopaedic surgery procedures. Methods Two multidisciplinary panels consisting of 13 and 11 members (physicians and nurses) for general and orthopaedic surgery, respectively, reviewed the available literature regarding the impact of different perioperative Catheter use strategies. Using a standardised, multiround rating process, the panels independently rated clinical scenarios (91 general surgery, 36 orthopaedic surgery) for Urinary Catheter placement and postoperative duration of use as appropriate (ie, benefits outweigh risks), inappropriate or of uncertain appropriateness. Results Appropriateness of Catheter use varied by procedure, accounting for procedure-specific risks as well as expected procedure time and intravenous fluids. Procedural appropriateness ratings for Catheters were summarised for clinical use into three groups: (1) can perform surgery without Catheter; (2) use intraoperatively only, ideally remove before leaving the operating room; and (3) use intraoperatively and keep Catheter until postoperative days 1–4. Specific recommendations were provided by procedure, with postoperative day 1 being appropriate for Catheter removal for first voiding trial for many procedures. Conclusion We defined the appropriateness of indwelling Urinary Catheter use during and after common general and orthopaedic surgical procedures. These ratings may help reduce Catheter-associated complications for patients undergoing these procedures.
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Reducing Inappropriate Urinary Catheter Use
2017Co-Authors: Mohamad G Fakih, Sarah L Krein, Russell N Olmsted, Sam R. Watson, M. Todd Greene, Edward H. Kennedy, Sanjay SaintAbstract:Results: The Urinary Catheter use rate decreased from 18.1% (95% CI, 16.8%-19.6%) at baseline to 13.8% (95% CI, 12.9%-14.8%) at end of year 2 (P.001). The proportion of Catheterized patients with appropriate indications increased from 44.3% (95% CI, 40.3%-48.4%) to 57.6% (95% CI, 51.7%-63.4%) by the end of year 2 (P=.005). Conclusions: A statewide effort to reduce inappropriate Urinary Catheter use was associated with a significant reduction in Catheter use and improved compliance with appropriate use. The effect of the intervention was sustained for at least 2 years.
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beyond infection device utilization ratio as a performance measure for Urinary Catheter harm
Infection Control and Hospital Epidemiology, 2016Co-Authors: Mohamad G Fakih, Sarah L Krein, Carolyn V Gould, Barbara W Trautner, Jennifer Meddings, Russell N Olmsted, Sanjay SaintAbstract:Catheter-associated Urinary tract infection (CAUTI) is considered a reasonably preventable event in the hospital setting, and it has been included in the US Department of Health and Human Services National Action Plan to Prevent Healthcare-Associated Infections. While multiple definitions for measuring CAUTI exist, each has important limitations, and understanding these limitations is important to both clinical practice and policy decisions. The National Healthcare Safety Network (NHSN) surveillance definition, the most frequently used outcome measure for CAUTI prevention efforts, has limited clinical correlation and does not necessarily reflect noninfectious harms related to the Catheter. We advocate use of the device utilization ratio (DUR) as an additional performance measure for potential Urinary Catheter harm. The DUR is patient-centered and objective and is currently captured as part of NHSN reporting. Furthermore, these data are readily obtainable from electronic medical records. The DUR also provides a more direct reflection of improvement efforts focused on reducing inappropriate Urinary Catheter use.
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Reducing Inappropriate Urinary Catheter Use: A Statewide Effort
Archives of internal medicine, 2012Co-Authors: Mohamad G Fakih, Sarah L Krein, Russell N Olmsted, Sam R. Watson, M. Todd Greene, Edward H. Kennedy, Sanjay SaintAbstract:Background Indwelling Urinary Catheters may lead to both infectious and noninfectious complications and are often used in the hospital setting without an appropriate indication. The objective of this study was to evaluate the results of a statewide quality improvement effort to reduce inappropriate Urinary Catheter use. Methods Retrospective analysis of data collected between 2007 and 2010 as part of a statewide collaborative initiative before, during, and after an educational intervention promoting adherence to appropriate Urinary Catheter indications. The data were collected from 163 inpatient units in 71 participating Michigan hospitals. The intervention consisted of educating clinicians about the appropriate indications for Urinary Catheter use and promoting the daily assessment of Urinary Catheter necessity during daily nursing rounds. The main outcome measures were change in prevalence of Urinary Catheter use and adherence to appropriate indications. We used flexible generalized estimating equation (GEE) and multilevel methods to estimate rates over time while accounting for the clustering of patients within hospital units. Results The Urinary Catheter use rate decreased from 18.1% (95% CI, 16.8%-19.6%) at baseline to 13.8% (95% CI, 12.9%-14.8%) at end of year 2 (P Conclusions A statewide effort to reduce inappropriate Urinary Catheter use was associated with a significant reduction in Catheter use and improved compliance with appropriate use. The effect of the intervention was sustained for at least 2 years.
