Infection Control & Hospital Epidemiology
905
Fig. 1. Outcomes by phase of intervention. Error bars represent upper limit of 95% confidence interval for the population proportion.
catheter reinsertions took place during the study period, a rate of 3·30%.
CAUTI rates
The CAUTI rate per 10,000 patient days declined incrementally in each study phase, from 9·06 in phase 1 to 1·65 in phase 4, for an overall decline of 81·8% (Table 2 and Fig. 1A). Similarly, the CAUTI rate per 1,000 catheterized patient days declined from 4·67 in phase 1 to 1·17 in phase 4, for an overall decline of 74·8%. The monthly CAUTI rate suggests an initial steep decline in CAUTIs in the first year of the phase 1 intervention (standardi- zation and training) followed by a possible plateau in the final 6 months and then a further decline with interventions specifi- cally targeting catheter use in phases 2, 3, and 4 (Fig. 2A). Notably, a decrease in the CAUTI rate occurred with the defi- nition change in January 2015.
Catheter use and duration
Overall, total catheter days decreased incrementally from 194·5in phase 1 to 140·7 in phase 4, for a total decrease of 27·7% (Table 2 and Fig. 1B). Fig. 2B shows a gradual decline in monthly catheter days during phase 1, which accelerated through each study intervention and then leveled off several months into phase 4. The rate of new catheters also declined between each phase, for
a total decrease of 26·0% (Table 1 and Fig. 1C). Monthly trends show that the rate of new catheter placement was relatively stable during phase 1, dropped dramatically with the onset of real-time catheter tracking in phase 2, and continued to gradually decline in phases 3 and 4 (Fig. 2C). Mean catheter duration increased from 2·56 in phase 1 to 2·80 in phase 2 before declining to 2·62 in phase 3 and 2·49 in phase 4.
However, in real terms, a steady decline occurred in catheters of all durations in each successive phase (Fig. 3A). The distribution density plot of catheter duration (Fig. 3B) shows that there was a proportionately greater decline in short-duration catheters (those lasting <1 full day) and a relative concentration of 1–3-day duration catheters, inflating the mean catheter duration. There was also a small decline in the proportion of catheters remaining >7 days in phases 3 and 4.
Catheter reinsertion rate
The catheter reinsertion rate declined from 3·66% in phase 1 to 3·15% with real-time track in phase 2, then to 2·67% with the pop-up reminder in phase 3 before increasing slightly to 3·25% with the automated removal and placement criteria in phase 4. Overall, we detected an 11·2% decline in the reinsertion rate.
Clinician use of decision support tools
In phase 2, the real-time tracking tab received 11,662 clinician views, or 83 views per 10,000 hospitalized patient days (Table S1). By contrast, in phase 3, the triggered pop-up alert had 98,068 views, or 3,139 views per 10,000 patient days. Only a small por- tion of elective tab views led to an assessment (2·6%), whereas 62·8% of alerts were assessed and 37·2% opted out. Of the 23,386 IUCs assessed by pop-up alert viewers, the clinician selected “remove today” in 9·6% of instances, “maintain” in 67·5%, and “already removed” in 22·9%. In response to the new order set in phase 4, clinicians chose to
manage patients with an IUC alternative in only 0·9% of cases and to proceed with an IUC in 99·1% of cases. Table S2 delineates the frequency with which clinicians selected each alternative or indi- cation. However, due to low baseline utilization rates, use of some
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116 |
Page 117 |
Page 118 |
Page 119 |
Page 120 |
Page 121 |
Page 122 |
Page 123 |
Page 124 |
Page 125 |
Page 126 |
Page 127 |
Page 128 |
Page 129 |
Page 130 |
Page 131 |
Page 132 |
Page 133 |
Page 134 |
Page 135 |
Page 136 |
Page 137 |
Page 138 |
Page 139 |
Page 140
