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Effectiveness of Multifaceted Hospitalwide Quality Improvement Programs Featuring an Intervention to Remove Unnecessary Urinary Catheters at a Tertiary Care Center in Thailand

Published online by Cambridge University Press:  02 January 2015

Anucha Apisarnthanarak ,
Kanokporn Thongphubeth ,
Sirinaj Sirinvaravong ,
Danai Kitkangvan ,
Chananart Yuekyen ,
Boonyasit Warachan ,
David K. Warren  and
Victoria J. Fraser
Anucha Apisarnthanarak*
Affiliation:
Divisions of Infectious Diseases and Infection Control, Faculty of Medicine, Thammasart University Hospital, Pratumthani, Thailand
Kanokporn Thongphubeth
Affiliation:
Divisions of Infectious Diseases and Infection Control, Faculty of Medicine, Thammasart University Hospital, Pratumthani, Thailand
Sirinaj Sirinvaravong
Affiliation:
Internal Medicine, Faculty of Medicine, Thammasart University Hospital, Pratumthani, Thailand
Danai Kitkangvan
Affiliation:
Internal Medicine, Faculty of Medicine, Thammasart University Hospital, Pratumthani, Thailand
Chananart Yuekyen
Affiliation:
Divisions of Infectious Diseases and Infection Control, Faculty of Medicine, Thammasart University Hospital, Pratumthani, Thailand
Boonyasit Warachan
Affiliation:
Department of Applied Statistics, Faculty of Science, King Mongkut's Institute of Technology, Ladkrabang, Bangkok, Thailand
David K. Warren
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, Missouri
Victoria J. Fraser
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, Missouri
*
Division of Infectious Diseases, Faculty of Medicine, Thammasart University Hospital, Pratumthani, Thailand 12120 ([email protected])
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Abstract

Objective.

To evaluate the efficacy of a multifaceted hospitalwide quality improvement program that featured an intervention to remind physicians to remove unnecessary urinary catheters.

Methods.

A hospitalwide preintervention-postintervention study was conducted over 2 years (July 1, 2004, through June 30, 2006). The intervention consisted of nurse-generated daily reminders that were used by an intervention team to remind physicians to remove unnecessary urinary catheters, beginning 3 days after insertion. Clinical, microbiological, pharmaceutical, and cost data were collected.

Results.

A total of 2,412 patients were enrolled in the study. No differences were found in the demographic and/or clinical characteristics of patients between the preintervention and postintervention periods. After the intervention, reductions were found in the rate of inappropriate urinary catheterization (mean rate, preintervention vs postintervention, 20.4% vs 11% [P = .04]), the rate of catheter-associated urinary tract infection (CA-UTI) (mean rate, 21.5 vs 5.2 infections per 1,000 catheter-days [P <.001]), the duration of urinary catheterization (mean, 11 vs 3 days [P < .001]), and the total length of hospitalization (mean, 16 vs 5 days [P < .001]). A linear relationship was seen between the monthly average duration of catheterization and the rate of CA-UTI (r = 0.89; P < .001). The intervention had the greatest impact on the rate of CA-UTI in the intensive care units (mean rate, preintervention vs postintervention, 23.4 vs 3.5 infections per 1,000 catheter-days [P = .01]). The monthly hospital costs for antibiotics to treat CA-UTI were reduced by 63% (mean, $3,739 vs $1,378 [P < .001]), and the hospitalization cost for each patient during the intervention was reduced by 58% (mean, $366 vs $154 [P < .001]).

Conclusions.

This study suggests that a multifaceted intervention to remind physicians to remove unnecessary urinary catheters can significantly reduced the duration of urinary catheterization and the CA-UTI rate in a hospital in a developing country.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 7 , July 2007 , pp. 791 - 798
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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