Implementing technical and socioadaptive bundles may decrease catheter-associated urinary tract infections in nursing homes
1. In this national implementation project involving community-based nursing homes, implementation of technical and socioadaptive bundles, which included training for catheter care and aseptic insertion, removal guidelines, regular assessments, resident and family engagement, and effective communication, significantly reduced the rates of catheter-associated urinary tract infections.
2. Catheter utilization did not change significantly over the time period. However, the number of urine cultures ordered for all residents decreased significantly.
Evidence Rating Level: 2 (Good)
Study Rundown: Use of urinary catheters, particularly in nursing homes, is a major risk factor for urinary tract infections (UTIs). Given the risk of sepsis, hospital admission, and mortality, it is important to reduce this risk. This study aimed to develop, implement, and evaluate interventions to reduce catheter-associated UTIs.
Adjusted catheter-associated UTI rates of nursing home residents decreased by approximately 50% with the implementation of the technical and socioadaptive bundles aimed at reducing these infections. These bundles included training for catheter care and aseptic insertion, catheter removal guidelines, regular catheter reassessments, resident and family engagement and effective communication. The number of urine cultures ordered for nursing home residents decreased by 15%. Catheter utilization did not decrease significantly over the study period. Strengths of this study include its large-scale, prospective design. Limitations of the study were not evaluating the effectiveness of individual components of the bundle to highlight the most important pieces.
Click to read the study, published in JAMA Internal Medicine
Relevant Reading: Resident and Facility Factors Associated With the Incidence of Urinary Tract Infections Identified in the Nursing Home Minimum Data Set
In-Depth [prospective cohort]: This large-scale prospective implementation project was conducted from March 2014 to August 2016 in community nursing homes across the US that were part of the Agency for Healthcare Research and Quality Safety Program for Long-Term Care. There were four 12-month cohorts totalling 404 nursing homes. The interventions of interest were technical and socioadaptive bundles that consisted of training for catheter care and aseptic insertion, catheter removal guidelines, regular catheter reassessments, resident and family engagement and effective communication. The main outcome of interest was urinary catheter use and catheter-associated UTIs. Other outcomes of interest included facility-level urine culture order rates. Random-effects negative binomial regression models were used to assess changes in outcomes after the 12-month implementation of the technical and socioadaptive bundles.
A total of 4 cohorts were followed over 30 months and consisted of 404 community-based nursing homes. Adjusted rates of catheter-associated UTIs decreased from 6.42 to 3.33 infections per 1000 catheter-days (IRR 0.46; 95%CI 0.36-0.58, p < 0.001). Catheter utilization did not change significantly over the study period (IRR 0.95; 95%CI 0.88-1.03; p = 0.26). The number of urine cultures ordered for residents decreased from 3.52 to 3.08 per 1000 resident-days (IRR 0.85; 95%CI 0.77-0.94; p = 0.001).
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