Successful strategy to decrease indwelling catheter utilization rates in an academic medical intensive care unit

Gupta, Sushilkumar Satish; Irukulla, Pavan; Shenoy, Mangalore Amith; Nyemba, Vimbai; Yacoub, Diana; Kupfer, Yizhak

doi:10.1016/j.ajic.2017.06.020

Cited by 17 publications

(8 citation statements)

References 20 publications

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“…Limited success of CAUTI prevention interventions in ICUs may be explained by inpatients in ICUs being ill enough to have clear and appropriate need for an IDC insertion (Saint et al, ). Interventions focused specifically in ICUs which aim to change such mindsets, such as that implemented by Gupta et al (), including a multidisciplinary team, nurse IDC removal protocol and bladder scanning, may be needed to reduce IDC use in ICUs.…”

Section: Discussionmentioning

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: Discussionmentioning

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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“…However, a biofilm is formed on the surface of the urinary catheter within 24 hours of indwelling catheterization. 20 , 21 Formation of a biofilm subsequently facilitates bacterial adhesion and colonization, leading to the occurrence of urinary tract infections. 22 More microbes are present in the urinary system of patients with AIS compared with patients without AIS.…”

Section: Discussionmentioning

confidence: 99%

Predictive value of the sequential organ failure assessment (SOFA) score for prognosis in patients with severe acute ischemic stroke: a retrospective study

et al. 2020

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Objective To identify the risk factors for early death and determine the predictive value of the sequential organ failure assessment (SOFA) score for prognosis of severe acute ischemic stroke (AIS). Methods A total of 110 patients with severe AIS were enrolled and divided into the non-survivor (n = 34) and survivor groups (n = 76). Logistic regression analysis was conducted to identify risk factors for early death, while the receiver operator characteristic (ROC) curve was used to determine the predictive effect of the SOFA score on prognosis. Results Logistic regression analysis showed that urinary tract infection (odds ratio [OR] = 17.364, 95% confidence interval [CI]: 1.903–158.427), mechanical ventilation (OR = 1.754, 95% CI: 1.648–2.219), and osmotic therapy (OR = 2.835, 95% CI: 1.871–5.102) were significantly correlated with early death of severe AIS. ROC curve analysis of the area under the curve after hospitalization showed that the maximum SOFA and ΔSOFA scores exceeded 0.7. Conclusion Our study shows that urinary tract infection, mechanical ventilation, and osmotic therapy are risk factors for early death of severe AIS. The SOFA score has good predictive value for prognosis of severe AIS. These findings may provide a guideline for improving clinical outcome.

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“…16 It is noticed that the aspects involved in the performance of bladder catheterization must be addressed in hospital protocols, including methods of continuing education, in order to direct nurses to the correct handling of catheters. 22 The application of training and capacity building is seen through continuing education courses for nurses who handle bladder catheters as an effective method for improving care praxis. 23 It is known that continuous bladder catheterization is an invasive and complex procedure that nurses perform in their daily care practice.…”

Section: Discussionmentioning

confidence: 99%

Práticas baseadas em evidências: cateterismo vesical contínuo na prática clínica

Rodrigues

daSilva

Silva

2020

Rev enferm UFPE on line.

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Objetivo: analisar aspectos da técnica de inserção do cateter vesical contínuo em unidades de internação clínica de um hospital. Método: trata-se de um estudo qualitativo, descritivo, exploratório. Procedeu-se à coleta de dados mediante entrevista semiestruturada, gravadas, transcritas e submetidas à técnica de Análise de Conteúdo na modalidade Análise Categorial. Resultados: elencaram-se as categorias: << Prática profissional frente ao cateterismo vesical contínuo >>; << Domínio e busca de conhecimento técnico-científico >> e << Sugestões para melhoria do cuidado ao paciente em uso de cateterismo vesical contínuo >>. Conclusão: conclui-se que o procedimento tem sido realizado de forma distinta e não uniforme, sendo relevantes a sua padronização e a necessidade premente de mais evidências e estudos sobre o tema. Observa-se que o procedimento de cateterismo vesical contínuo, assim como outros, enfrenta uma dicotomia entre a prática, o ensino e as evidências científicas sobre o assunto. Descritores: Cateterismo Urinário; Segurança do Paciente; Assistência ao Paciente; Cuidados de Enfermagem; Enfermagem Baseada em Evidências; Protocolos.AbstractObjective: to analyze aspects of the continuous bladder catheter insertion technique in clinical inpatient units of a hospital. Method: this is a qualitative, descriptive, exploratory study. Data were collected through semi-structured interviews, recorded, transcribed and submitted to the Content Analysis technique in the Categorical Analysis modality. Results: the categories were listed: << Professional practice in the face of continuous bladder catheterization >>; << Domain and search for technical and scientific knowledge >> and << Suggestions for improving patient care using continuous bladder catheterization >>. Conclusion: it is concluded that the procedure has been performed in a different and non-uniform way, with its standardization and the pressing need for more evidence and studies on the subject being relevant. It is observed that the continuous bladder catheterization procedure, like others, faces a dichotomy between practice, teaching and scientific evidence on the subject. Descriptors: Urinary Catheterization; Patient Safety; Patient Assistance; Nursing Care; Evidence Based Nursing; Protocols. ResumenObjetivo: analizar aspectos de la técnica de inserción continua de catéter vesical en unidades de internación clínica de un hospital. Método: este es un estudio cualitativo, descriptivo, exploratorio. Los datos fueron recolectados a través de entrevistas semiestructuradas, registradas, transcritas y enviadas a la técnica de Análisis de Contenido en la modalidad de Análisis Categorial. Resultados: se enumeraron las categorías: << Práctica profesional frente a la cateterización vesical continua >>; << Dominio y búsqueda de conocimientos técnicos y científicos >> y << Sugerencias para mejorar la atención al paciente mediante cateterismo vesical continuo >>. Conclusión: se concluye que el procedimiento se realizó de manera distinta y no uniforme, con su estandarización y la urgente necesidad de más evidencia y estudios sobre el tema que sean relevantes. Se observa que el procedimiento de cateterización vesical continua, como otros, enfrenta una dicotomía entre la práctica, la enseñanza y la evidencia científica sobre el tema. Descriptores: Cateterismo Urinario; Seguridad del Paciente; Asistencia al Paciente; Cuidados de Enfermería; Enfermería Basada en la Evidencia; Protocolos.

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Successful strategy to decrease indwelling catheter utilization rates in an academic medical intensive care unit

Cited by 17 publications

References 20 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

Predictive value of the sequential organ failure assessment (SOFA) score for prognosis in patients with severe acute ischemic stroke: a retrospective study

Práticas baseadas em evidências: cateterismo vesical contínuo na prática clínica

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