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systematic review and meta analysis reminder systems to reduce Catheter associated Urinary tract infections and Urinary Catheter use in hospitalized patients
Clinical Infectious Diseases, 2010Co-Authors: Jennifer Meddings, Mary A M Rogers, Michelle L Macy, Sanjay SaintAbstract:Background. Prolonged Catheterization is the primary risk factor for Catheter-associated Urinary tract infection (CAUTI). Reminder systems are interventions used to prompt the removal of unnecessary Urinary Catheters. To summarize the effect of Urinary Catheter reminder systems on the rate of CAUTI, Urinary Catheter use, and the need for reCatheterization, we performed a systematic review and meta-analysis. Methods. Studies were identified in MEDLINE, the Cochrane Library, Biosis, the Web of Science, EMBASE, and CINAHL through August 2008. Only interventional studies that used reminders to physicians or nurses that a Urinary Catheter was in use or stop orders to prompt Catheter removal in hospitalized adults were included. A total of 6679 citations were identified; 118 articles were reviewed, and 14 articles met the selection criteria. Results. The rate of CAUTI (episodes per 1000 Catheter-days) was reduced by 52% (P<.001) with use of a reminder or stop order. The mean duration of Catheterization decreased by 37%, resulting in 2.61 fewer days of Catheterization per patient in the intervention versus control groups; the pooled standardized mean difference (SMD) in the duration of Catheterization was - 1.11 overall (P = .070), including a statistically significant decrease in studies that used a stop order (SMD, -0.30; P = .001) but not in those that used a reminder (SMD, -1.54; P = .071). ReCatheterization rates were similar in control and intervention groups. Conclusion. Urinary Catheter reminders and stop orders appear to reduce the rate of CAUTI and should be strongly considered to enhance the safety of hospitalized patients.
Mary H. Wilde - One of the best experts on this subject based on the ideXlab platform.
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Testing a Model of Self-Management of Fluid Intake in Community-Residing Long-term Indwelling Urinary Catheter Users.
Nursing research, 2016Co-Authors: Mary H. Wilde, Hugh F. Crean, James M. Mcmahon, Margaret V. Mcdonald, Wan Tang, Judith Brasch, Eileen Fairbanks, Shivani Shah, Feng-feng ZhangAbstract:Background: Urinary tract infection and blockage are serious and recurrent challenges for people with long-term indwelling Catheters, and these Catheter problems cause worry and anxiety when they disrupt normal daily activities. Objective: The goal was to determine whether Urinary Catheter-related self-management behaviors focusing on fluid intake would mediate fluid intake-related self-efficacy toward decreasing Catheter-associated Urinary tract infection (CAUTI) and/or Catheter blockage. Methods: The sample involved data collected from 180 adult community-living, long-term indwelling Urinary Catheter users. The authors tested a model of fluid intake self-management related to fluid intake self-efficacy for key outcomes of CAUTI and blockage. To account for the large number of zeros in both outcomes, a zero-inflated negative binomial (ZINB) structural equation model was tested. Results: Structurally, fluid intake self-efficacy was positively associated with fluid intake self-management, suggesting that higher fluid intake self-efficacy predicts more (higher) fluid intake self-management; however, fluid intake self-management was not associated with either the frequency of CAUTIs or the presence or absence of CAUTI. Fluid intake self-efficacy was positively related to fluid intake self-management, and fluid intake self-management predicted less frequency of Catheter blockage, but neither fluid intake self-efficacy nor fluid intake self-management predicted the presence or absence of blockage. Discussion: Further research is needed to better understand determinants of CAUTI in long-term Catheter users and factors which might influence or prevent its occurrence. Increased confidence (self-efficacy) and self-management behaviors to promote fluid intake could be of value to long-term Urinary Catheter users to decrease Catheter blockage.
