Decreasing Nosocomial Urinary Tract Infection in a Large Academic Community Hospital

Doyle, Barbara; Mawji, Zubina; Horgan, Margaret; Stillman, Paula L.; Rinehart, Amy; Bailey, Judith; Mullin, Edward M.

doi:10.1097/00129234-200105000-00007

Cited by 20 publications

(11 citation statements)

References 16 publications

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“…Daily reminders from nurses to physicians after specific durations of catheter placement (such as 3 to 5 days) have been included as part of several multi-modal interventions (20-22); these before-and-after (uncontrolled) studies demonstrate significantly reduced incidence of catheter-associated urinary tract infection. Reminders to physicians have also been evaluated in several forms, including reminders to physicians that a urinary catheter was placed in the emergency department (23) and by placing restrictions on catheter placement to appropriate indications (usually by prompting physicians to designate an appropriate indication as part of the catheter placement order) (24-26). Expiring urinary catheter orders (e.g., “stop orders”) serve to remind and prompt removal of catheters after pre-specified time periods and can be directed to physicians (24) or nurses, and can authorize nurses to remove unnecessary catheters (based on criteria provided) without requiring an additional order from the physician (23, 25, 27).…”

Section: How Preventable Is Catheter-associated Urinary Tract Infection?mentioning

confidence: 99%

Catheter-Associated Urinary Tract Infection and the Medicare Rule Changes

Meddings²,

et al. 2009

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Catheter-associated urinary tract infection, a common and potentially preventable complication of hospitalization, is one of the hospital-acquired complications chosen by the Centers for Medicare and Medicaid Services (CMS) for which hospitals no longer receive additional payment. To help understand the potential consequences of the recent CMS rule changes we examine the preventability of catheter-associated infection, review the CMS rules changes regarding catheter-associated urinary tract infection, offer our assessment of the possible consequences of these changes, and provide guidance for hospital-based administrators and clinicians. Though controversial, we conclude that the CMS rule changes related to catheter-associated urinary tract infection may do more good than harm since hospitals are likely to re-double their efforts in preventing catheter-associated urinary tract infection, which may minimize unnecessary placement and facilitate prompt removal of indwelling catheters. While we applaud CMS for forcing hospitals to increase efforts to prevent complications stemming from hospital-acquired infection, the opportunity costs and potential for unintended consequences cannot be overlooked. Consequently, how hospitals and physicians respond to the CMS rule changes must be monitored closely.

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Section: How Preventable Is Catheter-associated Urinary Tract Infection?mentioning

confidence: 99%

Catheter-Associated Urinary Tract Infection and the Medicare Rule Changes

Meddings²,

et al. 2009

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“…In addition, for patients with indwelling bladder catheters, this performance measure could be combined with other performance measures that address (1) the indications for initial bladder catheter insertion [26][27][28], (2) using aseptic technique and hand washing when inserting the catheter [29], (3) securing the catheter to avoid pulling on the bladder trigone, (4) maintaining a closed system, and (5) early removal of the bladder catheter (within 3-4 days). All of these measures should be combined to form the "urinary catheter bundle.…”

mentioning

confidence: 99%

Reducing Antibiotic Overuse: A Call for a National Performance Measure for Not Treating Asymptomatic Bacteriuria

Groß

Patel

2007

Clinical Infectious Diseases

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Positive urinary tract culture results often represent asymptomatic bacteriuria, which does not need to be treated with antimicrobial agents. Avoiding treatment of asymptomatic bacteriuria in adults should reduce the risk of development of antibiotic resistance and is consistent with the Infectious Diseases Society of America and US Preventive Services Task Force guidelines on bacteriuria. A similar approach for not treating upper respiratory illnesses with antibiotics was initiated by the Centers for Disease Control and Prevention. We propose that a hospital and ambulatory performance measure should be developed for not treating asymptomatic bacteriuria in adults. In addition, such an effort would aid hospitals in confronting the proposal of the Centers for Medicare and Medicaid Services (to be implemented in 2009) to not pay the expenses associated with catheter-associated urinary tract infection.

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“…It is reported in the literature that urinary catheters must be applied by experienced individuals under aseptic conditions (Geng et al., ; Mangnall, ). Studies show that educating healthcare workers who apply urinary catheters and maintain aseptic conditions has a positive effect on the rate of CAUTIs (Doyle et al., ; Gokulo, Smith, & Hickner, ). In this study, urinary catheters were applied by nurses to patients in both the pre‐education and posteducation groups.…”

Section: Discussionmentioning

confidence: 99%