Effectiveness of Multifaceted Hospitalwide Quality Improvement Programs Featuring an Intervention to Remove Unnecessary Urinary Catheters at a Tertiary Care Center in Thailand

Apisarnthanarak, Anucha; Thongphubeth, RN Kanokporn; Sirinvaravong, Sirinaj; Kitkangvan, Danai; Yuekyen, RN Chananart; Warachan, Boonyasit; Warren, David K.; Fraser, Victoria J.

doi:10.1086/518453

Cited by 90 publications

(81 citation statements)

References 34 publications

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“…Successful strategies have included educating nursing staff to limit catheter use and providing monthly reports of CAUTI rates, 15 daily reminders to physicians and nurses to remove unnecessary catheters, [16][17][18] implementation of criteria-based catheter guidelines and daily determination of whether or not patients meet the criteria, [19][20][21] and introduction of nurse-promoted protocols for discontinuing catheters. 18,19 All strategies have resulted in a reduction in the duration of catheterization or in the number of CAUTIs or both.…”

Section: Discussionmentioning

confidence: 99%

Reducing Use of Indwelling Urinary Catheters and Associated Urinary Tract Infections

Elpern

Killeen

Ketchem

et al. 2009

American Journal of Critical Care

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Background Use of indwelling urinary catheters can lead to complications, most commonly catheter-associated urinary tract infections. Duration of catheterization is the major risk factor. These infections can result in sepsis, prolonged hospitalization, additional hospital costs, and mortality. Objectives To implement and evaluate the efficacy of an intervention to reduce catheter-associated urinary tract infections in a medical intensive care unit by decreasing use of urinary catheters. Methods Indications for continuing urinary catheterization with indwelling devices were developed by unit clinicians. For a 6-month intervention period, patients in a medical intensive care unit who had indwelling urinary catheters were evaluated daily by using criteria for appropriate catheter continuance. Recommendations were made to discontinue indwelling urinary catheters in patients who did not meet the criteria. Days of use of a urinary catheter and rates of catheter-associated urinary tract infections during the intervention were compared with those of the preceding 11 months. Results During the study period, 337 patients had a total of 1432 days of urinary catheterization. With use of guidelines, duration of use was significantly reduced to a mean of 238.6 d/mo from the previous rate of 311.7 d/mo. The number of catheter-associated urinary tract infections per 1000 days of use was a mean of 4.7/mo before the intervention and zero during the 6-month intervention period. Conclusions Implementation of an intervention to judge appropriateness of indwelling urinary catheters may result in significant reductions in duration of catheterization and occurrences of catheter-associated urinary tract infections.

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Section: Discussionmentioning

confidence: 99%

Reducing Use of Indwelling Urinary Catheters and Associated Urinary Tract Infections

Elpern

Killeen

Ketchem

et al. 2009

American Journal of Critical Care

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“…Although not all CAUTIs can be prevented, it is believed that the incidence can be reduced through active surveillance and by the proper management of the indwelling catheter (Apisarnthanarak et al, 2007). Therefore, this study was designed to determine the spectrum of bacterial etiology and antibiotic resistance pattern of uropathogens in catheter associated UTI and to provide local epidemiological data on CAUTI in our hospital in support of the activities of the Infection Control Unit.…”

Section: Introductionmentioning

confidence: 99%

Urinary Pathogens and Their Antimicrobial Susceptibility in Patients with Indwelling Urinary Catheter

Onipede¹,

Oyekale²,

Olopade³

et al. 2010

Sierra Leone j. biomed. res.

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The indwelling urinary catheter (IUC) is the most significant risk factor for developing nosocomial urinary tract infections (UTIs). In order to determine the spectrum of bacterial etiology and antibiotic resistance pattern of uropathogens causing catheter associated UTI, a convenient sample size of ninety-two (92) patients on urethral catheter was investigated. Ethical approval for the study was obtained from the OAUTHC research and ethical committee. Catheter stream urine samples were obtained from all patients and cultured on appropriate culture media. Suspected isolates were identified by a combination of standard tests and using MICROBACT GNA12A/B/E. Susceptibility of the isolates against thirteen (13) antibiotics was performed by the disc diffusion method. Significant bacteriuria was observed in 60.9% (56) catheter specimen urine (CSU) received, while 39.1% (36) were culture negative. Of the 56 positive culture, the predominant organisms were Klebsiella oxytoca, 28.6 %( 16), Proteus vulgaris, 23.2% (13) and Staphylococcus aureus, 12.5% (7). Overall, the antimicrobial susceptibility results showed that all the isolates were highly resistant to the antibiotics tested. Over 50% resistance was recorded for trimethoprim/sulfamethoxazole, gentamicin and amoxicillin/clavulanic acid. More than 25% of the isolates were resistant to nitrofurantoin. This study indicates that catheter stream UTI caused by multiply resistant bacteria are common in our hospital. There is a need to establish standard guidelines on the care of catheter for all units in the hospital with a view to preventing nosocomial infections associated with the use of the catheter in patients. We also advocated prudent use of antibiotics. Key words: Antibiotic resistance, Urinary catheter, Uropathogens, Urinary tract infection Received 27 March 2010/ Accepted 1 June 2010 INTRODUCTIONUrinary tract infections (UTIs) are the most common infections found in the hospital as well as long-term care setting. The indwelling urinary catheter (IUC) is the most significant risk factor for developing catheter-associated urinary tract infections (CAUTIs). The risk of acquiring a urinary tract infection depends on the method and duration of catheterisation, the quality of catheter care, and host susceptibility among others. Several studies have indicated that between 75 and 80% of all healthcare associated UTIs follow the insertion of a urinary catheter (Bryan and

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“…Finally, multifaceted interventions often incorporated audits and feedback. 22 Meddings et al 20 Fuchs et al 23 Elpern et al 24 Fakih et al 7 Apisarnthanarak et al 25 Knoll et al 1 …”

Section: Resultsmentioning

confidence: 99%

Do System-Based Interventions Affect Catheter-Associated Urinary Tract Infection?

Halm

OʼConnor

2014

American Journal of Critical Care

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Effectiveness of Multifaceted Hospitalwide Quality Improvement Programs Featuring an Intervention to Remove Unnecessary Urinary Catheters at a Tertiary Care Center in Thailand

Abstract: "Effectiveness of multifaceted hospitalwide quality improvement programs featuring an intervention to remove unnecessary urinary catheters at a Tertiary

Cited by 90 publications

References 34 publications

Reducing Use of Indwelling Urinary Catheters and Associated Urinary Tract Infections

Reducing Use of Indwelling Urinary Catheters and Associated Urinary Tract Infections

Urinary Pathogens and Their Antimicrobial Susceptibility in Patients with Indwelling Urinary Catheter

Do System-Based Interventions Affect Catheter-Associated Urinary Tract Infection?

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