Catheter‐associated urinary tract infection (CAUTI) is the most common health care–associated infection (HAI), accounting for more than 40% of all HAIs. Approximately 15% of patients admitted to acute care hospitals in the United States receive an indwelling urinary catheter during their hospital stay, many without an accepted indication. The Michigan Health and Hospital Association (MHA) Keystone Center for Patient Safety & Quality has begun a statewide initiative that focuses on preventing CAUTI by implementing evidence‐based best practices (the “Bladder Bundle”) to reduce the burden of disease associated with indwelling catheterization. Although successful patient safety initiatives must involve key medical personnel, the extent to which hospitalists can be leveraged to help prevent CAUTI remains unknown.
We conducted a mixed‐methods study to assess barriers and facilitators to implementing practices to prevent CAUTI. We surveyed infection preventionists at all Michigan hospitals in 2009 and asked about the Bladder Bundle and the use of CAUTI preventive practices in their hospital. In 2010, we subsequently surveyed infection preventionists at the 102 Michigan hospitals that responded to the 2009 survey to learn more about the potential role for hospitalists in the Bladder Bundle, clinician engagement, and team leadership. In addition to the survey, we conducted semistructured interviews with 38 individuals, including chief medical officers, chief nurses, infection preventionists, frontline physicians, and nurses. All interviews were transcribed and analyzed using qualitative techniques.
The response rate for the 2010 survey was 75% (76 of 102). Infection preventionists were most often chosen as the “ideal” team leader for Bladder Bundle implementation (n = 18, 24%), followed by nurse managers (n = 15, 20%), bedside nurses (n = 14, 18%), and hospitalists (n = 7, 9%). However, most respondents (92%) believed that hospitalists had a key role in the implementation of the Bladder Bundle. According to infection preventionists, the best way to engage both frontline clinicians and hospital leadership is to focus on CAUTI prevention rather than preventing non‐infectious complications of urinary catheter use (e.g., improving ambulation). Interviews demonstrated: (1) a perception of improved nurse–physician communication and increased continuity of care with hospitalists and (2) a clear role for hospitalists in CAUTI prevention activities.
Our results suggest that although hospitalists may not be selected as team leaders for implementation efforts focused on preventing CAUTI, they could have a key role in implementing the Bladder Bundle. National initiatives designed to prevent HAIs—CAUTI, in particular—should ideally engage hospitalists to facilitate the uptake of best practices.
S. Flanders ‐ IHI/CDC Foundation/BCBS of Michigan, honorarium/research support; S. Krein ‐ none; C. Kowalski ‐ none; L. Kuhn ‐ none; S. Saint ‐ IHI/MHA, honorarium for speaking
To cite this abstract:Flanders S, Krein S, Kowalski C, Kuhn L, Saint S. The Potential Role of Hospitalists in Preventing Catheter‐Associated Urinary Tract Infection: Results of a Statewide Initiative. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 47. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/the-potential-role-of-hospitalists-in-preventing-catheterassociated-urinary-tract-infection-results-of-a-statewide-initiative/. Accessed April 1, 2020.