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long term Urinary Catheter users self care practices and problems
Journal of Clinical Nursing, 2013Co-Authors: Mary H. Wilde, James M. Mcmahon, Margaret V. Mcdonald, Wan Tang, Judith Brasch, Eileen Fairbanks, Shivani Shah, Eileen ScheidAbstract:Aims The aims were to characterize a sample of 202 adult community-living long-term indwelling Urinary Catheter users, to describe self-care practices and Catheter problems, and to explore relationships among demographics, Catheter practices, and problems.
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long term Urinary Catheter users self care practices and problems
Journal of Clinical Nursing, 2013Co-Authors: Mary H. Wilde, James M. Mcmahon, Margaret V. Mcdonald, Wan Tang, Judith Brasch, Eileen Fairbanks, Shivani Shah, Eileen ScheidAbstract:Aims and objectives To characterise a sample of 202 adult community-living long-term indwelling Urinary Catheter users, to describe self-care practices and Catheter problems, and to explore relationships among demographics, Catheter practices and problems. Background Long-term Urinary Catheter users have not been well studied, and persons using the device indefinitely for persistent Urinary retention are likely to have different patterns of Catheter practices and problems. Design The study was a cross-sectional descriptive and exploratory analysis. Methods Home interviews were conducted with Catheter users who provided information by self-reported recall over the previous two months. Data were analysed by descriptive statistics and tests of association between demographics, Catheter practices and Catheter problems. Results The sample was widely diverse in age (19–96 years), race and medical diagnosis. Urethral Catheters were used slightly more often (56%) than suprapubic (44%), for a mean of six years (SD 7 years). Many persons were highly disabled, with 60% having difficulty in bathing, dressing, toileting and getting out of the bed; 19% also required assistance in eating. A high percentage of Catheter problems were reported with: 43% experiencing leakage (bypassing of urine), 31% having had a Urinary tract infection, 24% blockage of the Catheter, 23% Catheter-associated pain and 12% accidental dislodgment of the Catheter. Treatments of Catheter-related problems contributed to additional health care utilisation, including extra nurse or clinic visits, trips to the emergency department or hospitalisation. Symptoms of Catheter-associated Urinary tract infections were most often related to changes in the colour or character of urine or generalised symptoms. Conclusions Catheter-related problems contribute to excess morbidity and health care utilisation and costs. Relevance to clinical practice More research is needed in how to minimise Catheter-associated problems in long-term Catheter users. Information from this study could help inform the development of interventions in this population.
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life with an indwelling Urinary Catheter the dialectic of stigma and acceptance
Qualitative Health Research, 2003Co-Authors: Mary H. WildeAbstract:The purpose of this hermeneutic phenomenology was to describe and interpret the lived experience of long-term users of Urinary Catheters. Living with a Urinary Catheter involved a dialectical swing between acknowledgment that the Catheter was “a part of me” and feelings of alienation and vulnerability when it was experienced as a stigma. Themes include Adjusting to embodied changes by perceiving the Catheter as a “part of me,” Shame and responding to shame by normalizing, and Embarrassment and coping with embarrassment by humor. Providers can minimize stigma related to the visibility of the Catheter by coaching patients in strategies to manage going out of the home with a minimum of urine accidents or by helping develop ways to conceal the urine bag.
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Long‐term indwelling Urinary Catheter care: conceptualizing the research base
Journal of Advanced Nursing, 1997Co-Authors: Mary H. WildeAbstract:The traditional public health concepts of agent, host, and environment can provide a useful interdisciplinary model for analyzing the current state of knowledge in long term indwelling Urinary Catheter care. A broad review of literature about Urinary Catheter care was carried out to identify major areas of research and gaps in knowledge. Most research in the past decade has focused on understanding how Catheter encrustations develop and how such encrustations may contribute to leaking/blocking of the Catheter and Urinary tract infection. Two tables are presented which summarize research related to the development of sediment/encrustation of the Catheter and to irrigation of the Catheter. Nevertheless, many areas related to Catheter care have not been studied extensively. The patient's perspective is one such area. Other areas that have not been studied in depth in depth include care of the drainage bag and the role of fluid intake. These under-studied concerns relate to environmental factors with which the nurse is directly involved, namely, asepsis and hydrokinetic forces. Further conceptualization of the nursing role in long-term Urinary Catheter care might aid in the development of nursing theories that could be tested to understand how best to help people manage these Catheters.
Barbara W Trautner - One of the best experts on this subject based on the ideXlab platform.
