Nurse-Sensitive Indicators as Predictors of Trauma Patient Discharge Disposition.

BACKGROUND: About 3.5 million trauma patients are hospitalized every year, but 35%-40% require further care after discharge. Nurses' ability to affect discharge disposition by minimizing the occurrence of nurse-sensitive indicators (catheter-associated urinary tract infection [CAUTI], central line-associated bloodstream infection [CLABSI], and hospital-acquired pressure injury [HAPI]) is unknown. These indicators may serve as surrogate measures of quality nursing care. OBJECTIVE: The purpose of this study was to determine whether nursing care, as represented by three nurse-sensitive indicators (CAUTI, CLABSI, and HAPI), predicts discharge disposition in trauma patients. METHODS: This study was a secondary analysis of the 2021 National Trauma Data Bank. We performed logistic regression analyses to determine the predictive effects of CAUTI, CLABSI, and HAPI on discharge disposition, controlling for participant characteristics. RESULTS: A total of n = 29,642 patients were included, of which n = 21,469 (72%) were male, n = 16,404 (64%) were White, with a mean (SD) age of 44 (14.5) and mean (SD) Injury Severity Score of 23.2 (12.5). We created four models to test nurse-sensitive indicators, both individually and compositely, as predictors. While CAUTI and HAPI increased the odds of discharge to further care by 1.4-1.5 and 2.1 times, respectively, CLABSI was not a statistically significant predictor. CONCLUSIONS: Both CAUTI and HAPI are statistically significant predictors of discharge to further care for patients after traumatic injury. High-quality nursing care to prevent iatrogenic complications can improve trauma patients' long-term outcomes.

Preventing Catheter-Associated Urinary Tract Infections with Incontinence Management Alternatives: PureWick and Condom Catheter.

Catheter-associated urinary tract infections (CAUTI) have a high financial and human impact on patients and society at large, making CAUTI prevention strategies essential. A shift has occurred where nurses play an increased role in infection prevention. Nurses promote staff and patient education on CAUTI prevention, identification of appropriate urinary incontinence management, and implementation of bundles and patient care strategies to minimize complications from urinary incontinence management. Because they understand the severity of CAUTI and current recommendations, nurses at the bedside are in the best position to identify appropriate indications of indwelling urinary catheters and external urine collection devices for patients.

The management of urinary tract infections in older patients within an urgent care out-of-hours setting.

This article critically analyses the prevalence, assessment and management of urinary tract infections (UTIs) in patients over the age of 65, in an urgent care out-of-hours service in order to enhance care. It is undertaken from the perspective of working as an Advanced Nurse Practitioner (ANP). A synopsis of UTI is presented, examining the epidemiology and aetiology. The process of assessment, diagnosis and management of UTI in older people is appraised based on current evidence. Difficulties associated with the recognition of UTI in elderly are evaluated. Finally, recommendations are made for the improvement of future practice as an ANP.

Understanding the most commonly billed diagnoses in primary care: Urinary tract infections.

This article, one of 12 in a series on most commonly billed diagnoses in primary care, provides a comprehensive overview of the pathophysiologic processes related to urinary tract infections (UTIs). The clinical manifestations, diagnostic tests, treatments, and billing codes associated with UTIs will be described.

Preventing Catheter-Associated Urinary Tract Infection: A Multipronged Collaborative Approach.

BACKGROUND: Research has shown that catheter-associated urinary tract infections (CAUTIs) are highly preventable and have significant impact on patient morbidity and mortality as well as financial consequences for the health care system. LOCAL: CAUTI rates were documented to be higher in the general internal medicine units when compared with the overall hospital rates. METHODS: A comparative analysis was undertaken. INTERVENTION: An interprofessional working group developed and implemented a quality improvement initiative bundled approach to reducing CAUTIs. RESULTS: There was a 79% reduction in average CAUTI rates following the bundle implementation along with reduced variability in rates. CONCLUSIONS: Implementation of a standardized bundle of practices aimed at reducing CAUTIs resulted in decreased CAUTI rates. Organizations can use the design and implementation approach to reduce and minimize CAUTI rates, which can positively impact cost, care experience, and outcomes.

