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


attrition. However, data collected by the VHA Inpatient Evaluation Center, independent of the AHRQ Safety program, confirm the relatively low CAUTI rate across the VHA15 and that CAUTI rates among participating VHA nursing homes remained steady during the 12-month program period. Additional sensitivity analyses (not shown) also revealed no significant difference in CAUTI rates among those providing at least 2 months of data versus all expected data. Also, the extent to which each facility participated in collaborative activities, used the tools that were provided, or made specific practice changes was not tracked; therefore, whether facility engage- ment might affect the results could not be assessed. Finally, since this study was conducted as part of a quality improve- ment program, other potentially important factors, including patient characteristics and antimicrobial use, may have influenced the study findings but were not measured. In summary, unlike the reduction in CAUTI observed


among community-based nursing homes that participated in the AHRQ Safety Program for Long-Term Care,10 the current study found no significant changes in CAUTI, catheter use, or urine culture orders among participating VHA nursing homes. We identified several potential reasons for this finding, including lower baseline CAUTI rates, a more robust infection prevention infrastructure, and resident characteristics, which could account for the lack of influence of the collaborative initiative in the VHA nursing home setting. Indeed, the lack of change in CAUTI rates specifically might also be considered evidence of the success of prior VHA emphasis on CAUTI prevention and ongoing support for infection prevention. Furthermore, while broad-scale collaborative approaches may be effective in some settings, more specific targeting of higher prevalence safety issues may be warranted at sites already engaged in extensive infection prevention efforts.


acknowledgments


The authors would like to thank Sara E. McNamara, MPH, MT(ASCP), for her assistance throughout the program, Marianne Shaughnessy, PhD, CRNP, for her assistance and feedback during preparation of the manuscript and the work of HRET staff, and all members of the AHRQ Safety Program for Long-Term Care: Healthcare-Associated Infections/Catheter-Associated Urinary Tract Infection program. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Agency for Healthcare Research and Quality, the US Department of Health and Human Services, or the Department of Veterans Affairs. Financial support: This study was supported by a contract from the Agency


for Healthcare Research and Quality (AHRQ), US Department of Health and Human Services (contract no. HHSA 290201000025I). Other author funding was provided by the National Institutes of Health (grant no. R01 AG41780 to Mody; grant no. NIH DK092293 to Trautner); the University of Michigan Claude D. Pepper Older Americans Independence Center (grant no. NIA P30 AG024824 to Mody); the Department of Veterans Affairs (grant no. VA RRP 12-433 to Trautner); the Center for Innovations in Quality, Effectiveness and Safety at the Michael E. DeBakey VA Medical Center, Houston, Texas (grant no. CIN13-413 to Trautner); the VA National Center for Patient Safety Patient Safety Center of Inquiry (to Saint and Krein); and the VA Health Services Research and Development Research Career Scientist Award (RCS 11-222 to Krein).


Potential conflicts of interest: Dr Saint has received fees for serving on


advisory boards for Doximity and Jvion. Dr Trautner has received honoraria for speaking from Baylor Scott & White, TX A&M Health Sciences Center. She has provided consultation for Zambon Pharmaceuticals and Paratek Pharmaceuticals. All other authors report no conflicts of interest.


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.


references


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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;38:461–466.


4. Wang L, Lansing B, Symons K, et al. Infection rate and coloni- zation with antibiotic-resistant organisms in skilled nursing facility residents with indwelling devices. Eur J Clin Microbiol Infect Dis 2012;31:1797–1804.


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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;58:1532–1537.


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;43:298–300.


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;38:83–88.


10. Mody L, Greene MT, Meddings J, et al. A national implementa- tion project to prevent catheter-associated urinary tract infection in nursing home residents. JAMA Intern Med 2017;177: 1154–1162.


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;45:1342–1348.


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;374:2111–2119.


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;42:485–496.


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