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beyond infection device utilization ratio as a performance measure for Urinary Catheter harm
Infection Control and Hospital Epidemiology, 2016Co-Authors: Mohamad G Fakih, Sarah L Krein, Carolyn V Gould, Barbara W Trautner, Jennifer Meddings, Russell N Olmsted, Sanjay SaintAbstract:Catheter-associated Urinary tract infection (CAUTI) is considered a reasonably preventable event in the hospital setting, and it has been included in the US Department of Health and Human Services National Action Plan to Prevent Healthcare-Associated Infections. While multiple definitions for measuring CAUTI exist, each has important limitations, and understanding these limitations is important to both clinical practice and policy decisions. The National Healthcare Safety Network (NHSN) surveillance definition, the most frequently used outcome measure for CAUTI prevention efforts, has limited clinical correlation and does not necessarily reflect noninfectious harms related to the Catheter. We advocate use of the device utilization ratio (DUR) as an additional performance measure for potential Urinary Catheter harm. The DUR is patient-centered and objective and is currently captured as part of NHSN reporting. Furthermore, these data are readily obtainable from electronic medical records. The DUR also provides a more direct reflection of improvement efforts focused on reducing inappropriate Urinary Catheter use.
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antibiotic prophylaxis for Urinary tract infections after removal of Urinary Catheter meta analysis
BMJ, 2013Co-Authors: Barbara W Trautner, Jonas Marschall, Chris Carpenter, Susan FowlerAbstract:Objective To determine whether antibiotic prophylaxis at the time of removal of a Urinary Catheter reduces the risk of subsequent symptomatic Urinary tract infection . Design Systematic review and meta-analysis of studies published before November 2012 identified through PubMed, Embase, Scopus, and the Cochrane Library; conference abstracts for 2006-12 were also reviewed. Inclusion criteria Studies were included if they examined antibiotic prophylaxis administered to prevent symptomatic Urinary tract infection after removal of a short term (≤14 days) Urinary Catheter. Results Seven controlled studies had symptomatic Urinary tract infection after Catheter removal as an endpoint; six were randomized controlled trials (five published; one in abstract form) and one was a non-randomized controlled intervention study. Five of these seven studies were in surgical patients. Studies were heterogeneous in the type and duration of antimicrobial prophylaxis and the period of observation. Overall, antibiotic prophylaxis was associated with benefit to the patient, with an absolute reduction in risk of Urinary tract infection of 5.8% between intervention and control groups. The risk ratio was 0.45 (95% confidence interval 0.28 to 0.72). The number needed to treat to prevent one Urinary tract infection was 17 (12 to 30). Conclusions Patients admitted to hospital who undergo short term Urinary Catheterization might benefit from antimicrobial prophylaxis when the Catheter is removed as they experience fewer subsequent Urinary tract infections. Potential disadvantages of more widespread antimicrobial prophylaxis (side effects and cost of antibiotics, development of antimicrobial resistance) might be mitigated by the identification of which patients are most likely to benefit from this approach.
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Accuracy of a Urinary Catheter surveillance protocol
American journal of infection control, 2011Co-Authors: Allison C. Burns, Nancy J. Petersen, Armandina Garza, Monisha Arya, Jan E. Patterson, Aanand D. Naik, Barbara W TrautnerAbstract:Background Many hospitals are increasing surveillance for Catheter-associated Urinary tract infections, which requires documentation of Urinary Catheter device-days. However, device-days are usually obtained by chart review or nursing reports. The aim of this study was to demonstrate that chart review can provide accurate Urinary Catheter data compared with physical inspection of the Urinary Catheter at the bedside. Methods We compared 2 methods for collecting Urinary Catheter data over a 6-month period on 10 wards at our VA hospital. For the chart reviews, we created a daily bed-occupancy roster from the electronic medical record. Catheter data were extracted from the daily progress notes for each patient using a standardized review process. Bedside reviews were conducted by visiting the ward and verifying the presence and type of Urinary Catheters. Agreement between the 2 methods was calculated. Results We obtained Urinary Catheter data by both methods in 621 cases. The presence or type of Urinary Catheter differed between chart and bedside review in only 10 cases (1.6%). Chart review had a sensitivity of 100%, a specificity of 97.7%, raw agreement of 98.4%, and a κ value of 0.96. Conclusions Individual chart review in the electronic medical record provided very accurate data on Urinary Catheter use.
Jennifer Meddings - One of the best experts on this subject based on the ideXlab platform.