Benefits of nurse-led continence prescription services for effective stock management and streamlined prescribing.

The UK has an ageing population, and with continence-related issues expected to rise, there will be increasing demands for specialist input within nurse-led continence prescription services. Continence nurse specialists can apply expert product knowledge to ensure patients are prescribed bladder and bowel appliances that are of high quality, the most appropriate product for the patient and also cost effective. The management of catheter drainage and fixation supplies can be challenging, particularly for services managing caseloads of multiple patients living with catheters. Ugo 4 Weeks has been created to help streamline the process of ordering continence products and reducing appliance wastage for catheterised patients living in the community setting. Each box provides a 4-week supply of catheter drainage and fixation supplies and can be prescribed on a single prescription. It enables better control over stock levels, reducing the risk of accidental over-ordering and stockpiling, thereby generating significant cost savings.

Patologias urologicas asociadas a paralisis cerebral. El rol de la enfermera / Cerebral palsy associated urological pathologies. Nurse's role

Objetivos: Los objetivos de este estudio fueron: analizar las causas de consulta urológica del niño con Parálisis Cerebral (PC), analizar el rol de enfermería en el cuidado urológico de niños con PC referidos a Urología, y conocer la relación entre la infección urinaria del niño con PC y su grado de independencia. Material y método: Estudio observacional analítico retrospectivo en base a la revisión del expediente clínico de pacientes con diagnóstico de parálisis cerebral. Se incluyeron en el estudio a 47 pacientes seleccionados mediante aleatorización simple en un rango de edad de 2 a 16 años en una clínica de atención ambulatoria para pacientes con PC, ubicada en una población del norte de México. Resultados: Las causas de consulta urológica del niño con PC, referidos por enfermería fueron: infección urinaria, fimosis, testículo retráctil, criptorquidia, hipogonadismo, vejiga hiperactiva, e hipospadias. La relación entre la infección urinaria del niño con PC y su grado de independencia se estableció con el nivel de control de esfínter urinario. Conclusiones: El personal de enfermería es factor clave y decisivo en el diagnóstico, referencia temprana para tratamiento y vigilancia de la evolución de los trastornos urinarios en niños con PC. No está indicado iniciar un programa de control de esfínteres en niños con PC, sin haber descartado antes una infección urinaria

Objectives: The objectives of this study were: To analyze the causes of urological consultation of the child with CP, to analyze the role of nursing in the urological care of children with CP referred to Urology, and to know the relationship between the child’s urinary tract infection and CP and its degree of independence. Method: Retrospective analytical observational study based on the review of the clinical records of patients diagnosed with cerebral palsy. Forty-seven patients selected by simple randomization in an age range of 2 to 16 years were included in the study in an outpatient clinic for CP patients located in a town in northern Mexico. Results: The causes of urological consultation of the child with CP, referred by nursing were: urinary infection, phimosis, retractable testicle, cryptorchidism, hypogonadism, overactive bladder, and hypospadias. The relationship between the urinary infection of the child with CP and its degree of independence was established with the level of urinary sphincter control. Conclusions: The nursing staff is a key and decisive factor in the diagnosis, early reference for treatment and monitoring of the evolution of urinary disorders in children with CP. It is not indicated to start a toilet training program in children with CP, without having previously ruled out a urinary tract infection

Variations in indwelling urinary catheter use in four Australian acute care hospitals.

