Prevention of Nosocomial Catheter-Associated Urinary Tract Infections Through Computerized Feedback to Physicians and a Nurse-Directed Protocol

Abstract

Catheter-associated urinary tract infections (CAUTIs) represent the most common nosocomial infection. The authors' baseline rate of CAUTI for general medical service was elevated at 36 per 1000 catheter-days. The medical literature has consistently linked inappropriate catheter use with the development of CAUTI. The baseline data also revealed a high rate of inappropriate use of indwelling urinary catheters. Using the dual modalities of technology through prompts in the computerized order/entry system and handheld bladder scanners, as well as in combination with staff education and nurse empowerment, the authors were successful in reducing the use and duration of urinary catheters as well as the incidence of CAUTI. In subsequent data collection cycles over the following 2 years, 81% reduction in device use and a 73% reduction in the clinical end point of nosocomial CAUTI (36/1000 catheter-days to 11/1000 catheter-days; P < .001) was demonstrated.

Interventions to minimise the initial use of indwelling urinary catheters in acute care: A systematic review

“…Three of the papers (Topal et al, 2005;Patrizzi et al, 2009;Voss, 2009) stated that their studies were part of a local quality improvement or patient safety project rather than formal research studies. Distinguishing between research and quality improvement projects (QIPs) is not always clear cut and there is often overlap between the methods used.…”

“…The duration of data collection, including follow-up period, varied from 8 weeks (Voss, 2009) to 2 years (Topal et al, 2005;Stephan et al, 2006).…”

“…Danchaivijitr et al (1992) collected data from 13 randomly selected hospitals in Thailand and was one of the only three studies not set in the USA, the other two were Slappendel and Weber (1999) in the Netherlands and Stephan et al (2006) in Switzerland. Three of the studies took place in an emergency department (Fakih et al, 2010;Gokula et al, 2007;Patrizzi et al, 2009), two in surgical units (Stephan et al, 2006;Slappendel and Weber, 1999), two within medical wards (Topal et al, 2005;Voss, 2009) and one both medical and surgical wards (Danchaivijitr et al, 1992).…”

“…The other methods of change used were the introduction of bladder scanners (Patrizzi et al, 2009;Slappendel and Weber, 1999;Topal et al, 2005), the introduction or adaptation of IUC guidelines (Gokula et al, 2007;Slappendel and Weber, 1999;Stephan et al, 2006;Voss, 2009), indication checklist reminders (Danchaivijitr et al, 1992;Fakih et al, 2010;Gokula et al, 2007;Patrizzi et al, 2009), removal of IUC kits from bedsides (Patrizzi et al, 2009), feedback on IUC usage (Patrizzi et al, 2009) and introduction of physician's IUC ''champion'' (Fakih et al, 2010).…”

“…Although none of the studies directly compared efficacy of different components of interventions or combinations of components of interventions, some studies noted the importance of combining different mechanisms. Topal et al (2005) identified the importance of merging increased awareness of the risks of catheterisation with directives to avoid unnecessary use in order to achieve cultural change. According to Patrizzi et al (2009), practice change was dependent upon addressing a combination of educational, behavioural and cultural factors.…”