Infection Control & Hospital Epidemiology (2018), 39, 1494–1496 doi:10.1017/ice.2018.251
Concise Communication
Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections: The tale of two teaching hospitals
Ana Cecilia Bardossy MD1, Takiah Williams RN2, Karen Jones MPH, RN, CIC2, Susan Szpunar PhD3,
Marcus Zervos MD1, George Alangaden MD1, Katherine Reyes MD, MPH1 and Mohamad G. Fakih MD, MPH4 1Division of Infectious Diseases, Henry Ford Health System, Detroit, Michigan, 2Department of Infection Prevention and Control, Ascension St John Hospital, 3Medical Education, Ascension St John Hospital, Detroit, Michigan and 4Care Excellence, Ascension Healthcare, St Louis, Missouri
Abstract
We compared interventions to improve urinary catheter care and urine culturing in adult intensive care units of 2 teaching hospitals. Compared to hospital A, hospital B had lower catheter utilization, more compliance with appropriate indications and maintenance, but higher urine culture use and more positive urine cultures per 1,000 patient days.
(Received 25 June 2018; accepted 26 August 2018; electronically published October 10, 2018)
The prevention of catheter-associated urinary tract infections (CAUTIs) has historically focused on appropriate use and maintenance. It is not clear how culturing practices affect the National Healthcare Safety Network (NHSN)-defined CAUTI events in the setting of other interventions to reduce catheter risk. The objectives of this study were to assess compliance with best practices related to the use and maintenance of devices and to evaluate how culturing practices affect CAUTI rates in the intensive care units (ICU) of 2 large teaching hospitals.
Methods
We conducted an intervention to reduce catheter risk and to improve culturing stewardship in the adult medical and surgical ICUs at 2 academic tertiary-care hospitals (hospital A: 60 ICU beds; hospital B: 140 ICU beds) for the first 6 months of 2015. We compared the use of urinary catheters, urine cultures, and NHSN- defined CAUTI events in the ICUs of both hospitals for the first 6 months of 2014 and 2015. The intervention consisted of edu- cating the ICU teams, including resident physicians and nurses, on strategies to reduce the risk of urinary catheter use, and appropriate testing for CAUTI. A toolkit was developed and used to educate resident physicians at both institutions.1 Identical presentations were given to resident physicians at both institu- tions addressing the appropriate use of devices and laboratory
Author for correspondence: Mohamad Fakih, MD, MPH, Care Excellence, Ascen-
sion Healthcare, 4600 Edmundson Rd, St. Louis, MO 63134. E-mail: Mohamad.Fakih@
ascension.org PREVIOUS PRESENTATION: This study was presented in part (abstracts #502 and #509) at the SHEA Spring 2016 conference on May XX, 2016, in Atlanta, Georgia. Cite this article: Cecilia Bardossy A, et al. (2018). Culturing practices and the care of
the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections: The tale of two teaching hospitals. Infection Control & Hospital Epidemiology 2018, 39, 1494–1496. doi: 10.1017/ice.2018.251
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
workups for CAUTI. Face-to-face weekly audits and feedback on appropriate device use were provided to nurses and/or physicians along with monthly lectures to resident physicians. During the first 6 months of 2015, weekly audits were per-
formed on the maintenance elements (break in the seal, urinary bag position, and catheter securement). Appropriate indications for urinary catheter use were based on the 2009 Centers for Disease Control and Prevention guidelines.2 Urinary output monitoring in critically ill patients was considered appropriate only if there was need for hourly measurement of urinary output.3 Catheter utilization, urine culture use and the 2015 NHSN- defined CAUTI rates4 were measured and compared for the first 6-month periods of 2014 and 2015. Because the NHSN CAUTI definitions changed between 2014 and 2015, we reevaluated all the 2014 events to match the 2015 definition. The institutional review boards at each of the participating institutions approved the study.
Statistical analysis
Data on device use and compliance on maintenance processes were analyzed using the Pearson χ2 test. The z test was used to compare person-time rates. All data were analyzed using SPSS version 25.0 software (IBM, Armonk, NY), and a P value of .05 or less was considered statistically significant.
Results
Of 2,447 patients evaluated in weekly audits, 1,575 patients (64.4%) had urinary catheters present (Table 1). Urinary catheters were present with appropriate indication in 1,331 of 1,575 patients (84.5%). The most common appropriate reasons for using catheters were accurate measurement of urinary output in 1,038 of 1,575 patients (65.9%), perioperative use in 149 of 1,575
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