AIMS AND OBJECTIVES: To identify the point prevalence of indwelling urinary catheters (IDCs) in adult inpatients in acute care hospitals, and to describe the indications for IDC insertion based on patient age, gender, specialty and hospital. BACKGROUND: Catheter-associated urinary tract infections (CAUTIs) are preventable healthcare-associated infections. IDC duration is the strongest predictor of CAUTI, and little is known about characteristics of patients who receive an IDC. DESIGN: Two single-day point prevalence surveys collected baseline patient data as part of a larger pre-post control-intervention study. METHODS: Surveys were conducted at four acute care hospitals in NSW, Australia, for all adult patients. Data collection included IDC presence, insertion details and urine culture collection. Point prevalence data were linked with electronically extracted patient demographic data. This study is presented in line with STROBE checklist (See Supplementary File 1). RESULT: Data from 1,630 patients were analysed, with 196 patients (12%) identified as having an IDC on the survey dates. IDC prevalence rates were higher in males (13%) than in females (11%). Critical care had the highest rate of patients with IDCs (42%). Urine cultures were collected in 70 patients with an IDC (43%). CONCLUSIONS: Findings indicated similar rates of IDC use in males and females, and there was no significant difference in age between patients with or without an IDC. However, indication for IDC varied by patient age and gender. High rates of urine culture collection may represent routine collection. RELEVANCE TO CLINICAL PRACTICE: IDC use is found across genders, all age groups and specialties. Nurses should be aware that any of their patients may have an IDC and be particularly aware of certain indications based on patient age and gender. Routine urine culture collection is not advised, and instead, nurses should be guided by clinical decision-making tools.

Navel to Knees With Chlorhexidine Gluconate: Preventing Catheter-Associated Urinary Tract Infections.

Urinary tract infections are the most common type of health care-associated infection, and greater than 75% of them are attributed to an indwelling urinary catheter. A catheter-associated urinary infection may lead to a longer hospital length of stay by as many as 4 days. A new patient care standard requiring twice-daily chlorhexidine cleansing from umbilicus to knees was implemented on all patients of the pilot unit with a urinary catheter. This same technique was used after a patient with a urinary catheter had an incontinent bowel movement. The 9-month average catheter-associated urinary infection rate decreased from 3.06/1000 urinary catheter days to 0.46/1000 urinary catheter days after implementation of the new standard. The use of chlorhexidine for routine urinary catheter care and after bowel movements from umbilicus to knees for patients with urinary catheters may significantly decrease catheter-associated urinary tract infections when compared with the standard of care using soap and water. Standards for Quality Improvement Reporting Excellence guidelines were used in reporting these data.

Gestión de calidad en el prenatal: atención a las infecciones urinarias en un municipio de la Amazonia Legal / Gestão da qualidade no pré-natal: atenção às infecções urinárias em um município da Amazônia Legal / Quality management in pre-natal care: urinary infections care in a municipality of the Legal Amazon

Objetivo: evaluar efectos del ciclo de mejora de la calidad en la prevención y manejo de las infecciones urinarias gestacionales. Método: se trata de un estudio cuantitativo, con delineamiento casi experimental, tipo antes y después, sin grupo control, realizado en Cacoal / RO, entre marzo de 2015 y febrero de 2016. Se aplicó un ciclo externo de mejora de la calidad para la prevención y manejo de las infecciones urinarias en el prenatal. Esto ocurrió con evaluaciones de cinco criterios de calidad. Resultados: la mayoría de los criterios presentaron p <0,001, excepto el criterio 1. Los criterios 1, 2 y 4 alcanzaron un porcentaje superior al 65% en los saludos. El criterio 3, a pesar de haber alcanzado el 30% de mejora absoluta, aún no alcanzó el 50% de cumplimiento. En el criterio 5, se deduce que el 10,8% de la muestra constaba de los resultados de exámenes de orina alterados, de las cuales 53% tenían registro de tratamiento adecuado. Conclusiones: la metodología empleada con el ciclo externo de la mejora de la calidad colaboró en el remodelamiento de los procesos asistenciales del prenatal, en la integración entre los equipos de trabajo, fortaleciendo la cogestión y la coparticipación de los trabajadores en los procesos de gestión. Posibilitó reflexiones acerca de los flujogramas vigentes, mejorando el acceso de las gestantes a los servicios de salud ya la calidad asistencial

