1073. Improving Urinary Catheter Use: a Pilot of 18 Emergency Departments
Session: Poster Abstract Session: Surveillance of HAIs: Evaluating National Strategy
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • ED UC Intervention ID week 2013.pdf (466.2 kB)
  • Background: Urinary catheters (UCs) are frequently used in the hospital setting and are associated with infectious and non-infectious complications. Avoiding placement of unnecessary UCs in the emergency department (ED) may significantly decrease the risk of patient exposure during hospitalization.

    Methods: 18 ED units implemented institutional guidelines for UC placement and identified each physician and nurse champions to lead the work. The pre-post quasi-experimental design included baseline (7 days), intervention (14 days), and sustainability (1 day a month for 6 months) for UC use, indications for use, and presence of physician order. Changes were evaluated comparing the 3 periods.

    Results: 13215 patients admitted through the ED were evaluated during the 3 periods, with 889 (6.7%) having a catheter placed. Catheter placement dropped from 309/3381 (9.1%) baseline, to 423/6896 (6.1%) intervention, and 157/2938 (5.3%) sustainability periods (p<0.001). Indications deemed appropriate improved from 226/309 (73.1%) baseline, to 384/423 (90.8%) intervention, and 144/157 (91.7%) sustainability periods (p<0.001). Physician order documentation in the presence of the urinary catheter was 785/885 (88.7%) and did not significantly change over the 3 periods. Improvements were noted for different size hospitals, and were more pronounced for hospitals with higher placement baseline (Table).

    Conclusion: The implementation of institutional guidelines for UC placement in the ED, coupled with the support of clearly identified physician and nurse champions, are associated with a reduction in unnecessary UC placement. The effort has a substantial potential of reducing patient harm hospital wide.

    Table: Emergency department urinary catheter placement during the 3 periods of the study

    Baseline (%)

    Intervention (%)

    Sustainability (%)

    P value

    All 18 emergency departments

    309/3381 (9.1)

    423/6896 (6.1)

    157/2938 (5.3)

    <0.001

    Hospital size

    Large (>500 beds, n=5)

    97/1167 (8.3)

    130/2344 (5.5)

    50 (4.2)

    <0.001

    Medium (201-500 beds, n=8)

    179/1903 (9.4)

    257/3819 (6.7)

    88/1467  (6.0)

    <0.001

    Small (up to 200 beds, n=5)

    33/311 (10.6)

    36/733 (4.9)

    19/279 (6.8)

    0.003

    Baseline urinary catheter use

    Baseline <10% (n=10)

    140/2048(6.8)

    198/4198 (4.7)

    91/1791 (5.1)

    0.002

    Baseline 10% or more (n=8)

    169/1333 (12.7)

    225/2698 (8.3)

    66/1147 (5.8)

    <0.001

    Mohamad Fakih, MD, MPH1, Michelle Heavens, BSN, MHA2, Julie Grotemeyer, BS2, Clariecia Groves, M.S.2 and Ascension Health Emergency Department Group to Reduce Catheter-Associated Urinary Tract Infection, (1)Infection Prevention and Control, St. John Hospital and Medical Center, Grosse Pointe Woods, MI, (2)Clinical Excellence, Ascension Health, St Louis, MO

    Disclosures:

    M. Fakih, None

    M. Heavens, None

    J. Grotemeyer, None

    C. Groves, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.