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. 2013 Summer;21(2):79-82.
doi: 10.1177/229255031302100205.

Catheter use and infection reduction in plastic surgery

Zach J Barnes  1 , Raman C Mahabir  1
Affiliations

Catheter use and infection reduction in plastic surgery

Zach J Barnes et al. Can J Plast Surg. 2013 Summer.

Abstract
in English, French

Background: Catheter-associated urinary tract infections (CAUTI) are the most common hospital-associated infection and can result in increased health care costs, morbidity and even mortality. In 2009, The Scott & White Memorial Hospital/Texas A&M Health Science Center (Texas, USA) system's CAUTI rate placed it in the upper quartile (ie, highest rate) for the country, necessitating a system-wide change.

Objective: To design and implement a guideline to reduce the incidence of CAUTI.

Methods: A multidisciplinary team was formed and completed both a root cause analysis and a review of the available literature. Consolidating the best evidence, the team formulated a best practice guideline detailing the proper indications for insertion of, improper use of and techniques to minimize infection with catheters. Included as part of this protocol was nursing and patient education, changes in identifying patients with a catheter and automatic termination orders. Three-, six- and 12-month reviews identifying additional opportunities for improvement at the end of 2010 were completed.

Results: In 2009, the hospital's CAUTI rate was 1.46 per 1000 catheter days. In 2011 - the first complete year of the finalized guideline - the hospital's CAUTI rate was 0.52 per 1000 catheter days, ranking the institution in the bottom quartile (ie, lowest rate) for the country. The surgery and plastic surgery subgroup analyses also demonstrated statistically significant reduction in both catheter use and CAUTI.

Conclusion: The incidence of CAUTI was successfully reduced at The Texas A&M Healthcare Center. The guideline, its development and how it applies to plastic surgery patients are discussed.

Historique: L’infection urinaire sur sonde (IUSS) est l’infection nosocomiale la plus fréquente. Elle peut accroître les coûts de santé, la morbidité et même la mortalité. En 2009, le taux d’IUSS du système de The Scott & White Memorial Hospital et du Texas A&M Health Science Center (Texas, États-Unis) la plaçait dans le quartile le plus élevé (c.-à-d. le taux le plus élevé) au pays, ce qui a exigé de modifier l’ensemble du système.

Objectif: Concevoir et mettre en œuvre des lignes directrices pour réduire l’incidence d’IUSS.

Méthodologie: Une équipe multidisciplinaire a été créée et a effectué à la fois une analyse par arbre de défaillances et une analyse bibliographique. Après avoir regroupé les meilleures données probantes, l’équipe a formulé des directives sur les pratiques exemplaires, détaillant les bonnes indications sur l’insertion de la sonde, sa mauvaise utilisation et les techniques pour réduire au minimum les infections sur sonde. L’éducation des infirmières et des patients faisait partie du protocole, de même que les modifications pour déterminer les patients sur sonde et les arrêts automatiques. À la fin de 2010, les chercheurs ont effectué une analyse au bout de trois, six et 12 mois pour établir d’autres possibilités d’amélioration.

Résultats: En 2009, le taux d’IUSS de l’hôpital s’élevait à 1,46 cas sur 1 000 journées sur sonde. En 2011, la première année complète suivant les directives finales, ce taux avait fléchi à 0,52 cas sur 1 000 jours sur sonde, plaçant l’établissement dans le quartile inférieur (c’est-à-dire le taux le plus bas) au pays. Les analyses du sous-groupe de chirurgie et de chirurgie plastique ont également fait foi d’une réduction statistiquement significative de l’utilisation de la sonde et des IUSS.

Conclusion: L’incidence d’IUSS a diminué à The Texas A&M Healthcare Center. Les directives, leur préparation et leur mode d’application à la chirurgie plastique sont exposés.

Keywords: Catheter; Catheter-associated urinary tract infection CAUTI; Hospital-associated infection HAI; Infection; Infection reduction; Risk reduction.

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Figures

Figure 1)
Figure 1)
National Surgical Quality Improvement Program (NSQIP) graph showing peer rank in 2009. Each bar represents one facility reporting catheter-associated urinary tract infection (CAUTI) rates to the NSQIP database. Yellow dots represent the facility average with the bars representing ±1 SD. ‘Our Hospital’ refers to the Scott & White Memorial Hospital (Texas, USA)
Figure 2)
Figure 2)
National Surgical Quality Improvement Program (NSQIP) graph showing peer rank in 2011. Each bar represents one facility reporting catheter-associated urinary tract infection (CAUTI) rates to the NSQIP database. Yellow dots represent the facility average with the bars representing ±1 SD. ‘Our Hospital’ refers to the Scott & White Memorial Hospital (Texas, USA)
Figure 3)
Figure 3)
Catheter-associated urinary tract infection (CAUTI) prevention poster. Included were epidemiology, indications, improper usage, techniques that make a difference, labelling instructions, nursing responsibilities, and sample insertion and daily renewal order sets
See this image and copyright information in PMC

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