Effectiveness of a bundled approach to reduce urinary catheters and infection rates in trauma patients.

BACKGROUND: Catheter-associated urinary tract infections (CAUTIs) are common nosocomial infections. In 2015, the Centers for Medicare and Medicaid Services began imposing financial penalties for institutions where CAUTI rates are higher than predicted. However, the surveillance definition for CAUTI is not a clinical diagnosis and may represent asymptomatic bacteriuria. The objective of this study was to compare rates of urinary catheterization and CAUTI before and after the implementation of a bundled intervention. METHODS: This retrospective review evaluated trauma patients from January 2013-January 2015. The bundled intervention optimized the urinary catheterization process and culturing practices to reduce false positives. The CAUTI rate was defined as a positive surveillance CAUTI divided by total catheter days multiplied by 1,000 days. RESULTS: A total of 6,236 patients were included (pre: n = 5,003; post: n = 1,233). Fewer patients in the post bundle group received a urinary catheter (pre: 25% vs post: 16%; P < .001). After bundle implementation, the CAUTI rate reduced over one third (pre: 4.07 vs post: 2.56; incidence rate ratio, 0.63; 95% confidence interval, 0.19-2.07). CONCLUSIONS: Although the number of patients exposed to urinary catheters and catheter days was decreased, optimization of culturing practices was essential to prevent the CAUTI rate from increasing from a reduced denominator. Implementation of a CAUTI prevention bundle works synergistically to improve patient safety and hospital performance.

Transmission-based contact precautions for multidrug-resistant organisms in trauma patients: fewer days in isolation with no increase in hospital-associated infections.

BACKGROUND: Our hospital transitioned from routine to selective contact isolation of patients based not on history or diagnosis of multidrug-resistant organisms (MDROs) but rather on the likelihood the patient was soiling their environment. We hypothesized that the change to true transmission-based contact isolation would not be associated with an increase in hospital-associated infections with MDROs. METHODS: We performed a retrospective study of trauma admissions during two periods: the first period (March to August 2011, PRE group) before and the second period (March to August 2012, POST group) after implementation of the new transmission-based contact isolation guidelines. We compared the PRE and POST groups for admission demographics and physiology as well as mechanism and severity of injury. The primary outcome was the number of patients placed in contact isolation. RESULTS: There were 1,465 and 1,617 trauma admissions during the PRE and POST periods, respectively. The PRE and POST groups were similar for age, sex, admission physiology, mechanism of injury, and injury severity. Overall, 3.3% (n = 49) of the patients in the PRE group were placed in contact isolation as compared with 1.7% (n = 25) in the POST group (p = 0.001). More than double the number of patient days were spent in isolation in the PRE period than the POST period (3.8% [n = 246 days] vs. 1.7% [n = 131 days], p < 0.001). There was no difference between the PRE and POST groups in the rates of developing hospital-acquired MDRO infections (0.2% [n = 3] vs. 0.2% [n = 4], p = 0.99). CONCLUSION: Transitioning from routine MDRO contact precautions to transmission-based MDRO contact precautions can reduce the number of trauma patients requiring isolation without an increase in hospital-acquired MDRO infections. LEVEL OF EVIDENCE: Therapeutic/care management, level IV.

"Take time. Save lives. Clean hands protect." A comparison of two hand hygiene health promotion posters.

Two posters were designed to encourage hospital staff hand hygiene. One focused on broad benefits of hand hygiene to patients and staff, and the other highlighted hand hygiene as a long-known measure to infection control. The former was better received in terms of attention, likability, and potential to promote hand hygiene. A third-person effect, the perception of stronger impact of communication messages on others, was observed. Implications on health promotion message design were discussed.