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Catheter-Associated Urinary Tract Infections in Intensive Care Units Can Be Reduced by Prompting Physicians to Remove Unnecessary Catheters

Published online by Cambridge University Press:  02 January 2015

Wei-Chun Huang
Affiliation:
Intensive Care Unit, Veterans General Hospital, Kaohsiung, China
Shue-Ren Wann
Affiliation:
Intensive Care Unit, Veterans General Hospital, Kaohsiung, China Section of Infectious Diseases and Microbiology, Kaohsiung, Veterans General Hospital, Kaohsiung, China
Shoa-Lin Lin*
Affiliation:
Intensive Care Unit, Veterans General Hospital, Kaohsiung, China National Yang-Ming University, School of Medicine, Taipei, Taiwan, Republic of China
Calvin M. Kunin
Affiliation:
Ohio State University College of Medicine and Public Health, Columbus, Ohio
Ming-Ho Kung
Affiliation:
Intensive Care Unit, Veterans General Hospital, Kaohsiung, China
Chin-Hsun Lin
Affiliation:
Intensive Care Unit, Veterans General Hospital, Kaohsiung, China
Chien-Wei Hsu
Affiliation:
Intensive Care Unit, Veterans General Hospital, Kaohsiung, China
Chun-Peng Liu
Affiliation:
National Yang-Ming University, School of Medicine, Taipei, Taiwan, Republic of China
Susan Shin-Jung Lee
Affiliation:
Section of Infectious Diseases and Microbiology, Kaohsiung, Veterans General Hospital, Kaohsiung, China
Yung-Ching Liu
Affiliation:
Section of Infectious Diseases and Microbiology, Kaohsiung, Veterans General Hospital, Kaohsiung, China
Kwok-Hung Lai
Affiliation:
National Yang-Ming University, School of Medicine, Taipei, Taiwan, Republic of China
Tzu-Wen Lin
Affiliation:
Chengshiu Institute of Technology, Kaohsiung, Taiwan, Republic of China
*
Intensive Care Unit, Kaohsiung Veterans General Hospital, No. 386, Dar-Chung First Road, Kaohsiung, Taiwan, Republic of China

Abstract

Objective:

Indwelling urinary catheters are the most common source of infections in intensive care units (ICUs). The aim of this study was to evaluate the efficacy of nurse-generated daily reminders to physicians to remove unnecessary urinary catheters 5 days after insertion.

Design:

A time-sequence nonrandomized intervention study.

Setting:

Adult ICUs (medical, surgical, cardiovascular surgical, neurosurgical, and coronary care) of a tertiary-care university medical center.

Patients:

All patients admitted to the adult ICUs during a 2-year period. The study consisted of a 12-month observational phase (15,960 patient-days) followed by a 12-month intervention phase (15,525 patient-days).

Intervention:

Daily reminders to physicians from the nursing staff to remove unnecessary urinary catheters 5 days after insertion.

Results:

The duration of urinary catheterization was significantly reduced during the intervention phase (from 7.0 ± 1.1 days to 4.6 ± 0.7 days; P < .001). The rate of catheter-associated urinary tract infection (CAUTI) was also significantly reduced (from 11.5 ± 3.1 to 8.3 ± 2.5 patients with CAUTI per 1,000 catheter-days; P = .009). There was a linear relationship between the monthly average duration of catheterization and the rate of CAUTI (r = 0.50; P = .01). The excess monthly cost of antibiotics for CAUTI was reduced by 69% (from $4,021 ± $1,800 to $1,220 ± $941; P = .004).

Conclusion:

This study demonstrated that a simple measure instituted as part of a continuous quality improvement program significantly reduced the duration of urinary catheterization, rate of CAUTI, and additional costs of antibiotics to manage CAUTI.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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References

