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Emergency Department Catheter-Associated Urinary Tract Infection Prevention: Multisite Qualitative Study of Perceived Risks and Implemented Strategies

Published online by Cambridge University Press:  03 November 2015

Eileen J. Carter ,
Daniel J. Pallin ,
Leslie Mandel ,
Corine Sinnette  and
Jeremiah D. Schuur
Eileen J. Carter*
Affiliation:
Columbia University School of Nursing, NewYork-Presbyterian Hospital, New York, New York
Daniel J. Pallin
Affiliation:
Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts
Leslie Mandel
Affiliation:
Regis College, School of Nursing and Health Sciences, Weston, Massachusetts
Corine Sinnette
Affiliation:
Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts
Jeremiah D. Schuur
Affiliation:
Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts
*
Address correspondence to Eileen J. Carter, PhD, RN, Columbia University School of Nursing, New York-Presbyterian Hospital, 617 West 168th Street, Suite 308, New York, NY 10032 (em2473@cumc.columbia.edu).
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Abstract

BACKGROUND

Existing knowledge of emergency department (ED) catheter-associated urinary tract infection (CAUTI) prevention is limited. We aimed to describe the motivations, perceived risks for CAUTI acquisition, and strategies used to address CAUTI risk among EDs that had existing CAUTI prevention programs.

METHODS

In this qualitative comparative case study, we enrolled early-adopting EDs, that is, those using criteria for urinary catheter placement and tracking the frequency of catheters placed in the ED. At 6 diverse facilities, we conducted 52 semistructured interviews and 9 focus groups with hospital and ED participants.

RESULTS

All ED CAUTI programs originated from a hospitalwide focus on CAUTI prevention. Staff were motivated to address CAUTI because they believed program compliance improved patient care. ED CAUTI prevention was perceived to differ from CAUTI prevention in the inpatient setting. To identify areas of ED CAUTI prevention focus, programs examined ED workflow and identified 4 CAUTI risks: (1) inappropriate reasons for urinary catheter placement; (2) physicians’ limited involvement in placement decisions; (3) patterns of urinary catheter overuse; and (4) poor insertion technique. Programs redesigned workflow to address risks by (1) requiring staff to specify the medical reason for catheter at the point of order entry and placement; (2) making physicians responsible for determining catheter use; (3) using catheter alternatives to address patterns of overuse; and (4) modifying urinary catheter insertion practices to ensure proper placement.

CONCLUSIONS

Early-adopting EDs redesigned workflow to minimize catheter use and ensure proper insertion technique. Assessment of ED workflow is necessary to identify and modify local practices that may increase CAUTI risk.

Infect. Control Hosp. Epidemiol. 2016;37(2):156–162

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Supplement 2 , February 2016 , pp. 156 - 162
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION. These study findings were presented at IDWeek 2014 in Philadelphia, Pennsylvania, October 8–12, 2014.

References

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