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

Published online by Cambridge University Press:  05 December 2016

Lona Mody ,
M. Todd Greene ,
Sanjay Saint ,
Jennifer Meddings ,
Barbara W. Trautner ,
Heidi L. Wald ,
Christopher Crnich ,
Jane Banaszak-Holl ,
Sara E. McNamara  and
Beth J. King
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Lona Mody*
Affiliation:
Geriatric Research Education and Clinical Center Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, Michigan Division of Geriatric and Palliative Care Medicine, University of Michigan Medical School, Ann Arbor, Michigan
M. Todd Greene
Affiliation:
Center for Clinical Management Research Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, Michigan Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
Sanjay Saint
Affiliation:
Center for Clinical Management Research Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, Michigan Medicine Service, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, Michigan Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
Jennifer Meddings
Affiliation:
Medicine Service, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, Michigan Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan
Barbara W. Trautner
Affiliation:
The Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Section of Infectious Diseases, Departments of Medicine and Surgery, Baylor College of Medicine, Houston, Texas
Heidi L. Wald
Affiliation:
Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
Christopher Crnich
Affiliation:
School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin William S. Middleton Veterans Affairs Hospital, Madison, Wisconsin
Jane Banaszak-Holl
Affiliation:
Institute of Gerontology, University of Michigan Medical School, Ann Arbor, Michigan Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan
Sara E. McNamara
Affiliation:
Division of Geriatric and Palliative Care Medicine, University of Michigan Medical School, Ann Arbor, Michigan
Beth J. King
Affiliation:
Veterans Affairs National Center for Patient Safety, Department of Veterans Affairs, Ann Arbor, Michigan
Robert Hogikyan
Affiliation:
Geriatric Research Education and Clinical Center Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, Michigan Medicine Service, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, Michigan Division of Geriatric and Palliative Care Medicine, University of Michigan Medical School, Ann Arbor, Michigan
Barbara S. Edson
Affiliation:
Health Research and Educational Trust, American Hospital Association, Chicago, Illinois
Sarah L. Krein*
Affiliation:
Center for Clinical Management Research Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, Michigan Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
*
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).
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).
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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

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 3 , March 2017 , pp. 287 - 293
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

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.Google Scholar
2. Jones, AL, Dwyer, LL, Bercovitz, AR, Strahan, GW. The national nursing home survey: 2004 overview. Vital Health Stat 2009;13:1–155.Google Scholar
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.Google Scholar
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;61:289–290.Google Scholar
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.Google Scholar
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;36:759–766.Google Scholar
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.Google Scholar
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;17:85–88.Google Scholar
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;61:86–94.Google Scholar
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;374:2111–2119.Google Scholar
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;175:714–723.Google Scholar
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;58:1532–1537.Google Scholar
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:e55–e57.Google Scholar
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;33:965–977.Google Scholar
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.Google Scholar
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;141:938–945.CrossRefGoogle ScholarPubMed
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;49:76–88.Google Scholar
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;315:582–592.CrossRefGoogle ScholarPubMed
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;42:60–62.Google Scholar
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;27:773–779.Google Scholar
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;82:672–678.CrossRefGoogle ScholarPubMed
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;20:725–732.CrossRefGoogle ScholarPubMed
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;20:498–507.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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;45:977–985.Google Scholar
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.CrossRefGoogle Scholar
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.Google Scholar
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;38:461–466.Google Scholar
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;37:761–767.CrossRefGoogle ScholarPubMed
32. McWilliams, JM, Chernew, ME, Zaslavsky, AM, Landon, BE. Post-acute care and ACOs—who will be accountable? Health Serv Res 2013;48:1526–1538.Google Scholar
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