Active training and surveillance: 2 good friends to reduce urinary catheterization rate.
Marigliano, A., Barbadoro P., Pennacchietti, L., D'Errico, M.M, Prospero, E., & the CAUTI Working Collaborative Group. (2012). American Journal of Infection Control, 40; 692-695. doi:10.1016/j.ajic.2012.01.021
As the most frequent health care-associated infection, catheter-associated urinary tract infections (CAUTIs) account for approximately 40% of all infections. Incidence rates of CAUTIs vary from 3.0 to 17/10,000 and are reported to increase 3% to 10% for each day the catheter remains in place. These Italian researchers assessed the impact that a multimodel intervention had in reducing CAUTI rates among those hospitalized in a teaching health care facility.
Pre- and post-intervention data were collected, with the educational session serving as the intervention. Pre-intervention data were collected for 5 months, providing data on 1,194 patients (709 males, 485 females). The educational intervention focused on the management of catheterized patients. Participants in this study were the 269 health care professionals who provided care at the study sites. Since randomization was not possible, this study provides Level IIb research evidence (Polit & Beck, 2012). After the intervention, a designated unit-based nurse provided surveillance for any patient who was catheterized and served as the data collector. This individual identified and monitored all patients who were catheterized for at least 48 hours while receiving care from their unit. Post-intervention data collected over five months provided 542 incidences (403 male and 139 female) of catheterization. Mean catheterization rates before the intervention was 18.5%, with 46 cases of CAUTI detected, or an incidence rate of 6.6/1,000 catheter days. After the intervention, the mean catheterization rate was 9.2%, with 19 cases of CAUTI detected, or an incidence rate of 5.8/100 catheter days. Thus, with the educational intervention together with the implementation of a surveillance system, a reduction on the use of catheterizations occurred, along with decreasing the incidences of CAUTI.
Comparing these data to published infection rates reveal that prior to the intervention, the infection rates at these study sites were higher than the mean rates reported by the National Healthcare Safety Network (NHSN). While the infection rates decreased as a result of the intervention, they remained higher than rates reported by the NHSN. Thus, while effective in decreasing infection rates, this intervention alone is not capable of achieving normed-accepted standards. It would be interesting to determine which part of the multimodel intervention (the education or the concurrent surveillance) had the greater effect. These authors note that further research, including a revised educational intervention, is planned. Persistence in identifying and evaluating any intervention are activities that provide evidence-based care.
Peggy Ward-Smith, PhD, RN, is Director, Faculty Center for Excellence in Teaching (FACET), University of Missouri-Kansas City, and an Associate Professor, School of Nursing, University of Missouri, Kansas City, MO, and a member of the Urologic Nursing Editorial Board.
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|Date:||May 1, 2013|
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