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Advani SD, Cawcutt K, Klompas M, Marschall J, Meddings J, Patel PK. The next frontier of healthcare-associated infection (HAI) surveillance metrics: Beyond device-associated infections. Infect Control Hosp Epidemiol 2024; 45:693-697. [PMID: 38221847 DOI: 10.1017/ice.2023.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
In recent years, it has become increasingly evident that surveillance metrics for invasive device-associated infections (ie, central-line-associated bloodstream infections, ventilator-associated pneumonias, and catheter-associated urinary tract infections) do not capture all harms; they capture only a subset of healthcare-associated infections (HAIs). Although prevention of device-associated infections remains critical, we need to address the full spectrum of potential harms from device use and non-device-associated infections. These include complications associated with additional devices, such as peripheral venous and arterial catheters, non-device-associated infections such as nonventilator hospital-acquired pneumonia, and noninfectious device complications such as trauma, thrombosis, and acute lung injury. As authors of the device-associated infection sections in the SHEA/IDSA/APIC Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals, we highlight catheter-associated urinary tract infection as an example of the strengths and limitations of the current emphasis on device-associated infection surveillance, suggest performance metrics that present a more comprehensive picture of patient harm, and provide a high-level overview of similar issues with other infection surveillance measures.
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Affiliation(s)
- Sonali D Advani
- Duke University School of Medicine, Durham, North Carolina, United States
| | - Kelly Cawcutt
- University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Michael Klompas
- Brigham and Women's Hospital and Harvard Medical School Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States
| | - Jonas Marschall
- Bern University Hospital, University of Bern, Bern, Switzerland
- Washington University School of Medicine, St. Louis, Missouri, United States
| | - Jennifer Meddings
- University of Michigan Medical School, Veterans' Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
| | - Payal K Patel
- Intermountain Healthcare, Salt Lake City, Utah, United States
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Paiva-Santos F, Santos-Costa P, Bastos C, Graveto J. Nurses' Adherence to the Portuguese Standard to Prevent Catheter-Associated Urinary Tract Infections (CAUTIs): An Observational Study. NURSING REPORTS 2023; 13:1432-1441. [PMID: 37873827 PMCID: PMC10594504 DOI: 10.3390/nursrep13040120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/22/2023] [Accepted: 10/01/2023] [Indexed: 10/25/2023] Open
Abstract
Urinary tract infections are among the most prevalent types of healthcare-associated infections (HAIs) in hospitals and nursing homes, and they are primarily a result of unnecessary catheter usage and inadequate care. In Portugal, epidemiological data indicate that catheter-associated urinary tract infections (CAUTIs) remain widespread in clinical settings, resulting in increased morbidity and mortality rates among vulnerable populations. This study aimed to assess urinary catheter use in an oncology ward in Portugal and to evaluate nurses' adherence to the government-endorsed standards for preventing CAUTIs. An observational study was conducted over a four-month period with daily assessments of nurses' practices during urinary catheter insertion and maintenance using a government-endorsed auditing tool. Data were collected through on-site observations and nurses' feedback. The findings revealed a urinary catheter utilization rate of 17.99%. However, there was a lack of complete adherence to government-endorsed standards among oncology nurses (0%). These results indicate that current practices lack evidence-based standardization. Therefore, there is a need to develop and implement quality improvement initiatives to enhance patient safety and experiences.
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Affiliation(s)
- Filipe Paiva-Santos
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal; (P.S.-C.); (J.G.)
- School of Medicine and Biomedical Sciences (ICBAS), University of Porto, 4050-313 Porto, Portugal
| | - Paulo Santos-Costa
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal; (P.S.-C.); (J.G.)
| | | | - João Graveto
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal; (P.S.-C.); (J.G.)
