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Multi-faceted approach reduces CAUTIs among nursing home patients

An approach that combined increased engagement with patients and family and improved training on catheter usage reduced the incidence of catheter-associated urinary tract infections in community-based nursing homes, according to research published in JAMA Internal Medicine.

“Up to 13% of men and 12% of women have an indwelling urinary catheter on admission to the nursing home, and urinary tract infection is one of the leading causes of infection among nursing home residents,” Lona Mody, MD, MSc, from the division of geriatric and palliative medicine at the University of Michigan Medical School, and colleagues wrote. “Catheters still remain in place for long periods, leading to higher risk of infections, especially antimicrobial-resistant infections. ... knowledge of evidence-based practices to care for these devices among health care personnel in the long-term setting is suboptimal.”

To evaluate an intervention aiming to reduce catheter-associated UTIs (CAUTIs), researchers conducted a national, large-scale implementation project in community-based nursing homes participating in the Agency for Healthcare Research and Quality (AHRQ) Safety Program for Long-Term Care.

They implemented the project over 12-month cohorts between March 1, 2014 and Aug. 31, 2016. The project included a socioadaptive bundle highlighting leadership, resident/family engagement and effective communication, and a technical bundle highlighting catheter removal, aseptic insertion, using regular assessments, training for catheter care and incontinence care planning. The investigators assessed urinary catheter use and CAUTI rates, and facility-level urine culture order rates.

The analysis included 404 community-based nursing homes. The results showed that the unadjusted rates of CAUTI decreased by 54% over the 12-month period, from 6.78 to 2.63 infections per 1,000 catheter-days, with 75% of the facilities showing a reduction of 40% or more. Using the regression model and adjusting for facility characteristics, researchers observed the rates decreased from 6.42 to 3.3 infections per 1,000 catheter-days (IRR = 0.46; 95% CI, 0.36-0.58). The catheter utilization rate remained unchained. The rate of urine cultures ordered for all residents declined from 3.49 to 3.08 per 1,000 resident-days, and similarly decreased from 3.52 to 3.09 after adjustment (IRR, 0.85; 95% CI, 0.77-0.94).

“Our findings add new information about how to effectively promote reduction in health care-associated infections in a geographically diverse and broad group of nursing homes,” Mody and colleagues wrote. “Although this project focused on reducing catheter-associated UTIs, a similar approach with an evidence-based implementation framework can be used to address other resident safety issues in community based nursing homes.”

In an accompanying commentary, Elizabeth G. Turnipseed, MD, MPH, and C. Seth Landefeld, MD, from the department of medicine at the University of Alabama at Birmingham, wrote that the study highlights the importance of the AHRQ. The AHRQ, which supported this intervention, specializes in the science that underlies the design and evaluation of the safety program.

They wrote, “Elimination of the AHRQ, as proposed in President Trump’s Budget Blueprint to Make America Great Again, would not be so great for the tens of thousands of Americas who benefit from this study and the Safety Program for Long-Term Care.” – by Savannah Demko

Disclosures: Mody reports no relevant financial disclosures. Please see the full study for a complete list of all other authors’ relevant financial disclosures. Turnipseed and Landefeld report no relevant financial disclosures.