Hostname: page-component-745bb68f8f-l4dxg Total loading time: 0 Render date: 2025-01-08T11:35:45.106Z Has data issue: false hasContentIssue false
  • English
  • Français

Effectiveness of Multifaceted Hospitalwide Quality Improvement Programs Featuring an Intervention to Remove Unnecessary Urinary Catheters at a Tertiary Care Center in Thailand

Published online by Cambridge University Press:  02 January 2015

Anucha Apisarnthanarak ,
Kanokporn Thongphubeth ,
Sirinaj Sirinvaravong ,
Danai Kitkangvan ,
Chananart Yuekyen ,
Boonyasit Warachan ,
David K. Warren  and
Victoria J. Fraser
Anucha Apisarnthanarak*
Affiliation:
Divisions of Infectious Diseases and Infection Control, Faculty of Medicine, Thammasart University Hospital, Pratumthani, Thailand
Kanokporn Thongphubeth
Affiliation:
Divisions of Infectious Diseases and Infection Control, Faculty of Medicine, Thammasart University Hospital, Pratumthani, Thailand
Sirinaj Sirinvaravong
Affiliation:
Internal Medicine, Faculty of Medicine, Thammasart University Hospital, Pratumthani, Thailand
Danai Kitkangvan
Affiliation:
Internal Medicine, Faculty of Medicine, Thammasart University Hospital, Pratumthani, Thailand
Chananart Yuekyen
Affiliation:
Divisions of Infectious Diseases and Infection Control, Faculty of Medicine, Thammasart University Hospital, Pratumthani, Thailand
Boonyasit Warachan
Affiliation:
Department of Applied Statistics, Faculty of Science, King Mongkut's Institute of Technology, Ladkrabang, Bangkok, Thailand
David K. Warren
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, Missouri
Victoria J. Fraser
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, Missouri
*
Division of Infectious Diseases, Faculty of Medicine, Thammasart University Hospital, Pratumthani, Thailand 12120 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To evaluate the efficacy of a multifaceted hospitalwide quality improvement program that featured an intervention to remind physicians to remove unnecessary urinary catheters.

Methods.

A hospitalwide preintervention-postintervention study was conducted over 2 years (July 1, 2004, through June 30, 2006). The intervention consisted of nurse-generated daily reminders that were used by an intervention team to remind physicians to remove unnecessary urinary catheters, beginning 3 days after insertion. Clinical, microbiological, pharmaceutical, and cost data were collected.

Results.

A total of 2,412 patients were enrolled in the study. No differences were found in the demographic and/or clinical characteristics of patients between the preintervention and postintervention periods. After the intervention, reductions were found in the rate of inappropriate urinary catheterization (mean rate, preintervention vs postintervention, 20.4% vs 11% [P = .04]), the rate of catheter-associated urinary tract infection (CA-UTI) (mean rate, 21.5 vs 5.2 infections per 1,000 catheter-days [P <.001]), the duration of urinary catheterization (mean, 11 vs 3 days [P < .001]), and the total length of hospitalization (mean, 16 vs 5 days [P < .001]). A linear relationship was seen between the monthly average duration of catheterization and the rate of CA-UTI (r = 0.89; P < .001). The intervention had the greatest impact on the rate of CA-UTI in the intensive care units (mean rate, preintervention vs postintervention, 23.4 vs 3.5 infections per 1,000 catheter-days [P = .01]). The monthly hospital costs for antibiotics to treat CA-UTI were reduced by 63% (mean, $3,739 vs $1,378 [P < .001]), and the hospitalization cost for each patient during the intervention was reduced by 58% (mean, $366 vs $154 [P < .001]).

Conclusions.