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Gray J, Rachakonda A, Karnon J. Pragmatic review of interventions to prevent catheter-associated urinary tract infections (CAUTIs) in adult inpatients. J Hosp Infect 2023; 136:55-74. [PMID: 37015257 DOI: 10.1016/j.jhin.2023.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Urinary tract infections (UTIs) are one of the most common hospital-acquired complications. Insertion of a urinary catheter and the duration of catheterization are the main risk factors, with catheter-associated UTIs (CAUTIs) accounting for 70-80% of hospital-acquired UTIs. Guidance is available regarding the prevention of hospital-acquired CAUTIs; however, how best to operationalize this guidance remains a challenge. AIM To map and summarize the peer-reviewed literature on model-of-care interventions for the prevention of CAUTIs in adult inpatients. METHODS PubMed, CINAHL and SCOPUS were searched for articles that reported UTI, CAUTI or urinary catheter outcomes. Articles were screened systematically, data were extracted systematically, and interventions were classified by intervention type. FINDINGS This review included 70 articles. Interventions were classified as single component (N=19) or multi-component (N=51). Single component interventions included: daily rounds or activities (N=4), protocols and procedure changes (N=6), reminders and order sets (N=5), audit and feedback interventions (N=3), and education with simulation (N=1). Overall, daily catheter reviews and protocol and procedure changes demonstrated the most consistent effects on catheter and CAUTI outcomes. The components of multi-component interventions were categorized to map common elements and identify novel ideas. CONCLUSION A range of potential intervention options with evidence of a positive effect on catheter and CAUTI outcomes was identified. This is intended to provide a 'menu' of intervention options for local decision makers, enabling them to identify interventions that are relevant and feasible in their local setting.
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Affiliation(s)
- J Gray
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.
| | - A Rachakonda
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - J Karnon
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
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Cho H, Song I, Jang J, Yoo Y. A Lightweight Deep Learning Network on a System-on-Chip for Wearable Ultrasound Bladder Volume Measurement Systems: Preliminary Study. Bioengineering (Basel) 2023; 10:bioengineering10050525. [PMID: 37237594 DOI: 10.3390/bioengineering10050525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/17/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
Bladder volume assessments are crucial for managing urinary disorders. Ultrasound imaging (US) is a preferred noninvasive, cost-effective imaging modality for bladder observation and volume measurements. However, the high operator dependency of US is a major challenge due to the difficulty in evaluating ultrasound images without professional expertise. To address this issue, image-based automatic bladder volume estimation methods have been introduced, but most conventional methods require high-complexity computing resources that are not available in point-of-care (POC) settings. Therefore, in this study, a deep learning-based bladder volume measurement system was developed for POC settings using a lightweight convolutional neural network (CNN)-based segmentation model, which was optimized on a low-resource system-on-chip (SoC) to detect and segment the bladder region in ultrasound images in real time. The proposed model achieved high accuracy and robustness and can be executed on the low-resource SoC at 7.93 frames per second, which is 13.44 times faster than the frame rate of a conventional network with negligible accuracy drawbacks (0.004 of the Dice coefficient). The feasibility of the developed lightweight deep learning network was demonstrated using tissue-mimicking phantoms.
