A Schweiger1, S P Kuster2, J Maag3, S Züllig4, S Bertschy5, E Bortolin6, G John7, H Sax2, A Limacher8, A Atkinson9, D Schwappach10, J Marschall11. 1. Swissnoso, National Centre for Infection Control, Bern, Switzerland; Department of Infectious Diseases and Hospital Epidemiology, Basel University Hospital, Basel, Switzerland; Zug Cantonal Hospital, Zug, Switzerland. 2. Swissnoso, National Centre for Infection Control, Bern, Switzerland; Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital Zurich, Zurich, Switzerland. 3. Swissnoso, National Centre for Infection Control, Bern, Switzerland. 4. Swiss Patient Safety Foundation, Zurich, Switzerland. 5. Lucerne Cantonal Hospital, Lucerne, Switzerland. 6. Ente Ospedaliero Cantonale, Bellinzona, Switzerland. 7. Department of Internal Medicine, Hôpital Neuchâtelois, Neuchâtel, Switzerland; University of Geneva, Geneva, Switzerland. 8. CTU Bern, University of Bern, Bern, Switzerland. 9. Department of Infectious Diseases, Inselspital, Bern University Hospital, Bern, Switzerland. 10. Swiss Patient Safety Foundation, Zurich, Switzerland; Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland. 11. Swissnoso, National Centre for Infection Control, Bern, Switzerland; Department of Infectious Diseases, Inselspital, Bern University Hospital, Bern, Switzerland. Electronic address: jonas.marschall@insel.ch.
Abstract
BACKGROUND: Multi-centre intervention studies tackling urinary catheterization and its infectious and non-infectious complications are lacking. AIM: To decrease urinary catheterization and, consequently, catheter-associated urinary tract infections (CAUTIs) and non-infectious complications. METHODS: Before/after non-randomized multi-centre intervention study in seven hospitals in Switzerland. Intervention bundle consisting of: (1) a concise list of indications for urinary catheterization; (2) daily evaluation of the need for ongoing catheterization; and (3) education on proper insertion and maintenance of urinary catheters. The primary outcome was urinary catheter utilization. Secondary outcomes were CAUTIs, non-infectious complications and process indicators (proportion of indicated catheters and frequency of catheter evaluation). FINDINGS: In total, 25,880 patients were included in this study [13,171 at baseline (August-October 2016) and 12,709 post intervention (August-October 2017)]. Catheter utilization decreased from 23.7% to 21.0% (P=0.001), and catheter-days per 100 patient-days decreased from 17.4 to 13.5 (P=0.167). CAUTIs remained stable at a low level with 0.02 infections per 100 patient-days (baseline) and 0.02 infections (post intervention) (P=0.98). Measuring infections per 1000 catheter-days, the rate was 1.02 (baseline) and 1.33 (post intervention) (P=0.60). Non-infectious complications decreased significantly, from 0.79 to 0.56 events per 100 patient-days (P<0.001), and from 39.4 to 35.4 events per 1000 catheter-days (P=0.23). Indicated catheters increased from 74.5% to 90.0% (P<0.001). Re-evaluations increased from 168 to 624 per 1000 catheter-days (P<0.001). CONCLUSION: A straightforward bundle of three evidence-based measures reduced catheter utilization and non-infectious complications, whereas the proportion of indicated urinary catheters and daily evaluations increased. The CAUTI rate remained unchanged, albeit at a very low level.
BACKGROUND: Multi-centre intervention studies tackling urinary catheterization and its infectious and non-infectious complications are lacking. AIM: To decrease urinary catheterization and, consequently, catheter-associated urinary tract infections (CAUTIs) and non-infectious complications. METHODS: Before/after non-randomized multi-centre intervention study in seven hospitals in Switzerland. Intervention bundle consisting of: (1) a concise list of indications for urinary catheterization; (2) daily evaluation of the need for ongoing catheterization; and (3) education on proper insertion and maintenance of urinary catheters. The primary outcome was urinary catheter utilization. Secondary outcomes were CAUTIs, non-infectious complications and process indicators (proportion of indicated catheters and frequency of catheter evaluation). FINDINGS: In total, 25,880 patients were included in this study [13,171 at baseline (August-October 2016) and 12,709 post intervention (August-October 2017)]. Catheter utilization decreased from 23.7% to 21.0% (P=0.001), and catheter-days per 100 patient-days decreased from 17.4 to 13.5 (P=0.167). CAUTIs remained stable at a low level with 0.02 infections per 100 patient-days (baseline) and 0.02 infections (post intervention) (P=0.98). Measuring infections per 1000 catheter-days, the rate was 1.02 (baseline) and 1.33 (post intervention) (P=0.60). Non-infectious complications decreased significantly, from 0.79 to 0.56 events per 100 patient-days (P<0.001), and from 39.4 to 35.4 events per 1000 catheter-days (P=0.23). Indicated catheters increased from 74.5% to 90.0% (P<0.001). Re-evaluations increased from 168 to 624 per 1000 catheter-days (P<0.001). CONCLUSION: A straightforward bundle of three evidence-based measures reduced catheter utilization and non-infectious complications, whereas the proportion of indicated urinary catheters and daily evaluations increased. The CAUTI rate remained unchanged, albeit at a very low level.
Authors: Alen Hascic; Aline Wolfensberger; Lauren Clack; Peter W Schreiber; Stefan P Kuster; Hugo Sax Journal: Antimicrob Resist Infect Control Date: 2022-08-25 Impact factor: 6.454