822 infection control & hospital epidemiology july 2018, vol. 39, no. 7


mixed-effects negative binomial regression with facility level random intercepts to examine changes in rates of CAUTI, catheter utilization, and urine culture orders during the project period. The change in the NHSN CAUTI rate was modeled using the log of the number of catheter days as an offset variable. The log of the number of resident days was used as an offset for the catheter utilization and urine culture order models. Data were collected in aggregate every month for 12 months, and the first month was counted as time zero. To derive an incidence rate ratio (IRR), subsequent months or reporting periods were counted as the number of days from the first reporting period. The estimated IRRs reflect rate changes across the entire 12-month continuum. Participating nursing homes were included in the analysis if they reported at least 2 months of outcome data and device days. These criteria resulted in an analytic cohort of 55 VHA nursing homes. Statistical analyses were performed using Stata/MP version 13.1 software (StataCorp, College Station, TX).


results Nursing Home Characteristics


Although 55VHAnursing homes met the eligibility criteria for analyses of outcome data, only 39 facilities completed the program needs assessment questionnaire. As shown in Table 1, the mean number of beds for these facilities was 112 (±92.4 SD), with a mean number of current residents of 78 (±43.4 SD). Most facilities (89.7%) had an infection preven- tion contact with 3 or more years of infection prevention experience, and more than half of the facilities reported that this individual was certified in infection control. Moreover, during a normal 40-hour work week, an average of 33 hours was spent on infection prevention related activities. Nearly all facilities also reported conducting CAUTI surveillance and the presence of a committee that reviews healthcare-associated infections, including CAUTIs.


Change in CAUTI, Catheter Use and Urine Culture Orders


As shown in Figure 1, the CAUTI rate was 2.26 per 1,000 catheter days atmonth 1, 2.66 atmonth 6, and 3.19 atmonth 12.


figure 1. Catheter-associated urinary tract infection (UTI) rates, as defined by the National Healthcare Safety Network, among reporting facilities during the 12-month collaborative. Legend: Number of catheter-associated UTIs per 1,000 catheter days.


table 1. Characteristics of Participating Veteran Health Administration (VHA) Nursing Homes Characteristic


Total beds, mean ±SD Current residents, mean ±SD


Infection prevention contact has ≥3 years of infection prevention experience, no. (%) Infection prevention contact certified in infection control, no. (%) Hours per week spent on infection prevention-related activities, mean±SD Have committee that reviews healthcare-associated infections, including CAUTI, no. (%) CAUTI surveillance performed at facility, no. (%)


NOTE. SD, standard deviation; CAUTI, catheter-associated urinary tract infection.


The rates in later months, especially month 12, should be interpreted with some caution, however, given the smaller number of facilities reporting. Nonetheless, over the course of the entire 12-month program, no significant changes in CAUTI rates were observed among participating VHA nursing homes (incidence rate ratio [IRR], 0.99; 95% confidence interval [CI], 0.67–1.44; P=.94). Similar results were observed for the population rate (ie,CAUTIs per 10,000 resident days), with rates of 2.49 at month 1 and 3.61 at month 12 (IRR, 0.99; 95% CI, .67–1.47; P=.95). Catheter utilization rates also remained virtually unchanged


during the program period, 11.02% at month 1, 11.28% at month 6, and 11.30%atmonth 12 (IRR, 1.02;95%CI, 0.95–1.09; P=.64) (Figure 2). Likewise, the number of urine culture orders per 1,000 resident days remained steady at 5.27 in month 1 and 5.31 in month 12 (IRR, 0.93; 95% CI, 0.82–1.05; P=.25).


discussion


Reducing infection risk and improving infection prevention are priorities for enhancing resident safety in nursing homes.


Participating VHA


Nursing Homes (n=39) 112.0±92.4


77.9±43.4 35 (89.7) 22 (56.4)


33.3±11.7 38 (97.4) 37 (94.9)


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