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michigan appropriate perioperative map criteria for Urinary Catheter use in common general and orthopaedic surgeries results obtained using the rand ucla appropriateness method
BMJ Quality & Safety, 2019Co-Authors: Jennifer Meddings, Ted A Skolarus, Karen E Fowler, Steven J Bernstein, Justin B Dimick, Jason Mann, Sanjay SaintAbstract:Background Indwelling Urinary Catheters are commonly used for patients undergoing general and orthopaedic surgery. Despite infectious and non-infectious harms of Urinary Catheters, there is limited guidance available to surgery teams regarding appropriate perioperative Catheter use. Objective Using the RAND Corporation/University of California Los Angeles (RAND/UCLA) Appropriateness Method, we assessed the appropriateness of indwelling Urinary Catheter placement and different timings of Catheter removal for routine general and orthopaedic surgery procedures. Methods Two multidisciplinary panels consisting of 13 and 11 members (physicians and nurses) for general and orthopaedic surgery, respectively, reviewed the available literature regarding the impact of different perioperative Catheter use strategies. Using a standardised, multiround rating process, the panels independently rated clinical scenarios (91 general surgery, 36 orthopaedic surgery) for Urinary Catheter placement and postoperative duration of use as appropriate (ie, benefits outweigh risks), inappropriate or of uncertain appropriateness. Results Appropriateness of Catheter use varied by procedure, accounting for procedure-specific risks as well as expected procedure time and intravenous fluids. Procedural appropriateness ratings for Catheters were summarised for clinical use into three groups: (1) can perform surgery without Catheter; (2) use intraoperatively only, ideally remove before leaving the operating room; and (3) use intraoperatively and keep Catheter until postoperative days 1–4. Specific recommendations were provided by procedure, with postoperative day 1 being appropriate for Catheter removal for first voiding trial for many procedures. Conclusion We defined the appropriateness of indwelling Urinary Catheter use during and after common general and orthopaedic surgical procedures. These ratings may help reduce Catheter-associated complications for patients undergoing these procedures.
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beyond infection device utilization ratio as a performance measure for Urinary Catheter harm
Infection Control and Hospital Epidemiology, 2016Co-Authors: Mohamad G Fakih, Sarah L Krein, Carolyn V Gould, Barbara W Trautner, Jennifer Meddings, Russell N Olmsted, Sanjay SaintAbstract:Catheter-associated Urinary tract infection (CAUTI) is considered a reasonably preventable event in the hospital setting, and it has been included in the US Department of Health and Human Services National Action Plan to Prevent Healthcare-Associated Infections. While multiple definitions for measuring CAUTI exist, each has important limitations, and understanding these limitations is important to both clinical practice and policy decisions. The National Healthcare Safety Network (NHSN) surveillance definition, the most frequently used outcome measure for CAUTI prevention efforts, has limited clinical correlation and does not necessarily reflect noninfectious harms related to the Catheter. We advocate use of the device utilization ratio (DUR) as an additional performance measure for potential Urinary Catheter harm. The DUR is patient-centered and objective and is currently captured as part of NHSN reporting. Furthermore, these data are readily obtainable from electronic medical records. The DUR also provides a more direct reflection of improvement efforts focused on reducing inappropriate Urinary Catheter use.
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systematic review and meta analysis reminder systems to reduce Catheter associated Urinary tract infections and Urinary Catheter use in hospitalized patients
Clinical Infectious Diseases, 2010Co-Authors: Jennifer Meddings, Mary A M Rogers, Michelle L Macy, Sanjay SaintAbstract:Background. Prolonged Catheterization is the primary risk factor for Catheter-associated Urinary tract infection (CAUTI). Reminder systems are interventions used to prompt the removal of unnecessary Urinary Catheters. To summarize the effect of Urinary Catheter reminder systems on the rate of CAUTI, Urinary Catheter use, and the need for reCatheterization, we performed a systematic review and meta-analysis. Methods. Studies were identified in MEDLINE, the Cochrane Library, Biosis, the Web of Science, EMBASE, and CINAHL through August 2008. Only interventional studies that used reminders to physicians or nurses that a Urinary Catheter was in use or stop orders to prompt Catheter removal in hospitalized adults were included. A total of 6679 citations were identified; 118 articles were reviewed, and 14 articles met the selection criteria. Results. The rate of CAUTI (episodes per 1000 Catheter-days) was reduced by 52% (P<.001) with use of a reminder or stop order. The mean duration of Catheterization decreased by 37%, resulting in 2.61 fewer days of Catheterization per patient in the intervention versus control groups; the pooled standardized mean difference (SMD) in the duration of Catheterization was - 1.11 overall (P = .070), including a statistically significant decrease in studies that used a stop order (SMD, -0.30; P = .001) but not in those that used a reminder (SMD, -1.54; P = .071). ReCatheterization rates were similar in control and intervention groups. Conclusion. Urinary Catheter reminders and stop orders appear to reduce the rate of CAUTI and should be strongly considered to enhance the safety of hospitalized patients.