This study suggests that a multifaceted intervention to remind physicians to remove unnecessary urinary catheters can significantly reduced the duration of urinary catheterization and the CA-UTI rate in a hospital in a developing country.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 7 , July 2007 , pp. 791 - 798
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Maki, DG, Tambyah, PA. Engineering out the risk for infection with urinary catheters. Emerg Infect Dis 2001;7:342–337.Google Scholar
2.Steel, K, Gertman, PM, Crescenzi, C, Anderson, J. Iatrogenic illness on a general medical service at a university hospital. N Engl J Med 1981;304:638–640.Google Scholar
3.Siant, S. Clinical and economic consequences of nosocomial catheter-related bacteriuria. Am J Infect Control 2000;28:68–71.CrossRefGoogle Scholar
4.Platt, R, Polk, BF, Murdock, B, Rosner, B. Mortality associated with nosocomial urinary-tract infection. N Engl J Med 1982;307:637–642.CrossRefGoogle ScholarPubMed
5.Burke, JP, Yeo, TW. Nosocomial urinary tract infection. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2004:267–286.Google Scholar
6.Jain, P, Parad, JP, David, A, Smith, LG. Overuse of the indwelling urinary tract catheter in hospitalized medical patients. Arch Intern Med 1995;155:1425–1429.Google Scholar
7.Stark, RP, Maki, DG. Bacteriuria in the catheterized patient. N Engl J Med 1984;311:560–564.Google Scholar
8.Saint, S, Kaufman, SR, Rogers, MA, Baker, PD, Ossenkop, K, Lipsky, BA. Condom versus indwelling urinary catheters: a randomized trial. J Am Geriatr Soc 2006;54:1055–1061.Google Scholar
9.Burke, JP, Larsen, RA, Stevens, LE. Nosocomial bacteriuria: estimating the potential for prevention by closed sterile urinary drainage. Infect Control 1986;7:96–99.Google Scholar
10.Karchmer, TB, Giannetta, ET, Muto, CA, Strain, BA, Farr, BM. A randomized crossover study of silver-coated urinary catheters in hospitalized patients. Arch Intern Med 2000;160:3294–3298.Google Scholar
11.Brosnahan, J, Jull, A, Tracy, C. Types of urethral catheters for management of short-term voiding problems in hospitalised adults. Cochrane Database Syst Rev 2004;1:CD004013.Google Scholar
12.Saint, S, Wiese, I, Amory, JK, et al.Are physicians aware of which of their patients have indwelling urinary catheters? Am J Med 2000;109:476–480.CrossRefGoogle ScholarPubMed
13.Apisarnthanarak, A, Rutjanawech, S, Wichansawakun, S, et al.Initial inappropriate urinary catheters use in a tertiary care center: incidence, risk factors and outcomes. Am J Infect Control In press.Google Scholar
14.Munasinghe, RL, Yazdani, H, Siddique, M, Hafeez, W. Appropriateness of use of indwelling urinary catheters in patients admitted to the medical service. Infect Control Hosp Epidemiol 2001;22:647–649.Google Scholar
15.Huang, WC, Wann, SR, Lin, SL, et al.Catheter-associated urinary tract infections in intensive care units can be reduced by prompting physicians to remove unnecessary catheters. Infect Control Hosp Epidemiol 2004;25:974–978.CrossRefGoogle ScholarPubMed
16.Gokula, RR, Hickner, JA, Smith, MA. Inappropriate use of urinary catheters in elderly patients at a Midwest community teaching hospital. Am J Infect Control 2004;32:196–199.Google Scholar
17.Stamm, WE. Catheter-associated urinary tract infections: epidemiology, pathogenesis, and prevention. Am J Med 1991;91(suppl 3B):65S–71S.CrossRefGoogle Scholar
18.Warren, JW. Catheter-associated urinary tract infection. In: Andriole, VT, ed. Infectious Disease Clinics of North America: Urinary Tract Infections. Philadelphia, PA: WB Saunders Co; 1995:609–622.Google Scholar
