The Effect of Interdisciplinary Team Rounds on Urinary Catheter and Central Venous Catheter Days and Rates of Infection

Abstract

Interdisciplinary team (IDT) rounds were initiated in the intensive care unit (ICU) in June 2010. All catheters were identified by location, duration, and indication. Catheters with no indication were removed. Data were collected retrospectively on catheter days and associated infections in a 20-month period before and after intervention with an aggregate of 19 207 ICU days before and 23 576 ICU days after institution of rounds. Results showed a statistically significant decrease in the number of indwelling urinary catheter (IUC) days (5304 vs 4541 days, P = .05) and catheter-associated urinary tract infection rates (4.71 vs 1.98 infections/1000 ICU days, P < .05). Central line days statistically increased after IDT rounds (3986 vs 4305 days, P < .05) but the catheter-related bloodstream infection rate trended down (3.5 vs 1.6 infections/1000 ICU days, P = .62). This analysis suggests that IDT rounds may have an impact on reducing the number of IUC days and associated infections.

Keywords

multidisciplinary rounds CRBSI CAUTI catheter-related infections

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References

Fridkin

Welbel

Weinstein

. Magnitude and prevention of nosocomial infections in the intensive care unit. Infect Dis Clin North Am. 1997;11:479-496.

Vincent

Rello

Marshall

. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302:2323-2329.

Klevens

Edwards

Richards

Jr . Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep. 2007;122:160-166.

Saint

. Clinical and economic consequences of nosocomial catheter-related bacteriuria. Am J Infect Control. 2000;28:68-75.

Weinstein

Towns

Quartey

. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis. 1997;24:584-602.

Tambyah

Knasinski

Maki

. The direct cost of nosocomial catheter-associated urinary tract infection in the era of managed care. Infect Control Hosp Epidemiol. 2002;23:27-31.

Anderson

Kirkland

Kaye

. Underresourced hospital infection control and prevention programs: penny wise, pound foolish? Infect Control Hosp Epidemiol. 2007;28:767-773.

Clec’h

Schwebel

Français

. Does catheter-associated urinary tract infection increase mortality in critically ill patients? Infect Control Hosp Epidemiol. 2007;28:1367-1373.

Dimick

Pelz

Consunji

Swoboda

Hendrix

Lipsett

. Increased resource use associated with catheter-related bloodstream infection in the surgical intensive care unit. Arch Surg. 2001;136:229-234.

10.

Warren

Quadir

Hollenbeak

Elward

Cox

Farser

. Attributable cost of catheter-associated bloodstream infections among intensive care patients in a nonteaching hospital. Crit Care Med. 2006;34:2084-2089.

11.

Blot

Depuydt

Annemans

. Clinical and economic outcomes in critically ill patients with nosocomial catheter-related bloodstream infections. Clin Infect Dis. 2005;41:1591-1598.

12.

Renaud

Brun-Buisson

. Outcomes of primary and catheter-related bacteremia. A cohort and case-control study in critically ill patients. Am J Respir Crit Care Med. 2001;163:1584-1590.

13.

Mermel

. Prevention of intravascular catheter-related infections. Ann Intern Med. 2000;132:391-402. (Erratum: Ann Intern Med. 2000;133:395)

14.

Maki

Kluger

Crnich

. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc. 2006;81:1159-1171.

15.

Wong

. Guideline for prevention of catheter-associated urinary tract infections. Am J Infect Control. 1983;11:28-36.

16.

Pratt

Pellowe

Loveday

. The epic project: developing national evidence-based guidelines for preventing healthcare associated infections. Phase I: guidelines for preventing hospital-acquired infections. Department of Health (England). J Hosp Infect. 2001;47(suppl):S3-S82.

17.

Pratt

Pellowe

Wilson

. epic2: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect. 2007;65(suppl 1):S1-S64.

18.

Nicolle

Classen

. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29(suppl 1):S41-S50.

19.

Hooton

Bradley

Cardenas

. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010;50:625-663.

20.

Gould

Umscheid

Agarwal

Kuntz

Pegues

; Healthcare Infection Control Practices Advisory Committee. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol. 2010;31:319-326.

21.

Pronovost

Needham

Berenholtz

. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006;355:2725-2732.

22.

Berenholtz

Pronovost

Lipsett

. Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med. 2004;32:2014-2020.

23.

Lederle

Parenti

Berskow

Ellingson

. The idle intravenous catheter. Ann Intern Med. 1992;116:737-738.

24.

Parenti

Lederle

Impola

Peterson

. Reduction of unnecessary intravenous catheter use. Internal medicine house staff participate in a successful quality improvement project. Arch Intern Med. 1994;154:1829-1832.

25.

O’Grady

Alexander

Burns

, Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011;52(9):e162-e193.

26.

Horan

Andrus

Dudeck

. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36:309-332.

27.

Tissot

Limat

Cornette

Capellier

. Risk factors for catheter-associated bacteriuria in a medical intensive care unit. Eur J Clin Microbiol Infect Dis. 2001;20:260-262.

28.

Chenoweth

Saint

. Urinary tract infections. In Jarvis

, ed. Bennett & Brachman’s Hospital Infections. 5th ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2007:507-516.

29.

Saint

. Clinical and economic consequences of nosocomial catheter-related bacteriuria. Am J Infect Control. 2000;28:68-75.

30.

Tambyah

Maki

. Catheter-associated urinary tract infection is rarely symptomatic: a prospective study of 1,497 catheterized patients. Arch Intern Med. 2000;160:678-682.