Sarah L Krein - One of the best experts on this subject based on the ideXlab platform.
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detecting the presence of an indwelling Urinary Catheter and Urinary symptoms in hospitalized patients using natural language processing
Journal of Biomedical Informatics, 2017Co-Authors: Adi V Gundlapalli, Sarah L Krein, Guy Divita, Andrew Redd, Marjorie E Carter, Michael Rubin, Matthew H Samore, Judith Strymish, Kalpana Gupta, Anne E SalesAbstract:Abstract Objective To develop a natural language processing pipeline to extract positively asserted concepts related to the presence of an indwelling Urinary Catheter in hospitalized patients from the free text of the electronic medical note. The goal is to assist infection preventionists and other healthcare professionals in determining whether a patient has an indwelling Urinary Catheter when a Catheter-associated Urinary tract infection is suspected. Currently, data on indwelling Urinary Catheters is not consistently captured in the electronic medical record in structured format and thus cannot be reliably extracted for clinical and research purposes. Materials and methods We developed a lexicon of terms related to indwelling Urinary Catheters and Urinary symptoms based on domain knowledge, prior experience in the field, and review of medical notes. A reference standard of 1595 randomly selected documents from inpatient admissions was annotated by human reviewers to identify all positively and negatively asserted concepts related to indwelling Urinary Catheters. We trained a natural language processing pipeline based on the V3NLP framework using 1050 documents and tested on 545 documents to determine agreement with the human reference standard. Metrics reported are positive predictive value and recall. Results The lexicon contained 590 terms related to the presence of an indwelling Urinary Catheter in various categories including insertion, care, change, and removal of Urinary Catheters and 67 terms for Urinary symptoms. Nursing notes were the most frequent inpatient note titles in the reference standard document corpus; these also yielded the highest number of positively asserted concepts with respect to Urinary Catheters. Comparing the performance of the natural language processing pipeline against the human reference standard, the overall recall was 75% and positive predictive value was 99% on the training set; on the testing set, the recall was 72% and positive predictive value was 98%. The performance on extracting Urinary symptoms (including fever) was high with recall and precision greater than 90%. Conclusions We have shown that it is possible to identify the presence of an indwelling Urinary Catheter and Urinary symptoms from the free text of electronic medical notes from inpatients using natural language processing. These are two key steps in developing automated protocols to assist humans in large-scale review of patient charts for Catheter-associated Urinary tract infection. The challenges associated with extracting indwelling Urinary Catheter-related concepts also inform the design of electronic medical record templates to reliably and consistently capture data on indwelling Urinary Catheters.
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Reducing Inappropriate Urinary Catheter Use
2017Co-Authors: Mohamad G Fakih, Sarah L Krein, Russell N Olmsted, Sam R. Watson, M. Todd Greene, Edward H. Kennedy, Sanjay SaintAbstract:Results: The Urinary Catheter use rate decreased from 18.1% (95% CI, 16.8%-19.6%) at baseline to 13.8% (95% CI, 12.9%-14.8%) at end of year 2 (P.001). The proportion of Catheterized patients with appropriate indications increased from 44.3% (95% CI, 40.3%-48.4%) to 57.6% (95% CI, 51.7%-63.4%) by the end of year 2 (P=.005). Conclusions: A statewide effort to reduce inappropriate Urinary Catheter use was associated with a significant reduction in Catheter use and improved compliance with appropriate use. The effect of the intervention was sustained for at least 2 years.