19.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.Google Scholar
20.Ansari, F, Gray, K, Nathwani, D, et al.Outcomes of an intervention to improve hospital antibiotic prescribing: interrupted time series with segmented regression analysis. J Antimicrob Chemother 2003;52:842–848.Google Scholar
21.Huang, WC, Wann, SR, Lin, SL, et al.Catheter-associated urinary tract infections in intensive care units can be reduced by prompting physicians to remove unnecessary catheters. Infect Control Hosp Epidemiol 2004;25:974–978.Google Scholar
22.Rosenthal, VD, Guzman, S, Safdar, N. Effect of education and performance feedback on rates of catheter-associated urinary tract infection in intensive care units in Argentina. Infect Control Hosp Epidemiol 2004;25:47–50.Google Scholar
23.Goetz, AM, Kedzuf, S, Wagener, M, Muder, RR. Feedback to nursing staff as an intervention to reduce catheter-associated urinary tract infections. Am J Infect Control 1999;27:402–404.Google Scholar
24.Stephan, F, Sax, H, Wachsmuth, M, Hoffmeyer, P, Clergue, F, Pittet, D. Reduction of urinary tract infection and antibiotic use after surgery: a controlled, prospective, before-after intervention study. Clin Infect Dis 2006;42:1544–1551.Google Scholar
25.Cornia, PB, Amory, JK, Fraser, S, Saint, S, Lipsky, BA. Computer-based order entry decreases duration of indwelling urinary catheterization in hospitalized patients. Am J Med 2003;114:404–406.Google Scholar
26.Saint, S, Kaufman, SR, Thompson, M, Rogers, MA, Chenoweth, CE. A reminder reduces urinary catheterization in hospitalized patients, N Comm. J Qual Patient Saf 2005;31:455–462.Google Scholar
27.Krieger, JN, Keiser, DL, Wenzel, RRUrinary tract etiologies of bloodstream infections in hospitalized patients. J Infect Dis 1983;148:57–66.Google Scholar
28.Garibaldi, RA, Mooney, BR, Epstein, BJ, et al.An evaluation of daily bacteriologie monitoring to identify preventable episodes of catheter-associated urinary tract infection. Infect Control 1982;3:466–470.CrossRefGoogle Scholar
29.Brayan, CS, Raynolds, KL. Hospital-acquired bacteremic urinary tract infection: epidemiology and outcome. J Urol 1984;132:494–498.CrossRefGoogle Scholar
30.Emori, TG, Banerjee, SN, Culver, DH, et al.Nosocomial infections in elderly patients in the United States, 1986-1990: National Nosocomial Infections Surveillance System. Am J Med 1991;91:289S–293S.Google Scholar
31.Platt, R, Polk, R, Murdock, B, Rosner, B. Reduction of mortality associated with nosocomial urinary tract infection. Lancet 1983;1:893–897.Google Scholar
32.Given, CD, Wenzel, RP. Catheter-associated urinary tract infections in surgical patients: a controlled study on the excess morbidity and costs. J Urol 1980;124:646–648.Google Scholar
33.Haley, RW, Schaberg, DR, Crossley, KB, Von Allmen, SD, McGowan, JE Jr.Extra charges and prolongation of stay attributable to nosocomial infections: a prospective interhospital comparison. Am J Med 1981;70:51–58.Google Scholar
34.Saint, S, Lipsky, BA, Goold, SD. Indwelling urinary catheters: a one-point restraint? Ann Intern Med 2002;137:125–127.Google Scholar
35.Tambyah, PA, Knasinski, V, Maki, DG. The direct costs of nosocomial catheter-associated urinary tract infection in the era of managed care. Infect Control Hosp Epidemiol 2002;23:27–31.Google Scholar
36.Laupland, KB, Zygun, DA, Davies, HD, Church, DL, Louie, TJ, Doig, CJ. Incidence and risk factors for acquiring nosocomial urinary tract infection in the critically ill. J Crit Care 2002;17:50–57.Google Scholar