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Reducing urinary catheter use in geriatric patients - results of a single-center champion-led intervention
L Mrziglod1,2, S Saydan3,4, F Schwab3,4
1Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Insights
A champion-led intervention significantly reduced indwelling urinary tract catheter (UTC) use in geriatric patients. This highlights the importance of daily assessment and timely removal of unnecessary catheters to prevent infections.
Area of Science:
- Geriatric Medicine
- Infectious Disease Prevention
- Healthcare Quality Improvement
Background:
- Indwelling urinary tract catheters (UTC) are a significant risk factor for urinary tract infections (UTI).
- Geriatric patients face a heightened risk of infection, necessitating targeted interventions.
- This study focused on minimizing UTC use in acute care geriatric wards.
Purpose of the Study:
- To evaluate the effectiveness of a champion-led, surveillance-based intervention aimed at reducing UTC utilization in geriatric patients.
- To assess the impact of the intervention on catheter-associated urinary tract infections (CAUTI) rates.
- To analyze the correlation between checklist adherence for daily UTC necessity assessment and catheter utilization.
Main Methods:
- A quasi-experimental design was employed, collecting unit-based data on UTC use and nosocomial UTI from November 2018 to January 2020.
- The intervention, implemented from June 2019 to January 2020, included data feedback, aseptic technique education, daily necessity checklists, and timely catheter removal.
- Statistical analyses, including rate ratios and the Kruskal Wallis test, were used to compare pre- and post-intervention data and evaluate checklist quality impact.
Main Results:
- A significant decrease in UTC utilization rate was observed, from 19.1 to 15.2 per 100 patient days (RR=0.80, p<0.001).
- While CAUTI incidence per 100 patients decreased from 2.07 to 1.40, this change was not statistically significant (RR=0.68, p=0.1279).
- Only 53% of patients with prolonged UTC use had a necessity checklist, and only 23.1% of these were of good quality; good quality checklists correlated with fewer UTC days (p=0.001).
Conclusions:
- A champion-led, surveillance-based intervention effectively reduced UTC use in geriatric patients.
- Further research is warranted to clarify the impact of daily checklist use on CAUTI prevention.
- Thorough daily review of UTC necessity, supported by high-quality checklist completion, is encouraged to minimize catheter days.
Background:
Indwelling urinary tract catheters (UTC) are a well-known risk factor for urinary tract infections (UTI). Because geriatric patients are at high risk of infection, an intervention with a focus on appropriate and minimal UTC use was introduced in 4 acute care geriatric wards.
Methods:
Between 11/2018 and 1/2020, unit-based data on UTC use and nosocomial UTI was collected in accordance with the methods of the German national surveillance system KISS. From 6/2019 to 1/2020, a champion-led intervention was implemented which focused on: (i) feedback of surveillance data, (ii) education and training in aseptic UTC insertion and maintenance, (iii) HCW's daily assessment of UTC necessity based on a checklist and (iv) timely removal of unnecessary UTCs. UTC use, incidence, and incidence densities for catheter-associated UTI (CAUTI) were calculated before and during the intervention. In addition, we analyzed adherence to a scheduled daily assessment of UTC necessity. Rate ratios (RR) with 95% confidence intervals (95%CI) were calculated. Differences based on the quality of checklist completion were evaluated using the Kruskal Wallis test.
Results:
We analyzed the data of 3,564 patients with a total 53,954 patient days, 9,208 UTC days, and 61 CAUTI. Surveillance data showed a significant decrease in the pooled UTC utilization rate from 19.1/100 patient days to 15.2/100 patient days (RR = 0.80, 95%CI 0.77-0.83, p < 0.001). CAUTI per 100 patients dropped from 2.07 to 1.40 (RR = 0.68, 95%CI 0.41-1.12, p = 0.1279). Overall, 373 patients received a UTC during the intervention. Of those patients 351 patients had an UTC ≥ 2 days. The analysis of these patients showed that 186 patients (53%) received a checklist as part of their chart for daily evaluation of UTC necessity. 43 (23.1%) of the completed checklists were of good quality; 143 (76.9%) were of poor quality. Patients in the group whose checklists were of good quality had fewer UTC days (median 7 UTC days IQR (3-11)) than patients whose checklists were of poor quality (11 UTC days IQR (6-16), p = 0.001).
Conclusion:
We conclude that a champion-led, surveillance-based intervention reduces the use of UTC among geriatric patients. Further research is needed to determine to what extent the use of checklists in daily medical UTC assessment affects the prevention of CAUTI. The fact that patients whose checklists were completed well had fewer UTC days should encourage a conscientious and thorough daily review of the need for UTC.
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