A pilot study on improving the appropriateness of urine specimen collection among catheterised patients in acute aged care

Gralton, Jan; Boston, Belinda; Cook, Christine; Thomas, Kerrie; Taylor, Peter; Gordon, Alice Kizny; Smerdely, Peter; Hughes, Gwen; Louey, Margaret; Curtis, P.

doi:10.1016/j.idh.2016.12.003

Cited by 2 publications

(3 citation statements)

References 41 publications

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“…Whilst not specifically aiming to reduce IDC use, another Australian study piloted a decision‐support tool for urine specimen collection and found that use of the tool reduced catheter days and catheter utilisation (Gralton et al, ). A catheter reminder intervention was recently evaluated in an Australian hospital, which found a reduction in IDC duration in non‐ICU patients (Mitchell et al, ).…”

Section: Introductionmentioning

confidence: 99%

Implementation of a multifaceted nurse‐led intervention to reduce indwelling urinary catheter use in four Australian hospitals: A pre‐ and postintervention study

Giles

Graham

Ball

et al. 2020

Journal of Clinical Nursing

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Aims and objectives This study aimed to reduce indwelling urinary catheter (IDC) use and duration through implementation of a multifaceted “bundled” care intervention. Background Indwelling urinary catheters present a risk for patients through the potential development of catheter‐associated urinary tract infection (CAUTI), with duration of IDC a key risk factor. Catheter‐associated urinary tract infection is considered preventable yet accounts for over a third of all hospital‐acquired infections. The most effective CAUTI reduction strategy is to avoid IDC use where ever possible and to remove the IDC as early as appropriate. Design A cluster‐controlled pre‐ and poststudy at a facility level with a phased intervention implementation approach. Methods A multifaceted intervention involving a “No CAUTI” catheter care bundle was implemented, in 4 acute‐care hospitals, 2 in metropolitan and 2 in rural locations, in New South Wales, Australia. Indwelling urinary catheter point prevalence and duration data were collected at the bedside on 1,630 adult inpatients at preintervention and 1,677 and 1,551 at 4 and 9 months postintervention. This study is presented in line with the StaRI checklist (see Appendix S1). Results A nonsignificant trend towards reduction in IDC prevalence was identified, from 12% preintervention to 10% of all inpatients at 4 and 9 months. Variability in preintervention IDC prevalence existed across hospitals (8%–16%). Variability in reduction was evident across hospitals at 4 months (between −2% and 4%) and 9 months (between 0%–8%). Hospitals with higher preintervention prevalence showed larger decreases, up to 50% when preintervention prevalence was 16%. Indwelling urinary catheter duration increased as more of the short‐term IDC placements were avoided. Conclusions Implementation of a multifaceted intervention resulted in reduced IDC use in four acute‐care hospitals in Australia. This result was not statistically significant but did reflect a positive trend of reduction. There was a significant reduction in short‐term IDC use at 9 months postintervention. Relevance to clinical practice Clinical nurse leaders can effectively implement change strategies that influence patient outcomes. Implementation of the evidence‐based “No CAUTI” bundle increased awareness of appropriate indications and provided nurses with the tools to inform decision‐making related to insertion and removal of IDCs in acute inpatient settings. Working in partnership with inpatients and the multidisciplinary team is essential in minimising acute‐care IDC use.

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Section: Introductionmentioning

confidence: 99%

Implementation of a multifaceted nurse‐led intervention to reduce indwelling urinary catheter use in four Australian hospitals: A pre‐ and postintervention study

Giles

Graham

Ball

et al. 2020

Journal of Clinical Nursing

View full text Add to dashboard Cite

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“…Routine urine culture collection for IDC insertion is not recommended and leads to a break in the closed catheter system and potentially avoidable antimicrobial treatment (Garcia & Spitzer, ). Use of a decision‐making tool for CSU collection has been found to reduce inappropriate CSU collections in a pilot study (Gralton et al, ), and further use is warranted.…”

Section: Discussionmentioning

confidence: 99%

“…Use of a decision-making tool for CSU collection has been found to reduce inappropriate CSU collections in a pilot study (Gralton et al, 2017), and further use is warranted.…”

Section: Discussionmentioning

confidence: 99%

Variations in indwelling urinary catheter use in four Australian acute care hospitals

Giles

Graham

Ball

et al. 2019

Journal of Clinical Nursing

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Aims and objectives To identify the point prevalence of indwelling urinary catheters (IDCs) in adult inpatients in acute care hospitals, and to describe the indications for IDC insertion based on patient age, gender, specialty and hospital. Background Catheter‐associated urinary tract infections (CAUTIs) are preventable healthcare‐associated infections. IDC duration is the strongest predictor of CAUTI, and little is known about characteristics of patients who receive an IDC. Design Two single‐day point prevalence surveys collected baseline patient data as part of a larger pre‐post control‐intervention study. Methods Surveys were conducted at four acute care hospitals in NSW, Australia, for all adult patients. Data collection included IDC presence, insertion details and urine culture collection. Point prevalence data were linked with electronically extracted patient demographic data. This study is presented in line with STROBE checklist (See Supplementary File 1). Result Data from 1,630 patients were analysed, with 196 patients (12%) identified as having an IDC on the survey dates. IDC prevalence rates were higher in males (13%) than in females (11%). Critical care had the highest rate of patients with IDCs (42%). Urine cultures were collected in 70 patients with an IDC (43%). Conclusions Findings indicated similar rates of IDC use in males and females, and there was no significant difference in age between patients with or without an IDC. However, indication for IDC varied by patient age and gender. High rates of urine culture collection may represent routine collection. Relevance to clinical practice IDC use is found across genders, all age groups and specialties. Nurses should be aware that any of their patients may have an IDC and be particularly aware of certain indications based on patient age and gender. Routine urine culture collection is not advised, and instead, nurses should be guided by clinical decision‐making tools.

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A pilot study on improving the appropriateness of urine specimen collection among catheterised patients in acute aged care

Cited by 2 publications

References 41 publications

Implementation of a multifaceted nurse‐led intervention to reduce indwelling urinary catheter use in four Australian hospitals: A pre‐ and postintervention study

Implementation of a multifaceted nurse‐led intervention to reduce indwelling urinary catheter use in four Australian hospitals: A pre‐ and postintervention study

Variations in indwelling urinary catheter use in four Australian acute care hospitals

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