Improving Indwelling Catheter Use to Reduce CAUTI in the Nursing Home

描述（由申请人提供）：养老院（NHs）的主要感染类型是尿路感染，导尿管相关性尿路感染（CAUTI）是最常见的卫生保健相关感染类型。目前大约有150万美国人居住在美国近16,000个NHs中，其中留置导尿的患病率在入院时超过12%。我们的工作将集中在通过优化导尿管的使用来预防CAUTI，特别强调持续评估和尽快拔除导尿管，正如2009年医疗感染控制实践咨询委员会预防CAUTI指南所鼓励的那样。我们提出了一个具有以下目标的项目：(1)确定与留置导尿管使用相关的NH人口和NH组织和文化特征：(a)新入院的NH居民（“入院时”留置导尿管组）；(b)入院后14天内放置留置导尿管的NH居民（入院后“早期放置”导尿管组）；(2)在Aim 1中确定的NH居民中，确定与留置导管使用时间相关的NH人口和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先前临床信息的充分性及其与使用时间的关系；(3)评估研究NHs内当前的导管管理实践，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)以目标1-3所衍生的信息为指导，制作适应性工具包，包括可针对关键受众、利益相关者和与NH环境相关的组织条件量身定制的循证实践；(5)使用NH水平的块聚类随机设计评估该工具包，评估其覆盖范围、有效性、采用和实施（RE-AIM模型的组成部分）。该项目已得到联合委员会的赞同。

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. PUBLIC HEALTH RELEVANCE: Improving Indwelling Catheter Use to Reduce CAUTI in the Nursing Home Setting The leading type of infection in nursing homes is urinary tract infection, and catheter-associated urinary tract infection (CAUTI) is the most common type of health care-associated infection (HAI) in this setting. While the HHS Action Plan to Prevent Healthcare-Associated Infections included catheter-associated urinary tract infections (CAUTIs) as one of six high priority HAI-related areas, its implementation focus was limited to the acute care hospital setting. We propose to extend the focus on CAUTI beyond the hospital to the long-term care setting.