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Comparing Catheter-Associated Urinary Tract Infection Prevention Programs Between Veterans Affairs Nursing Homes and Non–Veterans Affairs Nursing Homes

  • Lona Mody (a1) (a2), M. Todd Greene (a3) (a4), Sanjay Saint (a3) (a5) (a4), Jennifer Meddings (a5) (a4) (a6), Barbara W. Trautner (a7) (a8), Heidi L. Wald (a9), Christopher Crnich (a10) (a11), Jane Banaszak-Holl (a12) (a13), Sara E. McNamara (a2), Beth J. King (a14), Robert Hogikyan (a1) (a5) (a2), Barbara S. Edson (a15) and Sarah L. Krein (a3) (a4)...
Abstract
OBJECTIVE

The impact of healthcare system integration on infection prevention programs is unknown. Using catheter-associated urinary tract infection (CAUTI) prevention as an example, we hypothesize that US Department of Veterans Affairs (VA) nursing homes have a more robust infection prevention infrastructure due to integration and centralization compared with non–VA nursing homes.

SETTING

VA and non-VA nursing homes participating in the AHRQ Safety Program for Long-Term Care collaborative.

METHODS

Nursing homes provided baseline information about their infection prevention programs to assess strengths and gaps related to CAUTI prevention via a needs assessment questionnaire.

RESULTS

A total of 353 of 494 nursing homes from 41 states (71%; 47 VA and 306 non-VA facilities) responded. VA nursing homes reported more hours per week devoted to infection prevention-related activities (31 vs 12 hours; P<.001) and were more likely to have committees that reviewed healthcare-associated infections. Compared with non-VA facilities, a higher percentage of VA nursing homes reported tracking CAUTI rates (94% vs 66%; P<.001), sharing CAUTI data with leadership (94% vs 70%; P=.014) and with nursing personnel (85% vs 56%, P=.003). However, fewer VA nursing homes reported having policies for appropriate catheter use (64% vs 81%; P=.004) and catheter insertion (83% vs 94%; P=.004).

CONCLUSIONS

Among nursing homes participating in an AHRQ-funded collaborative, VA and non-VA nursing homes differed in their approach to CAUTI prevention. Best practices from both settings should be applied universally to create an optimal infection prevention program within emerging integrated healthcare systems.

