infection control & hospital epidemiology july 2018, vol. 39, no. 7 original article
Assessing a National Collaborative Program To Prevent Catheter-Associated Urinary Tract Infection in a Veterans Health Administration Nursing Home Cohort
Sarah L. Krein, PhD, RN;1,3 M. Todd Greene, PhD, MPH;1,3 Beth King, RN, BSN, MA, CCM;5 Deborah Welsh, MS;5
Karen E. Fowler, MPH;1 BarbaraW. Trautner, MD, PhD;6,7 David Ratz, MS;1 Sanjay Saint, MD, MPH;1,3 Gary Roselle,MD;8 Marla Clifton, RN, MSN, CIC;8
StephenM.Kralovic,MD,MPH;8,9,10 Tina Martin, RN;11 Lona Mody,MD,MSc2,4
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;39:820–825
Veterans Health Administration (VHA) nursing homes, also called community living centers, provide a range of services including skilled nursing, rehabilitation, psychiatric, dementia, hospice and palliative care.1VHAnursing homes play critical roles in meeting both post-acute and long-term care needs of veterans. However, as in community-based nursing homes,2 infection is a common complication among VHA nursing home residents.3 Estimates suggest that, on any given day, ~12% of the more than 1 million nursing home residents in the United States
may have an infection.2 The most common of these is urinary tract infection (UTI), followed by pneumonia. While a point prevalence assessment in 2007 found a lower infection rate (5.3%) among VHA nursing homes, the most common infection was also UTI, and the infection rate was closer to 11% among veteran residents with indwelling devices, such as urinary catheters.3 These estimates become even more concerning when the growing prevalence and risk of antimicrobial-resistant infections are taken into account.4–6
Affiliations: 1. Center for Clinical Management Research, Ann Arbor Veteran Affairs (VA) Healthcare System, Ann Arbor, Michigan; 2. Geriatric Research
Education and Clinical Center, Ann Arbor Veteran Affairs (VA) Healthcare System, Ann Arbor, Michigan; 3. Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; 4. Division of Geriatric and Palliative Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; 5. VA National Center for Patient Safety (NCPS), Ann Arbor, Michigan; 6. Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; and; 7. Section of Health Services Research, Departments of Medicine and Surgery, Baylor College of Medicine, Houston, Texas; 8. VA National Infectious Diseases Service (NIDS), Washington, DC; 9. Cincinnati VA Medical Center, Cincinnati, Ohio; 10. Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio; 11. VA Inpatient Evaluation Center (IPEC), Cincinnati, Ohio; (
skrein@umich.edu).
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2018/3907-0008. DOI: 10.1017/ice.2018.99 Received January 23, 2018; accepted April 5, 2018; electronically published May 10, 2018
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