1. Stamm, WE. Catheter-associated urinary tract infections: epidemiology, pathogenesis, and prevention. Am J Med 1991;91:65S71S.CrossRefGoogle ScholarPubMed
2. Richards, MJ, Edwards, JR, Culver, DH, Gaynes, RP. Nosocomial infections in medical intensive care units in the United States: National Nosocomial Infections Surveillance System. Crit Care Med 1999:27: 887892.CrossRefGoogle ScholarPubMed
3. Lim, KS, Huang, CC, Hsu, ST, et al. Investigation of the nosocomial catheter- or device-associated infections in the intensive care unit. Nosocomial Infection Control Journal 2001;11:111.Google Scholar
4. Laupland, KB, Zygun, DA, Davies, HD, Church, DL, Louie, TJ, Doig, CJ. Incidence and risk factors for acquiring nosocomial urinary tract infection in the critically ill. J Crit Care 2002;17:5057.CrossRefGoogle ScholarPubMed
5. Saint, S. Clinical and economic consequences of nosocomial catheter-related bacteriuria. Am J Infect Control 2000;28:6875.CrossRefGoogle ScholarPubMed
6. Platt, R, Polk, BF, Murdock, B, Rosner, B. Mortality associated with nosocomial urinary-tract infection. N Engl J Med 1982;307:637641.CrossRefGoogle ScholarPubMed
7. Kunin, CM, Douthitt, S, Dancing, J, Anderson, J, Moeschberger, M. The association between the use of urinary catheters and morbidity and mortality among elderly patients in nursing homes. Am J Epidemiol 1992;135:291301.Google ScholarPubMed
8. Givens, CD, Wenzel, RP. Catheter-associated urinary tract infections in surgical patients: a controlled study on the excess morbidity and costs. J Urol 1980;124:646648.CrossRefGoogle Scholar
9. Saint, S, Lipsky, BA, Baker, PD, McDonald, LL, Ossenkop, K. Urinary catheters: what type do men and their nurses prefer? J Am Geriatr Soc 1999;47:14531457.CrossRefGoogle ScholarPubMed
10. Platt, R, Polk, BF, Murdock, B, Rosner, B. Risk factors for nosocomial urinary tract infection. Am J Epidemiol 1986;124:977985.CrossRefGoogle ScholarPubMed
11. Maki, DG, Tambyah, PA. Engineering out the risk of infection with urinary catheters. Emerg Infect Dis 2001;7:342347.CrossRefGoogle ScholarPubMed
12. Kunin, CM, McCormack, RC. Prevention of catheter-induced urinary-tract infections by sterile closed drainage. N Engl J Med 1966:274:115511 CrossRefGoogle ScholarPubMed
13. Stark, RP, Maki, DG. Bacteriuria in the catheterized patient: what quantitative level of bacteriuria is relevant? N Engl J Med 1984;311:560564.CrossRefGoogle ScholarPubMed
14. Saint, S, Wiese, J, Amory, JK, et al. Are physicians aware of which of their patients have indwelling urinary catheters? Am J Med 2000; 109:476480.CrossRefGoogle ScholarPubMed
15. Jain, R, Parada, JP, David, A, Smith, LG. Overuse of the indwelling urinary tract catheter in hospitalized medical patients. Arch Intern Med 1995;155:14251429.CrossRefGoogle ScholarPubMed
16. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections. Am J Infect Control 1988;16:2840.CrossRefGoogle ScholarPubMed
17. Kunin, CM. Urinary Tract Infections: Detection, Prevention and Management, ed. 5. Baltimore: Williams & Wilkins; 1999:266267.Google Scholar
18. Tambyah, PA, Maki, DG. The relationship between pyuria and infection in patients with indwelling urinary catheters: a prospective study of 761 patients. Arch Intern Med 2000;160:673677.CrossRefGoogle ScholarPubMed
19. Tambyah, PA, Maki, DG. Catheter-associated urinary tract infection is rarely symptomatic: a prospective study of 1497 catheterized patients. Arch Intern Med 2000;160:678682.CrossRefGoogle Scholar
20. Bjork, DT, Pelletier, LL, Tight, RR. Urinary tract infections with antibiotic resistant organisms in catheterized nursing home patients. Infect Control 1984;5:173176.CrossRefGoogle ScholarPubMed
21. Magee, JT, Pritchard, EL, Fitzgerald, KA, Dunstan, FD, Howard, AJ. Antibiotic prescribing and antibiotic resistance in community practice: retrospective study, 1996-8. Br Med J 1999;319:12391240.CrossRefGoogle ScholarPubMed
22. Haley, RW, Schaberg, DR, Crossley, KB, Von Allmen, SD, McGowan, JE Jr. Extra charges and prolongation of stay attributable to nosocomial infections: a prospective interhospital comparison. Am J Med 1981;70:5158.CrossRefGoogle ScholarPubMed
23. Saint, S, Lipsky, BA, Goold, SD. Indwelling urinary catheters: a one-point restraint? Ann Mem Med 2002;137:125127.Google ScholarPubMed
24. Tambyah, PA, Knasinski, V, Maki, DG. The direct costs of nosocomial catheter-associated urinary tract infection in the era of managed care. Infect Control Hosp Epidemiol 2002;23:2731.CrossRefGoogle ScholarPubMed
25. Fagon, JY, Novara, A, Stephan, F, Girou, E, Safar, M. Mortality attributable to nosocomial infections in the intensive care unit. Infect Control Hosp Epidemiol 1994;15:428434.CrossRefGoogle Scholar
26. Cornia, PB, Amory, JK, Fraser, S, Saint, S, Lipsky, BA. Computer-based order entry deceases duration of indwelling urinary catheterization in hospitalized patients. Am J Med 2003;114:404406.CrossRefGoogle Scholar
27. Slappendel, R, Weber, EW. Non-invasive measurement of bladder volume as an indication for bladder catheterization after orthopedic surgery and its effect on urinary tract infections. Eur J Anaesthesiol 1999;16:503506.CrossRefGoogle ScholarPubMed
28. Bologna, RA, Tu, LM, Polansky, M, Fraimow, HD, Gordon, DA, Whitmore, KE. Hydrogel/silver ion-coated urinary catheter reduces nosocomial urinary tract infection rates in intensive care unit patients: a multicenter study. Urology 1999;54:982987.CrossRefGoogle ScholarPubMed