Hostname: page-component-788cddb947-jbkpb Total loading time: 0 Render date: 2024-10-09T20:13:24.621Z Has data issue: false hasContentIssue false

Assessing a National Collaborative Program To Prevent Catheter-Associated Urinary Tract Infection in a Veterans Health Administration Nursing Home Cohort

Published online by Cambridge University Press:  10 May 2018

Sarah L. Krein*
Affiliation:
Center for Clinical Management Research, Ann Arbor Veteran Affairs (VA) Healthcare System, Ann Arbor, Michigan Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
M. Todd Greene
Affiliation:
Center for Clinical Management Research, Ann Arbor Veteran Affairs (VA) Healthcare System, Ann Arbor, Michigan Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
Beth King
Affiliation:
VA National Center for Patient Safety (NCPS), Ann Arbor, Michigan
Deborah Welsh
Affiliation:
VA National Center for Patient Safety (NCPS), Ann Arbor, Michigan
Karen E. Fowler
Affiliation:
Center for Clinical Management Research, Ann Arbor Veteran Affairs (VA) Healthcare System, Ann Arbor, Michigan
Barbara W. Trautner
Affiliation:
Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; and Section of Health Services Research, Departments of Medicine and Surgery, Baylor College of Medicine, Houston, Texas
David Ratz
Affiliation:
Center for Clinical Management Research, Ann Arbor Veteran Affairs (VA) Healthcare System, Ann Arbor, Michigan
Sanjay Saint
Affiliation:
Center for Clinical Management Research, Ann Arbor Veteran Affairs (VA) Healthcare System, Ann Arbor, Michigan Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
Gary Roselle
Affiliation:
VA National Infectious Diseases Service (NIDS), Washington, DC
Marla Clifton
Affiliation:
VA National Infectious Diseases Service (NIDS), Washington, DC
Stephen M. Kralovic
Affiliation:
VA National Infectious Diseases Service (NIDS), Washington, DC Cincinnati VA Medical Center, Cincinnati, Ohio Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
Tina Martin
Affiliation:
VA Inpatient Evaluation Center (IPEC), Cincinnati, Ohio
Lona Mody
Affiliation:
Geriatric Research Education and Clinical Center, Ann Arbor Veteran Affairs (VA) Healthcare System, Ann Arbor, Michigan Division of Geriatric and Palliative Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
*
Address correspondence to Sarah L. Krein, PhD, RN, VA Ann Arbor Center for Clinical Management Research, 2800 Plymouth Road, NCRC, Bldg. 16, 333W, Ann Arbor, MI 48109 (skrein@umich.edu)

Abstract

OBJECTIVE

Collaborative programs have helped reduce catheter-associated urinary tract infection (CAUTI) rates in community-based nursing homes. We assessed whether collaborative participation produced similar benefits among Veterans Health Administration (VHA) nursing homes, which are part of an integrated system.

SETTING

This study included 63 VHA nursing homes enrolled in the “AHRQ Safety Program for Long-Term Care,” which focused on practices to reduce CAUTI.

METHODS

Changes in CAUTI rates, catheter utilization, and urine culture orders were assessed from June 2015 through May 2016. Multilevel mixed-effects negative binomial regression was used to derive incidence rate ratios (IRRs) representing changes over the 12-month program period.

RESULTS

There was no significant change in CAUTI among VHA sites, with a CAUTI rate of 2.26 per 1,000 catheter days at month 1 and a rate of 3.19 at month 12 (incidence rate ratio [IRR], 0.99; 95% confidence interval [CI], 0.67–1.44). Results were similar for catheter utilization rates, which were 11.02% at month 1 and 11.30% at month 12 (IRR, 1.02; 95% CI, 0.95–1.09). The numbers of urine cultures per 1,000 residents were 5.27 in month 1 and 5.31 in month 12 (IRR, 0.93; 95% CI, 0.82–1.05).

CONCLUSIONS

No changes in CAUTI rates, catheter use, or urine culture orders were found during the program period. One potential reason was the relatively low baseline CAUTI rate, as compared with a cohort of community-based nursing homes. This low baseline rate is likely related to the VHA’s prior CAUTI prevention efforts. While broad-scale collaborative approaches may be effective in some settings, targeting higher-prevalence safety issues may be warranted at sites already engaged in extensive infection prevention efforts.

