Implementing Evidence to Prevent Urinary Infection and Enhance Patient Safety

落实预防泌尿道感染和增强患者安全的证据

• 批准号: 8102981
• 负责人: Sarah Krein
• 金额: $ 41.48万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-08-25 至 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8102981
• 关键词: Adoption; Bladder; Caring; Catheterization; Catheters; Clinical; Collaborations; Collection; Complex; Data; Diffusion; Ensure; Environment; Evaluation; Evidence based practice; Health; Healthcare; Healthcare Systems; Hospitals; Infection; Infection prevention; Intervention; Interview; Investigation; Learning; Methods; Michigan; Nurses; Outcome; Patients; Physicians; Play; Process; Qualitative Methods; Quality of Care; Research; Role; Site Visit; Survey Methodology; Telephone; Testing; United States; Urinary Catheterization; Urinary tract infection; Work; burden of illness; catheter associated UTI; clinical practice; innovation; insight; interest; patient safety; prevent; theories; tool; urinary

DESCRIPTION (provided by applicant): Ensuring the effective use of evidence-based practices in real-world clinical settings can be challenging. We believe that nurses play a key role in the implementation of such practices, especially practices aimed at preventing healthcare-associated infection. Catheter-related urinary tract infection} the most frequent healthcare-associated infection in the United States} is a costly and potentially lethal condition. The state of Michigan is initiating an ambitious patient safety project to ameliorate the burden of disease associated with indwelling catheterization. The overarching objective of this research is to identify and develop strategies to optimize the implementation of key practices in the field of patient safety and healthcare-associated infection prevention. This study has three aims: 1) To describe the adoption and implementation of a Catheter-Associated Urinary Tract Infection Prevention Bundle (Bladder Bundle) as part of a Michigan state-wide patient safety initiative and assess patient outcomes such as catheter utilization and infection rates; 2) To identify and compare the barriers to and facilitators of implementing the Bladder Bundle across a diverse group of hospitals; and 3) To develop and evaluate strategies to facilitate implementation of the Bladder Bundle and assess patient outcomes including catheter utilization, discontinuation, re-insertion, and infection rates. This investigation includes the collection and analysis of both quantitative and qualitative data. We have assembled an interdisciplinary team that has already worked successfully together on a prior study to conduct this timely and innovative patient safety project. For the first aim we will use survey methods to describe the diffusion, adoption, and implementation of the Bladder Bundle and key patient outcomes. For the second aim we will use primarily qualitative methods, consisting of both phone interviews and site visits. This approach will allow us to examine in greater depth complex organizational factors that serve as either facilitators or barriers to implementing the Bladder Bundle. We will also develop implementation strategies and tools that will then be evaluated in collaboration with three hospitals that are in the process of implementing the Bladder Bundle. For the third aim we propose to collect qualitative data before, during, and after the implementation of the intervention in order to conduct a formative evaluation, including an evaluation of implementation process, attainment, and sustainability. We will also collect quantitative data on patient outcomes such as catheter use, discontinuation, and infection rates. PUBLIC HEALTH RELEVANCE: Catheter-related urinary tract infection is a common, costly, and potentially lethal condition. The purpose of this research is to develop methods to help prevent catheter-related urinary tract infection. Our study will also provide insight on how to prevent other healthcare-associated infections, thereby creating a safer healthcare system.

描述（由申请人提供）：确保在现实世界的临床环境中有效使用循证实践可能具有挑战性。我们认为，护士在实施这些做法中发挥关键作用，特别是旨在预防医疗保健相关感染的做法。导尿管相关性尿路感染是美国最常见的与医疗保健相关的感染，是一种代价高昂且可能致命的疾病。密歇根州正在启动一项雄心勃勃的患者安全项目，以减轻与留置导尿相关的疾病负担。本研究的首要目标是确定和制定战略，以优化患者安全和卫生保健相关感染预防领域关键实践的实施。本研究有三个目的：1)描述作为密歇根州范围内患者安全倡议的一部分，导管相关尿路感染预防捆绑包（膀胱捆绑包）的采用和实施，并评估患者的结果，如导管使用率和感染率；2)确定并比较在不同医院群体中实施膀胱包的障碍和促进因素；3)制定和评估策略，以促进膀胱束的实施，并评估患者的结果，包括导管的使用、停置、重新插入和感染率。这项调查包括定量和定性数据的收集和分析。我们已经组建了一个跨学科的团队，他们已经在之前的一项研究中成功地合作，来开展这个及时而创新的患者安全项目。为了第一个目的，我们将使用调查方法来描述膀胱束的推广、采用和实施以及关键的患者结果。对于第二个目标，我们将主要使用定性方法，包括电话访谈和现场访问。这种方法将允许我们更深入地检查作为实现膀胱包的促进者或障碍的复杂组织因素。我们还将制定实施战略和工具，然后与正在实施膀胱一揽子计划的三家医院合作对其进行评估。对于第三个目标，我们建议在实施干预之前，期间和之后收集定性数据，以便进行形成性评估，包括对实施过程，成就和可持续性的评估。我们还将收集患者预后的定量数据，如导管使用、停药和感染率。公共卫生相关性：导尿管相关性尿路感染是一种常见、昂贵且具有潜在致命性的疾病。本研究的目的是开发有助于预防导尿管相关性尿路感染的方法。我们的研究还将提供如何预防其他医疗相关感染的见解，从而创建一个更安全的医疗保健系统。

项目成果

Is the use of antimicrobial devices to prevent infection correlated across different healthcare-associated infections? Results from a national survey.

使用抗菌设备预防感染是否与不同的医疗保健相关感染相关？

• DOI: 10.1086/671269
• 发表时间: 2013
• 期刊: Infection control and hospital epidemiology
• 影响因子: 4.5
• 作者: Saint,Sanjay;Greene,MTodd;Damschroder,Laura;Krein,SarahL
• 通讯作者: Krein,SarahL

Introducing a catheter-associated urinary tract infection (CAUTI) prevention guide to patient safety (GPS).

介绍导管相关尿路感染 (CAUTI) 患者安全预防指南 (GPS)。

• DOI: 10.1016/j.ajic.2013.12.019
• 发表时间: 2014
• 期刊: American journal of infection control
• 影响因子: 4.9
• 作者: Saint,Sanjay;Gaies,Elissa;Fowler,KarenE;Harrod,Molly;Krein,SarahL
• 通讯作者: Krein,SarahL

Variations in risk perceptions: a qualitative study of why unnecessary urinary catheter use continues to be problematic.

• DOI: 10.1186/1472-6963-13-151
• 发表时间: 2013-04-26
• 期刊: BMC health services research
• 影响因子: 2.8
• 作者: Harrod M;Kowalski CP;Saint S;Forman J;Krein SL
• 通讯作者: Krein SL

Perceived strength of evidence supporting practices to prevent health care-associated infection: results from a national survey of infection prevention personnel.

支持预防卫生保健相关感染的实践的证据强度：来自全国感染预防人员调查的结果。

• DOI: 10.1016/j.ajic.2012.10.007
• 发表时间: 2013
• 期刊: American journal of infection control
• 影响因子: 4.9
• 作者: Saint,Sanjay;Greene,MTodd;Olmsted,RussellN;Chopra,Vineet;Meddings,Jennifer;Safdar,Nasia;Krein,SarahL
• 通讯作者: Krein,SarahL