2116. Impact of an Evidence-Based Intervention on Urinary Catheter Utilization in Switzerland. (26th November 2018)

• Record Type: Journal Article
• Authors: Schweiger, Alexander; Kuster, Stefan; Maag, Judith; Züllig, Stephanie; Atkinson, Andrew; Bertschy, Sonja; Bortolin, Emmanuelle; John, Gregor; Sax, Hugo; Schwappach, David; Marschall, Jonas
• Is Part Of: Open forum infectious diseases. Volume 5(2018)Supplement 1
• Page Start: S621
• Page End: S621
• Publication Date: 2018-11-26
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofy210.1772
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: In acute care hospitals, urinary catheters are often inserted and kept without proper indication, and may lead to catheter-associated urinary tract infection (CAUTI) and various non-infectious complications. In this pilot study, we attempted to decrease urinary catheterization via an awareness campaign and an intervention bundle, consisting of (1) an indication list for urinary catheterization, (2) daily evaluation of the need for ongoing catheterization, and (3) education on proper catheter insertion and maintenance. Methods: We conducted a before/after intervention study in seven small, mid-size and academic hospitals distributed across Switzerland. After a 3-month pre-intervention surveillance, the intervention period started with a workshop for local project leaders who then implemented the intervention bundle. During the 3-month post-intervention surveillance, the primary outcome was catheter utilization; secondary outcomes were CAUTI, non-infectious outcomes, and process indicators (proportion of indicated catheters, frequency of catheter evaluation). Results: We analyzed data on 25, 880 mostly general medical or surgical patients, 13, 171 of which pre-intervention (August–October 2016) and 12, 709 post-intervention (August–October 2017). Catheter utilization dropped from 23.7% to 21.0% [adjusted odds ratio 0.9 (95% confidence interval, CI, 0.84–0.96); P = 0.001]. There were 1.02 CAUTI per 1, 000 catheter-days (before) and 1.33 (after) [aOR 1.2 (0.6–2.4); P = 0.6]. Non-infectious complications decreased slightly from 39.4 to 35.4 events per 1, 000 catheter-days [aOR 0.9 (0.77–1.07); P = 0.2]. The proportion of catheters with a documented proper indication went from 74.5% to 90.0% [aOR 4.1 (3.35–4.95); P < 0.001]. Reevaluations increased from 167 to 623 per 1, 000 catheter-days [aOR 3.12 (2.92–3.36); P < 0.001]. Conclusion: In this before/after intervention study, a simple bundle of 3 evidence-based measures reduced catheter utilization and led to increases in indicated urinary catheters and daily evaluations. The intervention had a small impact on non-infectious complications, whereas the CAUTI rate remained on a low level. The next step is planning the national rollout of both the surveillance module and the intervention bundle. Disclosures: All authors: No reported disclosures.