Objetivo: avaliar efeitos do ciclo de melhoria da qualidade na prevenção e manejo das infecções urinárias gestacionais. Método: trata-se de um estudo quantitativo, com delineamento quase-experimental, tipo antes e depois, sem grupo controle, realizado em Cacoal/RO, entre março de 2015 e fevereiro de 2016. Aplicou-se um ciclo externo de melhoria da qualidade para a prevenção e manejo das infecções urinárias no pré-natal. Este ocorreu com avaliações de cinco critérios de qualidade. Resultados: a maioria dos critérios apresentaram p<0,001, exceto o critério 1. Os critérios 1, 2 e 4 alcançaram percentual acima de 65% nos cumprimentos. O critério 3, apesar de ter alcançado 30% de melhoria absoluta, ainda não atingiu 50% de cumprimento. No critério 5, inferiu-se que 10,8% da amostra constava os resultados de exames de urina alterados, destas 53% tinham registro de tratamento adequado. Conclusões: a metodologia empregada com o ciclo externo da melhoria da qualidade colaborou no remodelamento dos processos assistenciais do pré-natal, na integração entre as equipes de trabalho, fortalecendo a cogestão e a coparticipação dos trabalhadores nos processos de gestão. Possibilitou reflexões acerca dos fluxogramas vigentes, o que refletiu na melhoria do acesso das gestantes aos serviços de saúde e à qualidade assistencial

Objective: to evaluate the effects of a quality improvement cycle in the prevention and management of UTI during pre-natal. Methodology: this is a quantitative study with partly completed experimental design type before and after, with no control group, carried out in Cacoal/RO between March 2015 and February 2016. An external quality improvement cycle was applied for the prevention and management of pre-natal urinary infections. This occurred with evaluations of five quality criteria. Results: multi-variate analysis of quality improvement, it was observed that most of the criteria of statistical significance (p> 0.001), except criterion 1 which showed a p lower than expected. The criteria 1, 2 and 4 achieved a percentage above 65% compliance in both the samples. With respect to criterion 5, it can be inferred that 10.8% of the analyzed sample contained record examination results EQU and/or altered urine culture, and of these 53% had adequate treatment record. Conclusion: the methodology used to improve the quality of the external cycle collaborated in the remodeling of the care processes of pre-natal and especially in the integration between care teams and managers of different levels of complexity worked, strengthening co-management and co-participation of workers involved directly in care for users in the municipal health management processes. It has also enabled reflections on the existing flowcharts, providing the re-design of the same as reflected in improving access of pregnant women to health services and quality care

ATOUM 6: does a multimodal intervention involving nurses reduce the use of antibiotics in French nursing homes?: A protocol for a cluster randomized study.

INTRODUCTION: Urinary tract infection (UTI) is common in elderly living in nursing homes, and antibiotics prescription for this infection is particularly challenging. In these facilities, due to the absence of on-site physicians, nurses play an essential role when an infection is suspected, as they are the ones who collect and communicate by phone all the information needed by the physician for the decision-making process. In that context, our study aims to reduce antibiotic consumption in nursing homes, using a multimodal intervention, by strengthening nurses' involvement during the process of prescription for UTI. METHODS/DESIGN: This is a planned 2-arm cluster randomized study of 40 nursing homes randomly assigned either to the control group or to the intervention group, using a 1:1 ratio. The intervention consists of reinforcing the nurses' knowledge concerning antibiotics and UTI; assist their clinical judgment using a decision aid diagram; improving their communication skills with the residents, their relatives, and the prescribers; and also increasing their involvement in the intervention' process by organizing a competition opposing the nursing homes of the interventional group to select additional intervention tools. ANALYSIS: The main outcome is the reduction of the relative frequency of antibiotics prescription for UTIs in the interventional group. ETHICS AND DISSEMINATION: Ethics approval was obtained from the French Committee for the Protection of Persons (N. 19.01.04/SI CNRIPH 18.12.07.48123). An article including the main outcome will be submitted to a peer review journal.

Risk factors for hospital-acquired non-catheter-associated urinary tract infection.

