Advertisement

Build upon basics: An intervention utilizing safety huddles to achieve near-zero incidence of catheter associated urinary tract infection at a department of Veterans Affairs long-term care facility

Published:March 30, 2021DOI:https://doi.org/10.1016/j.ajic.2021.03.017

      Highlights

      • Traditional interventions should be modified in long-term care for CAUTI prevention.
      • We used a structured huddle process to improve upon basics for CAUTI prevention.
      • We sustained a near-zero CAUTI rate for over 2 years.

      Abstract

      Background

      When traditional interventions are used in long term care for catheter associated urinary tract infection (CAUTI) prevention, residual rates are still high despite a decrease. We conducted a quality improvement study focusing our interventions on patient and staff behavioral patterns identified through a structured huddle process to improve upon the basics for CAUTI prevention.

      Methods

      Baseline was from January 2016 to March 2017; the intervention period was from April 2017 to June 2020. We implemented a systematic huddle to determine root cause of each CAUTI and applied lessons throughout the facility. We measured the monthly CAUTI incidence per 1000 urinary catheter days and analyzed the reduction in CAUTI during the intervention period.

      Results

      CAUTI decreased by 73% during the intervention period compared to the baseline period, with an IRR of 0.27 (95% confidence interval [CI]: 0.11-0.66; P = .004). The number of catheter days per month increased by 4% in the intervention period (17,407 in 39 months) compared to the baseline period (6,440 in 15 months) with IRR of 1.04 (95% confidence interval [CI]: 1.01-1.07; P = .008). No patterns were noted in organisms responsible for CAUTI.

      Conclusions

      Our findings stress the importance of looking beyond the traditional interventions for CAUTI prevention in long term care population. By doing this, interventions can be customized for this special population to achieve optimal outcomes.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Aronow WS.
        Clinical causes of death of 2372 older persons in a nursing home during 15-year follow-up.
        J Am Med Dir Assoc. 2000; 1: 95-96
        • Strausbaugh LJ
        • Joseph CL.
        The burden of infection in long-term care.
        Infect Control Hosp Epidemiol. 2000; 21: 674-679
        • Montoya A
        • Cassone M
        • Mody L.
        Infections in nursing homes: epidemiology and prevention programs.
        Clin Geriatr Med. 2016; 32: 585-607
      1. US Department of Health and Human Services, Office of the Inspector General. Adverse events in skilled nursing facilities: national incidence among Medicare beneficiaries. Available at: https://oig.hhs.gov/oei/reports/oei-06-11-00370.pdf. Accessed February 10, 2021.

        • Rogers MA
        • Mody L
        • Kaufman SR
        • Fries BE
        • McMahon Jr, LF
        • Saint S.
        Use of urinary collection devices in skilled nursing facilities in five states.
        J Am Geriatr Soc. 2008; 56: 854-861
        • Castle N
        • Engberg JB
        • Wagner LM
        • Handler S.
        Resident and facility factors associated with the incidence of urinary tract infections identified in the nursing home minimum data set.
        J Appl Gerontol. 2017; 36: 173-194
        • 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
        • Tsan L
        • Davis C
        • Langberg R
        • et al.
        Prevalence of nursing home-associated infections in the Department of Veterans Affairs nursing home care units.
        Am J Infect Control. 2008; 36: 173-179
        • Peach BC
        • Garvan GJ
        • Garvan CS
        • Cimiotti JP.
        Risk factors for urosepsis in older adults: a systematic review.
        Gerontol Geriatr Med. 2016; 2: 1-7
      2. Centers for Medicare & Medicaid Services. Data.Medicare.gov. Nursing home compare. Available at: https://data.medicare.gov/data/nursing-home-compare. Accessed February 10, 2021.

      3. Centers for Medicare & Medicaid Services. 5-Star quality rating system. 2021. Available at: https://www.cms.gov/medicare/provider-enrollment-and-certification/certificationandcomplianc/fsqrs.html. Accessed February 10, 2021.