Infect Control Hosp Epidemiol 2017;38:287–293

Copyright
Corresponding author
Address correspondence to Lona Mody, MD, MSc, University of Michigan Medical School, Division of Geriatric and Palliative Medicine, 300 N. Ingalls St, Room 905, Ann Arbor, MI 48109 (lonamody@umich.edu) or Sarah L. Krein, PhD, RN, Center for Clinical Management Research Ann Arbor Veterans Affairs Healthcare System, PO Box 130170, Ann Arbor, MI 48113 (skrein@umich.edu).
References
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1. Harris-Kojetin L, Sengupta M, Park-Lee E, Valverde R. Long-term care services in the United States: 2013 overview. National Center for Health Statistics. Vital Health Stat 2013;3(37). Centers for Disease Control and Prevention website. http://www.cdc.gov/nchs/data/nsltcp/long_term_care_services_2013.pdf. Published 2013. Accessed on July 7, 2016.
2. Jones AL, Dwyer LL, Bercovitz AR, Strahan GW. The national nursing home survey: 2004 overview. Vital Health Stat 2009;13:1155.
3. Adverse events in skilled nursing facilities: national incidence among Medicare beneficiaries. US Department of Health and Human Services, Office of the Inspector General website. http://oig.hhs.gov/oei/reports/oei-06-11-00370.pdf. Published 2014. Accessed July 7, 2016.
4. Peron EP, Hirsch AA, July LA, Jump RL, Donskey CJ. Another setting for stewardship: high rate of unnecessary antimicrobial use in a Veterans’ Affairs long-term care facility. J Am Geriatr Soc 2013;61:289290.
5. Collier WM, Collier WM. The Omnibus Budget Reconciliation Act of 1987, Public Law No. 100-203: As amending ERISA with respect to pension plans in cases under the bankruptcy code. New York: Matthew Bender; 1988.
6. Ye Z, Mukamel DB, Huang SS, Li Y, Temkin-Greener H. Healthcare-associated pathogens and nursing home policies and practices: results from a national survey. Infect Control Hosp Epidemiol 2015;36:759766.
7. National action plan to prevent health care-associated infections: road map to elimination, 2013. US Department of Health and Human Services website. http://health.gov/hcq/pdfs/hai-action-plan-ltcf.pdf. Published 2013. Accessed July 7, 2016.
8. Herzig CT, Stone PW, Castle N, et al. Infection prevention and control programs in US nursing homes: results of a national survey. J Am Med Dir Assoc 2016;17:8588.
9. Mody L, Meddings J, Edson BS, et al. Enhancing resident safety by preventing healthcare-associated infection: a national initiative to reduce catheter-associated urinary tract infections in nursing homes. Clin Infect Dis 2015;61:8694.
10. Saint S, Greene MT, Krein SL, et al. A program to prevent catheter-associated urinary tract infection in acute care. New Engl J Med 2016;374:21112119.
11. Mody L, Krein SL, Saint S, et al. A targeted infection prevention intervention in nursing home residents with indwelling devices: a randomized clinical trial. JAMA Intern Med 2015;175:714723.
12. Mody L, Saint S, Galecki A, Chen S, Krein S. Knowledge of evidence-based urinary catheter care practice recommendations among healthcare workers in nursing homes. J Am Geriatric Soc 2010;58:15321537.
13. Montoya A, Chen S, Galecki A, McNamara S, Lansing B, Mody L. Does policy awareness influence knowledge about hand hygiene and urinary catheter care in nursing homes? Am J Infect Control 2013;41:e55e57.
14. Stone ND, Ashraf MS, Calder J, et al. Surveillance definitions of infections in long-term care facilities: revisiting the McGeer criteria. Infect Control Hosp Epidemiol 2012;33:965977.
15. National Healthcare Safety Network (NHSN) protocol for tracking infections in long-term care facilities. Urinary tract infection (UTI) event for long-term care facilities. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/pdfs/ltc/ltcf-uti-protocol-current.pdf. Published January 2016. Accessed July 5, 2016.
16. Asch SM, McGlynn EA, Hogan MM, et al. Comparison of quality of care for patients in the Veterans’ Health Administration and patients in a national sample. Ann Intern Med 2004;141:938945.
17. Trivedi AN, Matula S, Miake-Lye I, Glassman PA, Shekelle P, Asch S. Systematic review: comparison of the quality of medical care in Veterans’ Affairs and non-Veterans’ Affairs settings. Med Care 2011;49:7688.
18. Nuti SV, Qin L, Rumsfeld JS, et al. Association of admission to Veterans’ Affairs hospitals vs non-Veterans’ Affairs hospitals with mortality and readmission rates among older men hospitalized with acute myocardial infarction, heart failure, or pneumonia. JAMA 2016;315:582592.
19. Evans ME, Kralovic SM, Simbartl LA, et al. Nationwide reduction of health care-associated methicillin-resistant Staphylococcus aureus infections in Veterans’ Affairs long-term care facilities. Am J Infect Control 2014;42:6062.
20. Krein SL, Kowalski CP, Hofer TP, Saint S. Preventing hospital-acquired infections: a national survey of practices reported by US hospitals in 2005 and 2009. J Gen Intern Med 2012;27:773779.
21. Krein SL, Hofer TP, Kowalski CP, et al. Use of central venous catheter-related bloodstream infection prevention practices by US hospitals. Mayo Clin Proc 2007;82:672678.
22. Render ML, Hasselbeck R, Freyberg RW, Hofer TP, Sales AE, Almenoff PL. Reduction of central line infections in Veterans’ Administration intensive care units: an observational cohort using a central infrastructure to support learning and improvement. BMJ Qual Saf 2011;20:725732.
23. Render ML, Freyberg RW, Hasselbeck R, et al. Infrastructure for quality transformation: measurement and reporting in Veterans’ Administration intensive care units. BMJ Qual Saf 2011;20:498507.
24. Nursing home compare. Centers for Medicare and Medicaid Services website. https://data.medicare.gov/data/nursing-home-compare. Updated 2016. Accessed July 5, 2016.
25. Five-star quality rating system. Centers for Medicare and Medicaid Services website. https://www.cms.gov/medicare/provider-enrollment-and-certification/certificationandcomplianc/fsqrs.html. Published 2015. Accessed July 5, 2016.
26. CMS manual systems. Urinary incontinence, tags F315 and F316, June 28, 2005. Centers for Medicare and Medicaid Services website. https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/r8som.pdf. Published 2005. Accessed July 6, 2016.
27. Hawes C, Mor V, Phillips CD, et al. The OBRA-87 nursing home regulations and implementation of the resident assessment instrument: effects on process quality. J Am Geriatr Soc 1997;45:977985.
28. Gurwitz JH, DuBeau C, Mazor K, et al. Use of indwelling urinary catheters in nursing homes: implications for quality improvement efforts. J Am Geriatr Soc 2016 Sep 19. doi: 10.1111/jgs.14464.
29. Castle N, Engberg JB, Wagner LM, Handler S. Resident and facility factors associated with the incidence of urinary tract infections identified in the nursing home minimum data set. J Appl Gerontol 2015 May 5. doi: 10.1177/0733464815584666.
30. Tsan L, Langberg R, Davis C, et al. Nursing-home associated infections in the Department of Veterans’ Affairs community living centers. Am J Infect Control 2010;38:461466.
31. van den Dool C, Haenen A, Leenstra T, Wallinga J. The role of nursing homes in the spread of antimicrobial resistance over the healthcare network. Infect Control Hosp Epidemiol 2016;37:761767.
32. McWilliams JM, Chernew ME, Zaslavsky AM, Landon BE. Post-acute care and ACOs—who will be accountable? Health Serv Res 2013;48:15261538.
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