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Intensive care unit rounding checklists to reduce catheter-associated urinary tract infections

Published online by Cambridge University Press:  04 March 2020

Nicholas J. Nassikas Open the ORCID record for Nicholas J. Nassikas [Opens in a new window] ,
Joao Filipe G. Monteiro ,
Barbara Pashnik ,
Judith Lynch ,
Gerardo Carino  and
Andrew T. Levinson
Nicholas J. Nassikas*
Affiliation:
Department of Pulmonary, Critical Care, and Sleep Medicine, Brown University, Alpert School of Medicine, Providence, Rhode Island, USA
Joao Filipe G. Monteiro
Affiliation:
Department of Medicine, Rhode Island Hospital, Providence, Rhode Island, USA
Barbara Pashnik
Affiliation:
Miriam Hospital, Providence, Rhode Island, USA
Judith Lynch
Affiliation:
Miriam Hospital, Providence, Rhode Island, USA
Gerardo Carino
Affiliation:
Department of Pulmonary, Critical Care, and Sleep Medicine, Brown University, Alpert School of Medicine, Providence, Rhode Island, USA
Andrew T. Levinson
Affiliation:
Department of Pulmonary, Critical Care, and Sleep Medicine, Brown University, Alpert School of Medicine, Providence, Rhode Island, USA
*
Author for correspondence: Nicholas J. Nassikas, E-mail: Nicholas_nassikas@brown.edu
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Abstract

Objective:

To assess whether the implementation of an intensive care unit (ICU) rounding checklist reduces the number of catheter-associated urinary tract infections (CAUTIs).

Design:

Retrospective before-and-after study that took place between March 2013 and February 2017.

Setting:

An academic community hospital 16-bed, mixed surgical, cardiac, medical ICU.

Patients:

Participants were all patients admitted to the adult mixed ICU and had a diagnosis of CAUTI.

Intervention:

Initiation of an ICU rounding checklist that prompts physicians to address any use of urinary catheters with analysis comparing the preintervention period before roll out of the rounding checklist versus the postintervention periods.

Results:

There were 19 CAUTIs and 9,288 urinary catheter days (2.04 CAUTIs per 1,000 catheter days). The catheter utilization ratio increased in the first year after the intervention (0.67 vs 0.60; P = .0079), then decreased in the second year after the intervention (0.53 vs 0.60; P = .0992) and in the third year after the intervention (0.53 vs 0.60; P = .0224). The rate of CAUTI (ie, CAUTI per 1,000 urinary catheter days) decreased from 4.62 before the checklist was implemented to 2.12 in the first year after the intervention (P = .2104). The CAUTI rate was 0.45 in the second year (P = .0275) and 0.96 in the third year (P = .0532).

Conclusions:

Our study suggests that utilization of a daily rounding checklist is associated with a decrease in the rates of CAUTI in ICU patients. Incorporating a rounding checklist is feasible in the ICU.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 6 , June 2020 , pp. 680 - 683
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Footnotes

PREVIOUS PRESENTATION: This work was summarized in abstract form at the Society of Critical Care Medicine’s (SCCM) Critical Care Congress on February 27, 2018, in San Antonio, Texas.

