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Published on: July 13, 2019
Catheter use and infection reduction in plastic surgery
Zach J Barnes1, Raman C Mahabir1
1Division of Plastic Surgery, Scott & White and Texas A&M Health Science Center, Temple, Texas, USA.
Insights
Implementing a new guideline significantly reduced catheter-associated urinary tract infections (CAUTI) at Texas A&M Health Science Center. This initiative lowered CAUTI rates, improving patient safety and reducing healthcare costs.
Area of Science:
- Healthcare-associated infections
- Infection control
- Patient safety
Background:
- Catheter-associated urinary tract infections (CAUTI) represent a significant healthcare burden, contributing to increased costs, morbidity, and mortality.
- The Texas A&M Health Science Center system faced high CAUTI rates in 2009, necessitating a comprehensive intervention.
- Addressing CAUTI is critical for improving hospital quality metrics and patient outcomes.
Purpose of the Study:
- To develop and implement a best-practice guideline aimed at reducing CAUTI incidence.
- To establish clear protocols for catheter insertion, usage, and maintenance.
- To enhance patient and nursing education regarding CAUTI prevention.
Main Methods:
- Formation of a multidisciplinary team to conduct root cause analysis and literature review.
- Development of a guideline encompassing proper catheter indications, usage, and infection minimization techniques.
- Implementation of patient/nursing education, improved patient identification, and automatic catheter termination orders.
Main Results:
- CAUTI rates decreased from 1.46 to 0.52 per 1000 catheter days between 2009 and 2011.
- The institution's CAUTI rate shifted from the upper to the lower quartile nationally.
- Statistically significant reductions in catheter use and CAUTI were observed in surgery and plastic surgery subgroups.
Conclusions:
- The implemented guideline effectively reduced CAUTI incidence at Texas A&M Health Science Center.
- The study highlights the success of evidence-based guideline development and implementation in infection control.
- The findings are applicable to plastic surgery patient populations, demonstrating broad utility.
Background:
Catheter-associated urinary tract infections (CAUTI) are the most common hospital-associated infection and can result in increased health care costs, morbidity and even mortality. In 2009, The Scott & White Memorial Hospital/Texas A&M Health Science Center (Texas, USA) system's CAUTI rate placed it in the upper quartile (ie, highest rate) for the country, necessitating a system-wide change.
Objective:
To design and implement a guideline to reduce the incidence of CAUTI.
Methods:
A multidisciplinary team was formed and completed both a root cause analysis and a review of the available literature. Consolidating the best evidence, the team formulated a best practice guideline detailing the proper indications for insertion of, improper use of and techniques to minimize infection with catheters. Included as part of this protocol was nursing and patient education, changes in identifying patients with a catheter and automatic termination orders. Three-, six- and 12-month reviews identifying additional opportunities for improvement at the end of 2010 were completed.
Results:
In 2009, the hospital's CAUTI rate was 1.46 per 1000 catheter days. In 2011 - the first complete year of the finalized guideline - the hospital's CAUTI rate was 0.52 per 1000 catheter days, ranking the institution in the bottom quartile (ie, lowest rate) for the country. The surgery and plastic surgery subgroup analyses also demonstrated statistically significant reduction in both catheter use and CAUTI.
Conclusion:
The incidence of CAUTI was successfully reduced at The Texas A&M Healthcare Center. The guideline, its development and how it applies to plastic surgery patients are discussed.
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