405. Preventing Catheter-Associated Urinary Tract Infection in Nursing Home Residents: Preliminary Results from a National Collaborative
Session: Poster Abstract Session: HAI: Preventing Device-Associated Infections
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • CAUTI LTC_IDweek_10-21-16 LM2.pdf (1021.2 kB)
  • Background: Catheter-associated urinary tract infection (CAUTI) in nursing home residents increases rates of sepsis, hospital admission, and healthcare costs. Active infection surveillance, appropriate catheter use and maintenance, proper hand hygiene, infection prevention education, and leadership engagement can reduce CAUTI incidence.

    Methods: TheAHRQ Safety Program for Long-term Care: HAIs/CAUTI” is a national collaborative aimed at reducing CAUTI, enhancing frontline personnel knowledge, and improving safety culture (Figure 1). Interventions included: A) a technical bundle: Catheter removal, Aseptic insertion, Using regular assessments and feedback, Training for catheter care, and Incontinence care planning and hydration practices (“CAUTI”) (Figure 2) and B) socio-adaptive elements emphasizing leadership, patient and family engagement, and effective communication. CAUTI rates using National Healthcare Safety Network (NHSN) criteria per 1,000 catheter-days (NHSN rate) and 10,000 resident-days (population rate) as well as catheter utilization data were collected. Random-effects negative binomial regression models were used to examine changes in catheter utilization and CAUTI rates.

    Results: In 4 cohorts over 30 months, 545 community-based facilities were recruited; 399 were included in this analysis (Figure 1). Bed size ranged from 20 to 574 and 64% were for-profit. At the start of the collaborative, mean catheter utilization ratio, NHSN and population CAUTI rates were 4.5%, 6.61/1,000 catheter-days and 2.98/10,000 resident-days. Both NHSN and population CAUTI rates decreased by 47% [incidence rate ratio (IRR)=0.53, 95% CI (0.44-0.63), p<0.001, for each respectively]; catheter utilization was largely unchanged [IRR=0.99, 95% CI (0.95-1.05), p=0.92]. CAUTI rates and catheter utilization remained similar after adjusting for cohort, ownership, bed size, provision of sub-acute care, infection prevention committee presence, infection preventionist experience, chain affiliation, and star rating.

    Conclusion: In a national infection prevention collaborative involving community-based nursing homes, we found that a combined technical and socio-adaptive CAUTI prevention program successfully reduced CAUTI.

     

    Lona Mody, MD, MSc1,2, M. Todd Greene, PhD3,4, Jennifer Meddings, MD, MSc4,5, Sarah Krein, PhD, RN3,4, Barbara W. Trautner, MD, PhD, FIDSA6,7, Sara Mcnamara, MPH, MT(ASCP)1, David Ratz, MS3,4, Nimalie D. Stone, MD, MS8, Steven J. Schweon, RN, MPH, FSHEA9, Andrew J. Rolle, MPH10, Russell Olmsted, MPH, CIC11, James B. Battles, PhD12, Barbara S. Edson, RN, MBA, MHA10 and Sanjay Saint, MD, MPH, FSHEA3,4,13, (1)Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, MI, (2)Geriatrics Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, (3)Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, (4)Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, MI, (5)Department of Pediatrics and Communicable Diseases, Division of General Pediatrics, University of Michigan Medical School, Ann Arbor, MI, (6)Departments of Medicine and Surgery, Baylor College of Medicine, Houston, TX, (7)Houston Center for Innovations in Quality, Effectiveness, and Safety (iQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, (8)Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, (9)Steven J. Schweon LLC, Saylorsburg, PA, (10)Health Research & Educational Trust, American Hospital Association, Chicago, IL, (11)Trinity Health, Livonia, MI, (12)Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Rockville, MD, (13)Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI

    Disclosures:

    L. Mody, None

    M. T. Greene, None

    J. Meddings, None

    S. Krein, None

    B. W. Trautner, Zambon Pharmaceuticals: Consultant , Consulting fee

    S. Mcnamara, None

    D. Ratz, None

    N. D. Stone, None

    S. J. Schweon, None

    A. J. Rolle, None

    R. Olmsted, None

    J. B. Battles, None

    B. S. Edson, None

    S. Saint, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.