Improving Indwelling Catheter Use to Reduce CAUTI in the Nursing Home

描述（由申请人提供）：疗养院（NH）感染的主要类型是尿路感染，导管相关性尿路感染（CANTITI）是该环境中最常见的医疗保健相关感染类型。目前，大约有150万美国人居住在美国近16，000个NH中，其中住院时留置导管插入术的流行率超过12%。我们的努力将集中在通过优化导尿管的使用来预防尿路感染，特别强调持续评估和尽快移除导管，这是医疗保健感染控制实践咨询委员会2009年预防尿路感染指南中所鼓励的。我们提出了一个项目，其目的如下：（1）确定NH人口和NH组织和文化特征与留置导尿管的使用之间的关系：（a）新入院的NH居民（a“入院时在场”导管组）;和（B）入院后14天内放置留置导管的NH居民（“早期放置”入院后导管组）;（2）在目标1中确定的NH居民中，确定NH人群以及与留置导管使用时间相关的NH组织和文化特征。此外，我们将检查与导管存在或后续需要相关的既往临床信息的充分性及其与使用持续时间的关系;（3）评估研究NH中当前的导管管理实践，并评估留置导管使用原则的知识，对导管使用的态度，以及实施适当导管管理策略和实践的感知障碍;（4）以根据目标1-3获得的信息为指导，制作一个可调整的工具包，其中包括可针对主要受众的循证做法，与NH设置相关的利益相关者和组织条件;（5）评估工具包，使用NH水平的区组聚类随机设计评估其覆盖范围，有效性，采用和实施（RE-AIM模型的组成部分）。该项目得到了联合委员会的认可。

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.