Improving Indwelling Catheter Use to Reduce CAUTI in the Nursing Home

描述(由申请人提供)：疗养院(NHS)的主要感染类型是尿路感染，而导管相关性尿路感染(CAUTI)是这种环境中最常见的卫生保健相关感染类型。目前约有150万美国人居住在全美近16,000家NHS中，在那里，留置导尿术的流行率在入院时超过了12%。我们的努力将集中于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，这是医疗感染控制实践咨询委员会2009年CAUTI预防指南所鼓励的。我们提出了一个有以下目标的项目：(1)在以下人群中确定与留置尿管有关的NH人群和NH的组织和文化特征：(A)新入院的NH患者(入院时在场的导尿管组)；以及(B)入院后14天内放置导尿管的NH患者(入院后早期放置导尿管组)；(2)在目标1中确定的NH居民中，确定与留置导管使用时间相关的NH人群和NH组织和文化特征。此外，我们将检查与存在或随后需要导管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内当前的导管管理做法，并评估对留置导管使用原则、对使用导管的态度的了解，以及实施适当的导管管理策略和做法的可感知的障碍；(4)以AIMS 1-3项下提供的信息为指导，编制一套适应性强的工具包，其中包括循证做法，这些做法可针对主要受众、利益攸关方和与NH环境相关的组织条件而量身定做；(5)在NH一级采用区块组群随机设计，评估工具包的覆盖范围、有效性、采用率和实施情况(RE-AIM模式的组成部分)。该项目已得到联合委员会的认可。

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.