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Affiliation(s)
- Hyunwoo Cho
- Department of Electronic Engineering, Sogang University, Seoul 04107, Republic of Korea
| | - Ilseob Song
- Medical Solutions Institute, Sogang University, Seoul 04107, Republic of Korea
- Edgecare Inc., TE1103, 35 Baekbeom-ro, Mapo-gu, Seoul 04107, Republic of Korea
| | - Jihun Jang
- Medical Solutions Institute, Sogang University, Seoul 04107, Republic of Korea
- Edgecare Inc., TE1103, 35 Baekbeom-ro, Mapo-gu, Seoul 04107, Republic of Korea
| | - Yangmo Yoo
- Department of Electronic Engineering, Sogang University, Seoul 04107, Republic of Korea
- Edgecare Inc., TE1103, 35 Baekbeom-ro, Mapo-gu, Seoul 04107, Republic of Korea
- Department of Biomedical Engineering, Sogang University, Seoul 04107, Republic of Korea
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Ramezani F, Khatiban M, Rahimbashar F, Soltanian AR, Mousavi-bahar SH, Elyasi E. Evaluating the Potential of a New Low-Profile Urinary Catheter in Preventing Catheter-Associated Urinary Tract Infections: A Prospective Randomized Blinded Clinical Trial. Health Serv Res Manag Epidemiol 2023; 10:23333928231211410. [PMID: 37954479 PMCID: PMC10638883 DOI: 10.1177/23333928231211410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023] Open
Abstract
Aim To investigate the efficacy of a new low-profile catheter on incidence of the catheter-associated urinary tract infections (CAUTI) in comatose patients admitted to the intensive care unit. Background Catheter-induced urothelial injury is a key component in the development of urinary tract infections in catheterized patients. Methods In this prospective randomized blinded clinical trial, 80 patients requiring indwelling urinary catheterization were equally randomized to either the standard Foley catheter (control) or the low-profile catheter (experimental) group. The signs of urinary tract infection for comatose patients were considered (ie, ≥105 of colony-forming unit/milliliter of urine, hematuria, serum leukocytes, and body temperature) and recorded at baseline and on days 3 and 5 after catheterization. The analysis of covariance was applied by the SPSS-20 software at a 95% confidence level. Results An increasing proportion of patients with elevated urinary colony counts were seen in the Foley catheter group compared with the low-profile catheter group (12.5% vs 5%). However, there were no between-group differences in the urinary colony counts and body temperature after controlling for antibiotic doses and fluid intake. Patients in the low-profile catheter group had significantly lower rates of hematuria and serum leukocytes than those in the Foley catheter group. Conclusion A newly designed low-profile urinary catheter has demonstrated a trend toward reducing the incidence of CAUTI in patients with indwelling urinary catheters. Further studies with larger sample sizes and follow-up are needed to confirm the benefits.
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Affiliation(s)
- Farahnaz Ramezani
- Besat Specialized and Sub-specialized Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mahnaz Khatiban
- Mother and Child Care Research Center, Department of Medical-Surgical Nursing, Department of Ethics Education in Medical Sciences, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Farshid Rahimbashar
- Besat Specialized and Sub-specialized Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Anesthesiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Reza Soltanian
- Modeling of Noncommunicable Disease Research Center, Department of Biostatistics and Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyed Habibollah Mousavi-bahar
- Besat Specialized and Sub-specialized Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
- Urology & Nephrology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ensieh Elyasi
- Besat Specialized and Sub-specialized Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
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Hascic A, Wolfensberger A, Clack L, Schreiber PW, Kuster SP, Sax H. Documentation of adherence to infection prevention best practice in patient records: a mixed-methods investigation. Antimicrob Resist Infect Control 2022; 11:107. [PMID: 36008823 PMCID: PMC9413896 DOI: 10.1186/s13756-022-01139-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 07/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background Healthcare-associated infections remain a preventable cause of patient harm in healthcare. Full documentation of adherence to evidence-based best practices for each patient can support monitoring and promotion of infection prevention measures. Thus, we reviewed the extent, nature, and determinants of the documentation of infection prevention (IP) standards in patients with HAI.
Methods We reviewed electronic patient records (EMRs) of patients included in four annual point-prevalence studies 2013–2016 who developed a device- or procedure-related HAI (surgical site infection (SSI), catheter-associated urinary tract infection (CAUTI), ventilator-associated infection (VAP), catheter-related bloodstream infection (CRBSI)). We examined the documentation quality of mandatory preventive measures published as institutional IP standards. Additionally, we undertook semi-structured interviews with healthcare providers and a two-step inductive (grounded theory) and deductive (Theory of Planned Behaviour) content analysis. Results Of overall 2972 surveyed patients, 249 (8.4%) patients developed 272 healthcare-associated infections. Of these, 116 patients met the inclusion criteria, classified as patients with SSI, CAUTI, VAP, CRBSI in 78 (67%), 21 (18%), 10 (9%), 7 (6%), cases, respectively. We found documentation of IP measures in EMRs in 432/1308 (33%) cases. Documentation of execution existed in the study patients’ EMRs for SSI, CAUTI, VAP, CRBSI, and overall, in 261/931 (28%), 27/104 (26%), 46/122 (38%), 26/151 (17%), and 360/1308 (28%) cases, respectively, and documentation of non-execution in 67/931 (7%), 2/104 (2%), 0/122 (0%), 3/151 (2%), and 72/1308 (6%) cases, respectively. Healthcare provider attitudes, subjective norms, and perceived behavioural control indicated reluctance to document IP standards. Conclusions EMRs rarely included conclusive data about adherence to IP standards. Documentation had to be established indirectly through data captured for other reasons. Mandatory institutional documentation protocols or technically automated documentation may be necessary to address such shortcomings in patient safety documentation.
