Katrin Blondal1,2, Brynja Ingadottir1,2, Hildur Einarsdottir3, Dorothea Bergs2,4, Ingunn Steingrimsdottir5, Sigrun Steindorsdottir6, Gudbjorg Gudmundsdottir3, Elin Hafsteinsdottir7. 1. Surgical Division, Landspitali - The National University Hospital of Iceland, 13A, 101 Reykjavik, Iceland. 2. Faculty of Nursing, University of Iceland, Eiriksgotu 34, 101 Reykjavik, Iceland. 3. Medical Division, Landspitali - The National University Hospital of Iceland, Eiriksgata 19, 101 Reykjavik, Iceland. 4. Medical Division, Landspitali - The National University Hospital of Iceland, Eiriksgata 19, 101 Reykjavik, Iceland. 5. Department of Infection Control, Landspitali - The National University Hospital of Iceland, Eiríksgata 29, 101 Reykjavik, Iceland. 6. Department of Urology, Landspitali - The National University Hospital of Iceland, 11A, 101 Reykjavik, Iceland. 7. Department of Quality Improvement, Landspitali - The National University Hospital of Iceland, Eiríksgata 5, 101 Reykjavik, Iceland.
Abstract
OBJECTIVE: To assess the effectiveness of implementation of evidence-based recommendations to reduce catheter-associated urinary tract infections (CAUTIs). DESIGN: Prospective cohort study, conducted in 2010-12, with a before and after design. SETTING: A major referral university hospital. PARTICIPANTS: Data were collected before (n = 244) and 1 year after (n = 255) the intervention for patients who received urinary catheters. INTERVENTION: The intervention comprised two elements: (i) aligning doctors' and nurses' knowledge of indications for the use of catheters and (ii) an educational effort consisting of three 30- to 45-minute sessions on evidence-based practice regarding catheter usage for nursing personnel on 17 medical and surgical wards. MAIN OUTCOME MEASURES: The main outcome measures were the proportion of (i) admitted patients receiving urinary catheters during hospitalization, (ii) catheters inserted without indication, (iii) inpatient days with catheter and (iv) the incidence of CAUTIs per 1000 catheter days. Secondary outcome measures were the proportion of (i) catheter days without appropriate indication and (ii) patients discharged with a catheter. RESULTS: There was a reduction in the proportion of inpatient days with a catheter, from 44% to 41% (P = 0.006). There was also a reduction in the proportion of catheter days without appropriate indication (P < 0.001) and patients discharged with a catheter (P = 0.029). The majority of catheters were inserted outside the study wards. CONCLUSIONS: A short educational intervention was feasible and resulted in significant practice improvements in catheter usage but no reduction of CAUTIs. Other measures than CAUTI may be more sensitive to detecting important practice changes.
OBJECTIVE: To assess the effectiveness of implementation of evidence-based recommendations to reduce catheter-associated urinary tract infections (CAUTIs). DESIGN: Prospective cohort study, conducted in 2010-12, with a before and after design. SETTING: A major referral university hospital. PARTICIPANTS: Data were collected before (n = 244) and 1 year after (n = 255) the intervention for patients who received urinary catheters. INTERVENTION: The intervention comprised two elements: (i) aligning doctors' and nurses' knowledge of indications for the use of catheters and (ii) an educational effort consisting of three 30- to 45-minute sessions on evidence-based practice regarding catheter usage for nursing personnel on 17 medical and surgical wards. MAIN OUTCOME MEASURES: The main outcome measures were the proportion of (i) admitted patients receiving urinary catheters during hospitalization, (ii) catheters inserted without indication, (iii) inpatient days with catheter and (iv) the incidence of CAUTIs per 1000 catheter days. Secondary outcome measures were the proportion of (i) catheter days without appropriate indication and (ii) patients discharged with a catheter. RESULTS: There was a reduction in the proportion of inpatient days with a catheter, from 44% to 41% (P = 0.006). There was also a reduction in the proportion of catheter days without appropriate indication (P < 0.001) and patients discharged with a catheter (P = 0.029). The majority of catheters were inserted outside the study wards. CONCLUSIONS: A short educational intervention was feasible and resulted in significant practice improvements in catheter usage but no reduction of CAUTIs. Other measures than CAUTI may be more sensitive to detecting important practice changes.