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Eight-year sustainability of a successful intervention to prevent urinary tract infection: A mixed-methods study


Sax, Hugo; Kuster, Stefan P; Tehrany, Yassaman Alipour; Ren, Ruoxi; Uçkay, Ilker; Agostinho, Americo; Stephan, François; Wachsmuth, Maud; Walder, Bernard; Hoffmeyer, Pierre; Pittet, Didier (2016). Eight-year sustainability of a successful intervention to prevent urinary tract infection: A mixed-methods study. American Journal of Infection Control, 44(7):820-824.

Abstract

BACKGROUND Data on long-term effects of interventions in infection control are scarce. We aimed to evaluate the 8-year sustainability of a successful intervention to reduce urinary tract infections (UTIs) through restriction of urinary catheter (UC) use in an orthopedic surgical population. METHODS Prospective UTI surveillance from November 2009-January 2010 was conducted to compare the results against the 2-year sustainability assessment performed in 2004. Semistructured staff interviews focused on UC indication, training, insertion techniques, and recall of the former intervention. RESULTS A total of 336 consecutive patients were included (median age, 63 years; range, 16-95 years; 55% women). A UC was placed in 17.6% of patients (operating room [OR], 10.1%; postanesthesia care unit [PACU], 3.6%; surgical wards [SW], 3.9%) compared with 20.0% in 2004 (OR, 15.7%; PACU, 1.0%; SW, 3.7%). The incidence rate of UTI was 2.4 per 1,000 patient-days in 2010 versus 2.6 per 1,000 patient-days in 2004; adjusted incidence rate ratio 0.76; 95% confidence interval, 0.21-2.76; P = .67. The qualitative inquiry demonstrated poor recall of the intervention and knowledge of guidelines except in the OR, where we identified a champion leader. DISCUSSION The intervention effect was sustained with regard to overall UTI rate and UC placement in the OR, but less in the PACU and SW. CONCLUSIONS Continuous leadership of a single opinion leader in a pivotal position can contribute critically to sustainability.

Abstract

BACKGROUND Data on long-term effects of interventions in infection control are scarce. We aimed to evaluate the 8-year sustainability of a successful intervention to reduce urinary tract infections (UTIs) through restriction of urinary catheter (UC) use in an orthopedic surgical population. METHODS Prospective UTI surveillance from November 2009-January 2010 was conducted to compare the results against the 2-year sustainability assessment performed in 2004. Semistructured staff interviews focused on UC indication, training, insertion techniques, and recall of the former intervention. RESULTS A total of 336 consecutive patients were included (median age, 63 years; range, 16-95 years; 55% women). A UC was placed in 17.6% of patients (operating room [OR], 10.1%; postanesthesia care unit [PACU], 3.6%; surgical wards [SW], 3.9%) compared with 20.0% in 2004 (OR, 15.7%; PACU, 1.0%; SW, 3.7%). The incidence rate of UTI was 2.4 per 1,000 patient-days in 2010 versus 2.6 per 1,000 patient-days in 2004; adjusted incidence rate ratio 0.76; 95% confidence interval, 0.21-2.76; P = .67. The qualitative inquiry demonstrated poor recall of the intervention and knowledge of guidelines except in the OR, where we identified a champion leader. DISCUSSION The intervention effect was sustained with regard to overall UTI rate and UC placement in the OR, but less in the PACU and SW. CONCLUSIONS Continuous leadership of a single opinion leader in a pivotal position can contribute critically to sustainability.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Infectious Diseases
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:1 July 2016
Deposited On:04 Aug 2016 12:59
Last Modified:04 Aug 2016 14:28
Publisher:Elsevier
ISSN:0196-6553
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1016/j.ajic.2016.01.013
PubMed ID:26988333

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