Emergency Department Catheter-Associated Urinary Tract Infection Prevention: Multisite Qualitative Study of Perceived Risks and Implemented Strategies.

BACKGROUND: Existing knowledge of emergency department (ED) catheter-associated urinary tract infection (CAUTI) prevention is limited. We aimed to describe the motivations, perceived risks for CAUTI acquisition, and strategies used to address CAUTI risk among EDs that had existing CAUTI prevention programs. METHODS: In this qualitative comparative case study, we enrolled early-adopting EDs, that is, those using criteria for urinary catheter placement and tracking the frequency of catheters placed in the ED. At 6 diverse facilities, we conducted 52 semistructured interviews and 9 focus groups with hospital and ED participants. RESULTS: All ED CAUTI programs originated from a hospitalwide focus on CAUTI prevention. Staff were motivated to address CAUTI because they believed program compliance improved patient care. ED CAUTI prevention was perceived to differ from CAUTI prevention in the inpatient setting. To identify areas of ED CAUTI prevention focus, programs examined ED workflow and identified 4 CAUTI risks: (1) inappropriate reasons for urinary catheter placement; (2) physicians' limited involvement in placement decisions; (3) patterns of urinary catheter overuse; and (4) poor insertion technique. Programs redesigned workflow to address risks by (1) requiring staff to specify the medical reason for catheter at the point of order entry and placement; (2) making physicians responsible for determining catheter use; (3) using catheter alternatives to address patterns of overuse; and (4) modifying urinary catheter insertion practices to ensure proper placement. CONCLUSIONS: Early-adopting EDs redesigned workflow to minimize catheter use and ensure proper insertion technique. Assessment of ED workflow is necessary to identify and modify local practices that may increase CAUTI risk.

Lack of Patient Understanding of Hospital-Acquired Infection Data Published on the Centers for Medicare and Medicaid Services Hospital Compare Website.

BACKGROUND: Public reporting of hospital quality data is a key element of US healthcare reform. Data for hospital-acquired infections (HAIs) are especially complex. OBJECTIVE: To assess interpretability of HAI data as presented on the Centers for Medicare and Medicaid Services Hospital Compare website among patients who might benefit from access to these data. METHODS: We randomly selected inpatients at a large tertiary referral hospital from June to September 2014. Participants performed 4 distinct tasks comparing hypothetical HAI data for 2 hospitals, and the accuracy of their comparisons was assessed. Data were presented using the same tabular formats used by Centers for Medicare and Medicaid Services. Demographic characteristics and healthcare experience data were also collected. RESULTS: Participants (N=110) correctly identified the better of 2 hospitals when given written descriptions of the HAI measure in 72% of the responses (95% CI, 66%-79%). Adding the underlying numerical data (number of infections, patient-time, and standardized infection ratio) to the written descriptions reduced correct responses to 60% (55%-66%). When the written HAI measure description was not informative (identical for both hospitals), 50% answered correctly (42%-58%). When no written HAI measure description was provided and hospitals differed by denominator for infection rate, 38% answered correctly (31%-45%). CONCLUSIONS: Current public HAI data presentation methods may be inadequate. When presented with numeric HAI data, study participants incorrectly compared hospitals on the basis of HAI data in more than 40% of the responses. Research is needed to identify better ways to convey these data to the public.

Patients' perspectives on timing of urinary catheter removal after surgery.

UNLABELLED: A prolonged catheter duration is a major risk factor for catheter-associated urinary tract infection, with bacteriuria increasing by 5% per day (Gokula et al, 2004). AIM: In this study, the authors explored patients' perceptions of the care process relating to peri-operative catheterisation to identify patient factors that encourage early removal. METHOD: Semi-structured interviews, incorporating a grounded theory approach, were performed on three men and seven women during 2010. Interviews were transcribed and analysed using constant comparative method and thematic framework analysis. RESULTS: Catheter duration ranged 1-10 days. Main themes elicited included: lack of understanding of the purpose and catheterisation process; loss of patient autonomy and dignity; and impact of environmental factors. CONCLUSION: Lack of knowledge of the catheterisation process among participants led to fears and concerns that may have contributed to delayed catheter removal. Changes to patient care that are likely to reduce catheter duration include ensuring the provision of pre-operative information, greater patient involvement in catheter removal decisions, and provision of easily accessible toilet facilities.