Infect Control Hosp Epidemiol 2018;820–825

Type
Original Article
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Tsan, L, Hojlo, C, Kearns, MA, et al. Infection surveillance and control programs in the Department of Veterans Affairs nursing home care units: a preliminary assessment. Am J Infect Control 2006;34:8083.Google Scholar
2. Dwyer, LL, Harris-Kojetin, LD, Valverde, RH, et al. Infections in long-term care populations in the United States. J Am Geriatr Soc 2013;61:342349.Google Scholar
3. Tsan, L, Langberg, R, Davis, C, et al. Nursing home-associated infections in Department of Veterans Affairs community living centers. Am J Infect Control 2010;38:461466.Google Scholar
4. Wang, L, Lansing, B, Symons, K, et al. Infection rate and colonization with antibiotic-resistant organisms in skilled nursing facility residents with indwelling devices. Eur J Clin Microbiol Infect Dis 2012;31:17971804.CrossRefGoogle ScholarPubMed
5. Manning, S, Lautenbach, E, Tolomeo, P, Han, JH. Risk factors for infection with Escherichia coli in nursing home residents colonized with fluoroquinolone-resistant E. coli . Infect Control Hosp Epidemiol 2015;36:575577.Google Scholar
6. Shilo, S, Assous, MV, Lachish, T, et al. Risk factors for bacteriuria with carbapenem-resistant Klebsiella pneumoniae and its impact on mortality: a case-control study. Infection. 2013;41:503509.Google Scholar
7. Mody, L, Saint, S, Galecki, A, Chen, S, Krein, SL. Knowledge of evidence-based urinary catheter care practice recommendations among healthcare workers in nursing homes. J Am Geriatr Soc 2010;58:15321537.CrossRefGoogle ScholarPubMed
8. Jump, RL, Heath, B, Crnich, CJ, et al. Knowledge, beliefs, and confidence regarding infections and antimicrobial stewardship: a survey of Veterans Affairs providers who care for older adults. Am J Infect Control 2015;43:298300.Google Scholar
9. Trautner, BW, Greene, MT, Krein, SL, et al. Infection prevention and antimicrobial stewardship knowledge for selected infections among nursing home personnel. Infect Control Hosp Epidemiol 2017;38:8388.Google Scholar
10. Mody, L, Greene, MT, Meddings, J, et al. A national implementation project to prevent catheter-associated urinary tract infection in nursing home residents. JAMA Intern Med 2017;177:11541162.Google Scholar
11. Krein, SL, Harrod, M, Collier, S, et al. A national collaborative approach to reduce catheter-associated urinary tract infections in nursing homes: a qualitative assessment. Am J Infect Control 2017;45:13421348.Google Scholar
12. Saint, S, Greene, MT, Krein, SL, et al. A program to prevent catheter-associated urinary tract infection in acute care. New Engl J Med 2016;374:21112119.Google Scholar
13. Zubkoff, L, Neily, J, King, BJ, et al. Virtual breakthrough series, part 1: preventing catheter-associated urinary tract infection and hospital-acquired pressure ulcers in the Veterans Health Administration. Jt Comm J Qual Patient Saf 2016;42:485496.Google Scholar
14. Mody, L, Greene, MT, Saint, S, et al. Comparing catheter-associated urinary tract infection prevention programs between Veterans Affairs nursing homes and non–Veterans Affairs nursing homes. Infect Control Hosp Epidemiol 2017;38:287293.CrossRefGoogle ScholarPubMed
15. Clifton, M, Kralovic, S, Simbartl, L, et al. National implementation of evidence-based bundles for prevention of device-associated infections in Veterans Health Administration (VHA) facilities. Am J Infect Control 2015;43:S59.Google Scholar
16. Mody, L, Meddings, J, Edson, BS, et al. Enhancing resident safety by preventing healthcare-associated infection: a national initiative to reduce catheter-associated urinary tract infections in nursing homes. Clin Infect Dis 2015;61:8694.CrossRefGoogle ScholarPubMed
17. Stone, ND, Ashraf, MS, Calder, J, et al. Surveillance definitions of infections in long-term care facilities: revisiting the McGeer criteria. Infect Control Hosp Epidemiol 2012;33:965977.Google Scholar
18. Hollingsworth, JM, Rogers, MA, Krein, SL, et al. Determining the noninfectious complications of indwelling urethral catheters: a systematic review and meta-analysis. Ann Intern Med 2013;159:401410.Google Scholar
19. Leuck, AM, Wright, D, Ellingson, L, Kraemer, L, Kuskowski, MA, Johnson, JR. Complications of Foley catheters—Is infection the greatest risk? J Urol 2012;187:16621666.CrossRefGoogle ScholarPubMed
20. Collier, HG. Long term care: recent developments. Health Matrix 1988;6:2129.Google ScholarPubMed
21. Ye, Z, Mukamel, DB, Huang, SS, Li, Y, Temkin-Greener, H. Healthcare-associated pathogens and nursing home policies and practices: results from a national survey. Infect Control Hosp Epidemiol 2015;36:759766.Google Scholar
22. Stone, PW, Herzig, CT, Pogorzelska-Maziarz, M, et al. Understanding infection prevention and control in nursing homes: a qualitative study. Geriatr Nurs 2015;36:267272.Google Scholar
23. Harris-Kojetin, L, Sengupta, M, P-L, E., et al. Long-term care providers and services users in the United States: data from the National Study of Long-Term Care Providers, 2013–2014. Nat Center Health Statist Vital Health Stat 2016;3:38.Google Scholar
24. Foxman, B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med 2002;113(Suppl 1A):5S13S.Google Scholar