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beyond infection device utilization ratio as a performance measure for Urinary Catheter harm
Infection Control and Hospital Epidemiology, 2016Co-Authors: Mohamad G Fakih, Sarah L Krein, Carolyn V Gould, Barbara W Trautner, Jennifer Meddings, Russell N Olmsted, Sanjay SaintAbstract:Catheter-associated Urinary tract infection (CAUTI) is considered a reasonably preventable event in the hospital setting, and it has been included in the US Department of Health and Human Services National Action Plan to Prevent Healthcare-Associated Infections. While multiple definitions for measuring CAUTI exist, each has important limitations, and understanding these limitations is important to both clinical practice and policy decisions. The National Healthcare Safety Network (NHSN) surveillance definition, the most frequently used outcome measure for CAUTI prevention efforts, has limited clinical correlation and does not necessarily reflect noninfectious harms related to the Catheter. We advocate use of the device utilization ratio (DUR) as an additional performance measure for potential Urinary Catheter harm. The DUR is patient-centered and objective and is currently captured as part of NHSN reporting. Furthermore, these data are readily obtainable from electronic medical records. The DUR also provides a more direct reflection of improvement efforts focused on reducing inappropriate Urinary Catheter use.
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Reducing Inappropriate Urinary Catheter Use: A Statewide Effort
Archives of internal medicine, 2012Co-Authors: Mohamad G Fakih, Sarah L Krein, Russell N Olmsted, Sam R. Watson, M. Todd Greene, Edward H. Kennedy, Sanjay SaintAbstract:Background Indwelling Urinary Catheters may lead to both infectious and noninfectious complications and are often used in the hospital setting without an appropriate indication. The objective of this study was to evaluate the results of a statewide quality improvement effort to reduce inappropriate Urinary Catheter use. Methods Retrospective analysis of data collected between 2007 and 2010 as part of a statewide collaborative initiative before, during, and after an educational intervention promoting adherence to appropriate Urinary Catheter indications. The data were collected from 163 inpatient units in 71 participating Michigan hospitals. The intervention consisted of educating clinicians about the appropriate indications for Urinary Catheter use and promoting the daily assessment of Urinary Catheter necessity during daily nursing rounds. The main outcome measures were change in prevalence of Urinary Catheter use and adherence to appropriate indications. We used flexible generalized estimating equation (GEE) and multilevel methods to estimate rates over time while accounting for the clustering of patients within hospital units. Results The Urinary Catheter use rate decreased from 18.1% (95% CI, 16.8%-19.6%) at baseline to 13.8% (95% CI, 12.9%-14.8%) at end of year 2 (P Conclusions A statewide effort to reduce inappropriate Urinary Catheter use was associated with a significant reduction in Catheter use and improved compliance with appropriate use. The effect of the intervention was sustained for at least 2 years.
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knowledge of evidence based Urinary Catheter care practice recommendations among healthcare workers in nursing homes
Journal of the American Geriatrics Society, 2010Co-Authors: Lona Mody, Andrzej T Galecki, Sanjay Saint, Shu Chen, Sarah L KreinAbstract:OBJECTIVES: To assess the knowledge of recommended Urinary Catheter care practices among nursing home (NH) healthcare workers (HCWs) in southeast Michigan. DESIGN: Self-administered survey. SETTING: Seven NHs in southeast Michigan. PARTICIPANTS: HCWs. MEASUREMENTS: The survey included questions about respondent characteristics and knowledge about indications, care, and personal hygiene pertaining to Urinary Catheters. The association between knowledge measures and occupation (nurses vs aides) was assessed using generalized estimating equations. RESULTS: Three hundred fifty-six of 440 HCWs (81%) responded. More than 90% of HCWs were aware of measures such as cleaning around the Catheter daily, glove use, and hand hygiene with Catheter manipulation. They were less aware of research-proven recommendations of not disconnecting the Catheter from its bag (59% nurses, 30% aides, Po.001), not routinely irrigating the Catheter (48% nurses, 8% aides, Po.001), and hand hygiene after casual contact (60% nurses, 69% aides, P 5.07). HCWs were also unaware of recommendations regarding alcohol-based hand rub (27% nurses and 32% aides with correct responses, P 5.38). HCWs reported informal (e.g., nurse supervisors) and formal (in-services) sources of knowledge about Catheter care. CONCLUSION: Significant discrepancies remain between research-proven recommendations pertaining to Urinary Catheter care and HCWs’ knowledge. Nurses and aides differ in their knowledge of recommendations against harmful practices, such as disconnecting the Catheter from the bag and routinely irrigating Catheters. Further research should focus on strategies to enhance dissemination of proven infection control practices in NHs. J Am Geriatr Soc 58:1532–1537, 2010.