References

Shuman, EK, Chenoweth, CE.Recognition and prevention of healthcare-associated urinary tract infections in the intensive care unit. Crit Care Med 2010;38 suppl 8:S373–S379.10.1097/CCM.0b013e3181e6ce8fCrossRefGoogle Scholar
Tominaga, GT, Dhupa, A, McAllister, SM, Calara, R, Peters, SA, Stuck, A.Eliminating catheter-associated urinary tract infections in the intensive care unit: is it an attainable goal? Am J Surg 2014;208:1065–1070.10.1016/j.amjsurg.2014.08.013CrossRefGoogle ScholarPubMed
Chant, C, Smith, OM, Marshall, JC, Friedrich, JO.Relationship of catheter-associated urinary tract infection to mortality and length of stay in critically ill patients: a systematic review and meta-analysis of observational studies. Crit Care Med 2011;39:1167–1173.10.1097/CCM.0b013e31820a8581CrossRefGoogle ScholarPubMed
Urinary tract infection (catheter-associated urinary tract infection [CAUTI] and non-catheter-associated urinary tract infection [UTI]) and other urinary system infection [USI]) events. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/PDFs/pscManual/7pscCAUTIcurrent.pdf. Published 2020. Accessed February 12, 2020.Google Scholar
Klevens, RM, Edwards, JR, Richards, CL Jr, et al.Estimating health care-associated infections and deaths in US hospitals, 2002. Public Health Rept 2007;122:160–166.10.1177/003335490712200205CrossRefGoogle Scholar
Lewis, SS, Knelson, LP, Moehring, RW, Chen, LF, Sexton, DJ, Anderson, DJ.Comparison of non-intensive care unit (ICU) versus ICU rates of catheter-associated urinary tract infection in community hospitals. Infect Control Hosp Epidemiol 2013;34:744–747.10.1086/671000CrossRefGoogle ScholarPubMed
Haque, M, Sartelli, M, McKimm, J, Abu Bakar, M.Healthcare-associated infections—an overview. Infect Drug Resist 2018;11:2321–2333.10.2147/IDR.S177247CrossRefGoogle Scholar
Jain, P, Parada, JP, David, A, Smith, LG.Overuse of the indwelling urinary tract catheter in hospitalized medical patients. Arch Intern Med 1995;155:1425–1429.10.1001/archinte.1995.00430130115012CrossRefGoogle ScholarPubMed
Meddings, J, Rogers, MA, Macy, M, Saint, S.Systematic review and meta-analysis: reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalized patients. Clin Infect Dis 2010;51:550–560.10.1086/655133CrossRefGoogle ScholarPubMed
Krein, SL, Kowalski, CP, Harrod, M, Forman, J, Saint, S.Barriers to reducing urinary catheter use: a qualitative assessment of a statewide initiative. JAMA Intern Med 2013;173:881–886.10.1001/jamainternmed.2013.105CrossRefGoogle ScholarPubMed
Peasah, SK, McKay, NL, Harman, JS, Al-Amin, M, Cook, RL.Medicare nonpayment of hospital-acquired infections: infection rates three years post implementation. Medicare Medicaid Res Rev 2013;3(3): pii: mmrr.003.03.a08.10.5600/mmrr.003.03.a08CrossRefGoogle Scholar
Fasugba, O, Koerner, J, Mitchell, BG, Gardner, A.Systematic review and meta-analysis of the effectiveness of antiseptic agents for meatal cleaning in the prevention of catheter-associated urinary tract infections. J Hosp Infect 2017;95:233–242.10.1016/j.jhin.2016.10.025CrossRefGoogle ScholarPubMed
Galiczewski, JM, Shurpin, KM.An intervention to improve the catheter associated urinary tract infection rate in a medical intensive care unit: direct observation of catheter insertion procedure. Intensive Crit Care Nurs 2017;40:26–34.10.1016/j.iccn.2016.12.003CrossRefGoogle Scholar
Mullin, KM, Kovacs, CS, Fatica, C, et al.A multifaceted approach to reduction of catheter-associated urinary tract infections in the intensive care unit with an emphasis on “stewardship of culturing.” Infect Control Hosp Epidemiol 2017;38:186–188.10.1017/ice.2016.266CrossRefGoogle Scholar
Rosenthal, VD, Todi, SK, Alvarez-Moreno, C, et al.Impact of a multidimensional infection control strategy on catheter-associated urinary tract infection rates in the adult intensive care units of 15 developing countries: findings of the International Nosocomial Infection Control Consortium (INICC). Infection 2012;40:517–526.CrossRefGoogle Scholar
Janzen, J, Buurman, BM, Spanjaard, L, de Reijke, TM, Goossens, A, Geerlings, SE.Reduction of unnecessary use of indwelling urinary catheters. BMJ Qual Safety 2013;22:984–988.10.1136/bmjqs-2013-001908CrossRefGoogle ScholarPubMed