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McNaughton J, Fairley-Murdoch M. Catheter valves: are they useful in supporting patients in a trial without catheter? Br J Community Nurs 2022; 27:294-300. [PMID: 35671208 DOI: 10.12968/bjcn.2022.27.6.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A trial without catheter (TWOC) is a common urological procedure undertaken to remove an indwelling urinary catheter when no longer clinically indicated. An appropriately trained practitioner should undertake a TWOC in a controlled environment to ensure that a further urinary retention does not occur. Indwelling urinary catheters are commonly used with a free drainage system such as a leg bag, which continually empties the bladder. This article examines the potential benefits of using a catheter valve as an alternative to free drainage, prior to undertaking a TWOC, to optimise clinical outcomes and patient experience. This article will guide nurses to increase their knowledge of catheter valves to promote person-centred informed decision-making.
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Ray-Barruel G. I-DECIDED ®-a decision tool for assessment and management of invasive devices in the hospital setting. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S37-S43. [PMID: 35439078 DOI: 10.12968/bjon.2022.31.8.s37] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Indwelling medical devices, including vascular access and urinary catheters, pose a risk for infection, and therefore daily assessment and consideration of their continued need is a patient safety priority. The I-DECIDED® device assessment and decision tool is an evidence-based checklist, designed to improve the assessment, care and timely removal of invasive devices in acute hospitalized patients. This paper explains each step of the tool, with rationale for inclusion.
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Keneally RJ, Chow JH, Pla RA, Heinz ER, Mazzeffi MA. Racial disparities in catheter related urinary tract infections among elderly trauma patients in the US. Am J Infect Control 2022; 50:77-80. [PMID: 34955191 DOI: 10.1016/j.ajic.2021.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/05/2021] [Accepted: 08/07/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Catheter associated urinary tract infections (CAUTIs) have become a focus for reducing healthcare costs. Reimbursement may be reduced to hospitals with higher rates. The implementation of bundles or other efforts to reduce infection numbers may not be as robust at hospitals caring for more diverse patient populations. This may lead to a disparity in hospital-associated infections rates that may lead to lower reimbursement and a downward spiral of quality of care and racial disparities. METHODS We analyzed patients in the National Trauma Data Bank from 2016 to 2017. The final analysis included patients 65 years or older with one or more day of mechanical ventilation. This was the population had the highest rate of CAUTI. We compared white patients to non-whites using students t test, Mann Whitney U test, or chi-square as appropriate. Logistic regression with odds ratios (ORs) and 95% confidence intervals (CI) was computed to identify risk factors for of CAUTI. RESULTS Risk factors for developing a CAUTI were race (OR 1.44, 95% confidence interval (95%CI) 1.23-1.71), injury severity score (OR 1.10 per increase of one, 95% CI 1.01-1.02), care at a teaching hospital (OR 1.17, 95%CI 1.02-1.35), private insurance (OR 1.28, 95%CI 1.09-1.51), hypertension (OR 1.18, 95%CI 1.02-1.37), female gender (OR 1.54, 95%CI 1.33-1.77). Non-white patients received care at teaching hospitals more often and had a higher rate of government insurance or no insurance. DISCUSSION The Center for Medicare and Medicaid Services (CMS) has put in place a reimbursement modification 87 plan based on the rates of hospital-associated infections including CAUTIs. We have demonstrated non-white 88 patients have higher odds for developing a CAUTI. CONCLUSION CMS may potentially worsen the racial disparity by further cutting reimbursement to hospitals who care for higher proportions of non-whites.
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