        • Hawes C
        • Mor V
        • Phillips CD
        • et al.
        The OBRA-87 nursing home regulations and implementation of the Resident Assessment Instrument: effects on process quality.
        J Am Geriatr Soc. 1997; 45: 977-985
        • Mody L
        • Greene MT
        • Meddings J
        • et al.
        A national implementation project to prevent catheter-associated urinary tract infection in nursing home residents.
        JAMA Intern Med. 2017; 177: 1154-1162
        • Mody L
        • Krein SL
        • Saint S
        • et al.
        A targeted infection prevention intervention in nursing home residents with indwelling devices: a randomized clinical trial [published correction appears in JAMA Intern Med. 2015 Jul;175(7):1247].
        JAMA Intern Med. 2015; 175: 714-723
        • Brownhill K.
        Training in care homes to reduce avoidable harm.
        Nurs Times. 2013; 109: 20-22
        • Fendler EJ
        • Ali Y
        • Hammond BS
        • Lyons MK
        • Kelley MB
        • Vowell NA.
        The impact of alcohol hand sanitizer use on infection rates in an extended care facility.
        Am J Infect Control. 2002; 30: 226-233
        • Darouiche RO
        • Goetz L
        • Kaldis T
        • Cerra-Stewart C
        • AlSharif A
        • Priebe M.
        Impact of StatLock securing device on symptomatic catheter-related urinary tract infection: a prospective, randomized, multicenter clinical trial.
        Am J Infect Control. 2006; 34: 555-560
        • Priefer BA
        • Duthie Jr, EH
        • Gambert SR.
        Frequency of urinary catheter change and clinical urinary tract infection. Study in hospital-based, skilled nursing home.
        Urology. 1982; 20: 141-142
        • Meddings J
        • Saint S
        • Krein SL
        • et al.
        Systematic review of interventions to reduce urinary tract infection in nursing home residents.
        J Hosp Med. 2017; 12: 356-368
      4. Chung DJ, Coffey CE, Watson K. Implementation of daily safety huddles to reduce harm events at a safety net hospital. Abstract published at Hospital Medicine 2020, Virtual Competition. Abstract 384. J Hosp Medic. Available at: https://shmabstracts.org/abstract/implementation-of-daily-safety-huddles-to-reduce-harm-events-at-a-safety-net-hospital/. Accessed April 23, 2021.

        • Lora AM
        • Hannahs D
        • Ashley P
        • Spencer S
        • Takhsh E
        • Bleasdale SC.
        Impact of a hospital-wide daily interdisciplinary safety huddle on device utilization and device-related hospital acquired infections.
        Open Forum Infect Dis. 2017; 4: S630
      5. Agency for Healthcare Research and Quality. Toolkit for reducing catheter-associated urinary tract infections in hospital units: implementation guide. Available at: https://www.ahrq.gov/hai/cauti-tools/guides/implguide-pt3.html. Accessed March 23, 2021.

      6. Agency for Healthcare Research and Quality. AHRQ safety program for long-term care: preventing CAUTI and other HAIs. Available at: https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/final-report.pdf. Accessed March 23, 2021.

      7. Agency for Healthcare Research and Quality. Toolkit for reducing catheter-associated urinary tract infections in hospital units: implementation guide. Appendix O. CAUTI event report template. Available at: https://www.ahrq.gov/hai/cauti-tools/impl-guide/implementation-guide-appendix-o.html. Accessed March 23, 2021.

        • Pronovost P
        • Needham D
        • Berenholtz S
        • et al.
        An intervention to decrease catheter-related bloodstream infections in the ICU [published correction appears in N Engl J Med. 2007 Jun 21;356(25):2660].
        N Engl J Med. 2006; 355: 2725-2732
        • Sopirala MM
        • Yahle-Dunbar L
        • Smyer J
        • et al.
        Infection control link nurse program: an interdisciplinary approach in targeting health care-acquired infection.
        Am J Infect Control. 2014; 42: 353-359
        • Sopirala MM
        • Syed A
        • Jandarov R
        • Lewis M.
        Impact of a change in surveillance definition on performance assessment of a catheter-associated urinary tract infection prevention program at a tertiary care medical center.
        Am J Infect Control. 2018; 46: 743-746