Improving Indwelling Catheter Use to Reduce CAUTI in the Nursing Home

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DESCRIPTION (provided by applicant): The leading type of infection in nursing homes (NHs) is urinary tract infection, and catheter-associated urinary tract infection (CAUTI) is the most common type of health care-associated infection in this setting. Approximately 1.5 million Americans currently reside in nearly 16,000 NHs across the United States, where the prevalence of indwelling catheterization exceeds 12% at the time of admission. Our efforts will center on preventing CAUTI by optimizing the use of urinary catheters, with a particular emphasis on continual assessment and catheter removal as soon as possible, as encouraged in the Healthcare Infection Control Practices Advisory Committee Guideline for Prevention of CAUTI 2009. We propose a project with the following aims: (1) To identify NH population and NH organizational and cultural characteristics associated with indwelling urethral catheter use among: (a) newly admitted NH residents (a "present on admission" catheter group); and (b) NH residents in whom indwelling catheters are placed within 14 days following admission to the facility (an "early placement" post-admission catheter group); (2) To identify NH population and NH organizational and cultural characteristics associated with duration of use of the indwelling catheter, among NH residents identified in Aim 1. In addition, we will examine the adequacy of prior clinical information available relevant to the presence of, or subsequent need for, the catheter, and its relation to duration of use; (3) To assess current catheter management practices within study NHs, and to assess knowledge of principles of indwelling catheter use, attitudes regarding the use of catheters, and perceived barriers to implementation of appropriate catheter management strategies and practices; (4) Guided by information derived under Aims 1-3, to produce an adaptable toolkit including evidence-based practices that can be tailored to key audiences, stakeholders and organizational conditions relevant to the NH setting; (5) To evaluate the toolkit, with an assessment of its Reach, Effectiveness, Adoption, and Implementation (components of the RE-AIM model) using a block cluster randomized design at the NH level. This project has received the endorsement of The Joint Commission.