BACKGROUND AND PURPOSE: Nosocomial urinary tract infection in patients with no Foley catheter [non-catheter-associated urinary tract infection (non-CAUTI)] has been a serious health issue that is associated with an increase in the cost of care, morbidity, and mortality. Identifying the risk factors of non-CAUTI would help determine patients at high risk and prevent complications. This study aims to identify the risk factors of non-CAUTI. METHOD: This study was conducted in four hospitals in three Middle Eastern countries: Jordan, Qatar, and Saudi Arabia. A convenience sample of 189 participants was recruited, of which 83 had non-CAUTI. Case-control design was used. Patients who had non-CAUTI while hospitalized were compared with others who did not. A questionnaire was developed based on the non-CAUTI diagnostic criteria from the Centers for Disease Control and Prevention. The questionnaire contained two parts: part one included participants' characteristics and part two assessed the symptoms of non-CAUTI. CONCLUSION: Comorbidity is associated with a higher risk of having nosocomial non-CAUTI among hospitalized patients. This study showed that the diagnosis and management of comorbidity is important in lowering the risk of non-CAUTI in hospitalized patients. Age and antibiotic administration were statistically significant; however, their effects were small and were unlikely to have any clinical significance. IMPLICATION FOR PRACTICE: Identifying patients at high risk is imperative to prevent the development of non-CAUTI. Nurse practitioners may implement an early intervention for patients with comorbidity to counteract its effect on patients' health.

Alternative to antibiotics for managing asymptomatic and non-symptomatic bacteriuria in older persons: a review.

Recurrent urinary tract infection (UTI) is one of the most common reasons for long-term antibiotic use in frail older people, and these individuals often have non-symptomatic bacteriuria. This article reviews the literature and recommendations for the treatment of UTIs particularly in the older population (>65 years). It considers the question: is there an alternative for antibiotics for asymptomatic and non-symptomatic bacteriuria in older adults? D-mannose powder has been recommended for the treatment of UTIs, as when applied locally, it reduces the adherence of Escherichia coli. In one study, D-mannose was reviewed for the prophylaxis of recurrent UTIs in women, and the findings indicated that it may be useful for UTI prevention instead of prophylactic antibiotics. There is a lack of information about the efficacy of cranberry products combined with D-mannose in this regard, and this is an area for further research.

Does treatment of urinary tract infections reflect the antibiotic stewardship program guidelines?

Protocols are required for antibiotic use for treatment of urinary tract infections (UTIs) in long-term care facilities (LTCFs). This project assessed antibiotic prescribing practices for UTI in three LTCFs to elucidate practice and its relationship to protocols in these settings. A retrospective chart review of UTI cases occurring between February 1, 2017, and July 30, 2017, was conducted to describe provider management in three LTCFs. Sixty-three cases with compelling urinary symptoms potentially suggestive of UTI were included in the review. Urine culture findings indicated that a more than 100,000 CFU/ml colony count was present in 46% (n = 29) of the cases; however, 63.5% (n = 40) of the cases received antibiotics. Eleven cases (17.4%) received antibiotics based on symptoms without UTI diagnosis. Empirical treatment was initiated in 35% (n = 22) of the cases. When urine culture reports were available, previously untreated 28.57% (n = 18) cases received antibiotics for colony counts of >100,000 CFU/ml. Antibiotics were given for colony counts of <100,000 CFU/ml for 17.46% (n = 11) of the cases. Increased urinary frequency or burning on urination (95.23%) and change in behavior (88.9%) were the primary reasons for initiation of urinalysis and urine culture testing. Nurse practitioner implementation of protocols for antibiotic stewardship programs in LTCFs can prevent overprescription for UTI in these facilities.

The CAUTI Prevention Tool Kit: A Professional Practice and Collaborative Project of the Wound, Ostomy and Continence Nurses Society.

In order to address the need for a tool to support hospital-based nurses in catheter-associated urinary tract infection (CAUTI) prevention, the American Nurses Association (ANA) was asked to convene a Technical Expert Panel of stakeholders in CAUTI prevention. The Technical Expert Panel was chaired by the ANA's Senior Policy Fellow, a certified wound, ostomy and continence (WOC) nurse. The panel comprised 23 representatives, including nurses from specialty practice organizations, nursing affiliated with the ANA, infection control specialists, patient safety authorities, award-winning hospitals using the National Database of Nursing Quality Indicators, and content experts. The Wound, Ostomy and Continence Society appointed 2 representatives to this panel, a key nurse researcher with expertise in this area of care and a former Society President. The CAUTI Prevention Tool Kit, combined with supplemental guidance documents developed, supports WOC nurses and Society members in achieving quality clinical outcomes for their patients.