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Assessing a National Collaborative Program To Prevent Catheter-Associated Urinary Tract Infection in a Veterans Health Administration Nursing Home Cohort

Published online by Cambridge University Press:  10 May 2018

Sarah L. Krein ,
M. Todd Greene ,
Beth King ,
Deborah Welsh ,
Karen E. Fowler ,
Barbara W. Trautner ,
David Ratz ,
Sanjay Saint ,
Gary Roselle  and
Marla Clifton
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Sarah L. Krein*
Affiliation:
Center for Clinical Management Research, Ann Arbor Veteran Affairs (VA) Healthcare System, Ann Arbor, Michigan Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
M. Todd Greene
Affiliation:
Center for Clinical Management Research, Ann Arbor Veteran Affairs (VA) Healthcare System, Ann Arbor, Michigan Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
Beth King
Affiliation:
VA National Center for Patient Safety (NCPS), Ann Arbor, Michigan
Deborah Welsh
Affiliation:
VA National Center for Patient Safety (NCPS), Ann Arbor, Michigan
Karen E. Fowler
Affiliation:
Center for Clinical Management Research, Ann Arbor Veteran Affairs (VA) Healthcare System, Ann Arbor, Michigan
Barbara W. Trautner
Affiliation:
Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; and Section of Health Services Research, Departments of Medicine and Surgery, Baylor College of Medicine, Houston, Texas
David Ratz
Affiliation:
Center for Clinical Management Research, Ann Arbor Veteran Affairs (VA) Healthcare System, Ann Arbor, Michigan
Sanjay Saint
Affiliation:
Center for Clinical Management Research, Ann Arbor Veteran Affairs (VA) Healthcare System, Ann Arbor, Michigan Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
Gary Roselle
Affiliation:
VA National Infectious Diseases Service (NIDS), Washington, DC
Marla Clifton
Affiliation:
VA National Infectious Diseases Service (NIDS), Washington, DC
Stephen M. Kralovic
Affiliation:
VA National Infectious Diseases Service (NIDS), Washington, DC Cincinnati VA Medical Center, Cincinnati, Ohio Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
Tina Martin
Affiliation:
VA Inpatient Evaluation Center (IPEC), Cincinnati, Ohio
Lona Mody
Affiliation:
Geriatric Research Education and Clinical Center, Ann Arbor Veteran Affairs (VA) Healthcare System, Ann Arbor, Michigan Division of Geriatric and Palliative Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
*
Address correspondence to Sarah L. Krein, PhD, RN, VA Ann Arbor Center for Clinical Management Research, 2800 Plymouth Road, NCRC, Bldg. 16, 333W, Ann Arbor, MI 48109 (skrein@umich.edu)
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Abstract

OBJECTIVE

Collaborative programs have helped reduce catheter-associated urinary tract infection (CAUTI) rates in community-based nursing homes. We assessed whether collaborative participation produced similar benefits among Veterans Health Administration (VHA) nursing homes, which are part of an integrated system.

SETTING

This study included 63 VHA nursing homes enrolled in the “AHRQ Safety Program for Long-Term Care,” which focused on practices to reduce CAUTI.

METHODS

Changes in CAUTI rates, catheter utilization, and urine culture orders were assessed from June 2015 through May 2016. Multilevel mixed-effects negative binomial regression was used to derive incidence rate ratios (IRRs) representing changes over the 12-month program period.

RESULTS

There was no significant change in CAUTI among VHA sites, with a CAUTI rate of 2.26 per 1,000 catheter days at month 1 and a rate of 3.19 at month 12 (incidence rate ratio [IRR], 0.99; 95% confidence interval [CI], 0.67–1.44). Results were similar for catheter utilization rates, which were 11.02% at month 1 and 11.30% at month 12 (IRR, 1.02; 95% CI, 0.95–1.09). The numbers of urine cultures per 1,000 residents were 5.27 in month 1 and 5.31 in month 12 (IRR, 0.93; 95% CI, 0.82–1.05).

CONCLUSIONS

No changes in CAUTI rates, catheter use, or urine culture orders were found during the program period. One potential reason was the relatively low baseline CAUTI rate, as compared with a cohort of community-based nursing homes. This low baseline rate is likely related to the VHA’s prior CAUTI prevention efforts. While broad-scale collaborative approaches may be effective in some settings, targeting higher-prevalence safety issues may be warranted at sites already engaged in extensive infection prevention efforts.

Infect Control Hosp Epidemiol 2018;820–825

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 7 , July 2018 , pp. 820 - 825
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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