Knoll, BM, Wright, D, Ellingson, L, et al.Reduction of inappropriate urinary catheter use at a Veterans’ Affairs hospital through a multifaceted quality improvement project. Clin Infect Dis 2011;52:1283–1290.CrossRefGoogle Scholar
Saint, S, Greene, MT, Krein, SL, et al.A program to prevent catheter-associated urinary tract infection in acute care. N Engl J Med 2016;374:2111–2119.10.1056/NEJMoa1504906CrossRefGoogle ScholarPubMed
Hales, BM, Pronovost, PJ.The checklist—a tool for error management and performance improvement. J Crit Care 2006;21:231–235.10.1016/j.jcrc.2006.06.002CrossRefGoogle ScholarPubMed
Byrnes, MC, Schuerer, DJ, Schallom, ME, et al.Implementation of a mandatory checklist of protocols and objectives improves compliance with a wide range of evidence-based intensive care unit practices. Crit Care Med 2009;37:2775–2781.10.1097/CCM.0b013e3181a96379CrossRefGoogle ScholarPubMed
Carlos, WG, Patel, DG, Vannostrand, KM, Gupta, S, Cucci, AR, Bosslet, GT.Intensive care unit rounding checklist implementation: effect of accountability measures on physician compliance. Ann Am Thorac Soc 2015;12:533–538.10.1513/AnnalsATS.201410-494OCCrossRefGoogle ScholarPubMed
Conroy, KM, Elliott, D, Burrell, AR.Testing the implementation of an electronic process-of-care checklist for use during morning medical rounds in a tertiary intensive care unit: a prospective before-after study. Ann Intensive Care 2015;5(1):60.10.1186/s13613-015-0060-1CrossRefGoogle Scholar
Centofanti, JE, Duan, EH, Hoad, NC, et al.Use of a daily goals checklist for morning ICU rounds: a mixed-methods study. Crit Care Med 2014;42:1797–1803.10.1097/CCM.0000000000000331CrossRefGoogle ScholarPubMed
Haynes, AB, Weiser, TG, Berry, WR, et al.A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009;360:491–499.CrossRefGoogle Scholar
Weiss, CH, Moazed, F, McEvoy, CA, et al.Prompting physicians to address a daily checklist and process of care and clinical outcomes: a single-site study. Am J Respir Crit Care Med 2011;184:680–686.10.1164/rccm.201101-0037OCCrossRefGoogle ScholarPubMed
Cavalcanti, AB, Bozza, FA, Machado, FR, et al.Effect of a quality improvement intervention with daily round checklists, goal setting, and clinician prompting on mortality of critically ill patients: a randomized clinical trial. JAMA 2016;315:1480–1490.Google ScholarPubMed
Marsteller, JA, Sexton, JB, Hsu, YJ, et al.A multicenter, phased, cluster-randomized controlled trial to reduce central-line–associated bloodstream infections in intensive care units. Crit Care Med 2012;40:2933–2939.CrossRefGoogle ScholarPubMed
Pronovost, P, Needham, D, Berenholtz, S, et al.An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355:2725–2732.10.1056/NEJMoa061115CrossRefGoogle ScholarPubMed
Menegueti, MG, Ciol, MA, Bellissimo-Rodrigues, F, et al.Long-term prevention of catheter-associated urinary tract infections among critically ill patients through the implementation of an educational program and a daily checklist for maintenance of indwelling urinary catheters: a quasi-experimental study. Medicine 2019;98(8):e14417.10.1097/MD.0000000000014417CrossRefGoogle Scholar
Jain, M, Miller, L, Belt, D, King, D, Berwick, DM.Decline in ICU adverse events, nosocomial infections and cost through a quality improvement initiative focusing on teamwork and culture change. Qual Safety Health Care 2006;15:235–239.CrossRefGoogle ScholarPubMed
Siegel, BI, Figueroa, J, Stockwell, JA.Impact of a daily PICU rounding checklist on urinary catheter utilization and infection. Pediatr Qual Safety 2018;3(3):e078.10.1097/pq9.0000000000000078CrossRefGoogle ScholarPubMed
Harris, PA, Taylor, R, Thielke, R, Payne, J, Gonzalez, N, Conde, JG.Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42:377–381.10.1016/j.jbi.2008.08.010CrossRefGoogle ScholarPubMed
Sampathkumar, P.Reducing catheter-associated urinary tract infections in the ICU. Curr Opin Crit Care 2017;23:372–377.10.1097/MCC.0000000000000441CrossRefGoogle ScholarPubMed
Patel, PK, Gupta, A, Vaughn, VM, Mann, JD, Ameling, JM, Meddings, J.Review of strategies to reduce central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) in adult ICUs. J Hosp Med 2018;13:105–116.Google Scholar
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