OBJECTIVE: To reduce catheter-related urinary tract infection rates in three intensive-care units to at or below the National Nosocomial Infection Surveillance System pooled mean for similar units. DESIGN: A nursing team, physician team, and laboratory team reviewed and revised protocols and procedures for better catheter management. SETTING: A 500-bed community teaching hospital. INTERVENTIONS: The teams developed medical indications for urinary catheter placement and criteria that allowed the registered nurse to remove a catheter without a physician's order when no longer medically necessary. They created a computer prompt to assure a urinalysis accompanied all urine cultures. RESULTS: After introducing the new protocols, the incidence density of catheter-related urinary tract infections fell 17% in the surgical intensive-care unit, 29% in the medical intensive-care acute unit, and 45% in the coronary intensive-care acute unit. The registered nurses' compliance in removing the catheter per protocol was 88%. Physician ordering of a concomitant urinalysis with each urine culture achieved 93%. CONCLUSIONS: A multidisciplinary approach assisted in reducing catheter-associated urinary tract infections in three intensive-care units, although not to the extent desired. The teams are investigating preconnected and antimicrobial-coated catheters further.
OBJECTIVE: To reduce catheter-related urinary tract infection rates in three intensive-care units to at or below the National Nosocomial Infection Surveillance System pooled mean for similar units. DESIGN: A nursing team, physician team, and laboratory team reviewed and revised protocols and procedures for better catheter management. SETTING: A 500-bed community teaching hospital. INTERVENTIONS: The teams developed medical indications for urinary catheter placement and criteria that allowed the registered nurse to remove a catheter without a physician's order when no longer medically necessary. They created a computer prompt to assure a urinalysis accompanied all urine cultures. RESULTS: After introducing the new protocols, the incidence density of catheter-related urinary tract infections fell 17% in the surgical intensive-care unit, 29% in the medical intensive-care acute unit, and 45% in the coronary intensive-care acute unit. The registered nurses' compliance in removing the catheter per protocol was 88%. Physician ordering of a concomitant urinalysis with each urine culture achieved 93%. CONCLUSIONS: A multidisciplinary approach assisted in reducing catheter-associated urinary tract infections in three intensive-care units, although not to the extent desired. The teams are investigating preconnected and antimicrobial-coated catheters further.
Authors: Sanjay Saint; Jennifer A Meddings; David Calfee; Christine P Kowalski; Sarah L Krein Journal: Ann Intern Med Date: 2009-06-16 Impact factor: 25.391
Authors: Jennifer Meddings; Mary A M Rogers; Sarah L Krein; Mohamad G Fakih; Russell N Olmsted; Sanjay Saint Journal: BMJ Qual Saf Date: 2013-09-27 Impact factor: 7.035