Urinary catheter alleviation navigator protocol (UCANP): Update to the hospital-wide implementation at a single tertiary health care center.

BACKGROUND: Catheter-associated urinary tract infections are commonly reported health care-associated infections. It was demonstrated that the urinary catheter alleviation navigator protocol (UCANP) pilot resulted in a reduction of catheter utilization and catheter days. METHODS: Quality improvement initiative that was implemented at a single urban, tertiary health care center, focusing on early discontinuation of indwelling urinary catheters (IUCs) and avoidance of reinsertion. The protocol was expanded hospital-wide from September 2020 to April 2022. We compared IUC utilization, IUC standardized utilization ratio (SUR), and catheter-associated urinary tract infection standardized infection ratio in the preintervention period (March 2020 to August 2020) to the postintervention period (May 2022 to October 2022). RESULTS: Preimplementation, 2 patients with IUC removal were placed on UCANP. Postimplementation, 835 (45%) patients with IUC removal participated in the protocol. The number of patients requiring IUC reinsertion did not differ among the 2 groups. IUC utilization was significantly decreased from 0.28 to 0.24 with a 14% reduction (P = .025). SUR decreased by 11% from 0.778 to 0.693 (P = .007) and standardized infection ratio by 84% from 0.311 to 0.049 (P = .009). CONCLUSIONS: Our protocol significantly reduced IUC utilization and SUR after hospital-wide implementation. UCANP is a safe and effective strategy that can potentially decrease unnecessary IUCs in patients with transient urinary retention.

Using interprofessional collaboration to reduce reported rates of central-line-associated bloodstream infection in an intensive care setting.

Using a multicomponent approach that included blood-culture stewardship, evaluation for secondary sources of bloodstream infection, improved documentation, and prompt central-line removal, an interprofessional team improved patient care and reduced central-line-associated bloodstream infection rates in collaboration with the primary team on the surgical intensive care unit.

Urinary catheter alleviation navigator protocol (UCANP): Overview of protocol and review of initial experience.

BACKGROUND: Given the associated morbidity, mortality, and financial consequences of catheter associated urinary tract infections (CAUTIs), efforts should be made to mitigate the risk. We sought to describe, and report results for a post-catheter removal bladder management protocol focused on decreasing catheter reinsertion, catheter days, and overall CAUTI risk. METHODS: This was a quality improvement initiative implemented over a 3-month period at a single urban, tertiary health care center. Patients with an indwelling urinary catheter deemed eligible for removal were followed and cared for according to the study protocol. Rates of catheter reinsertion, catheter days, and assessment of CAUTI risk were compared between cohorts. RESULTS: A total of 173 patients were eligible for protocol enrollment. Catheter reinsertion rate was 16% during the pilot, compared to 21% and 27% for the historical cohorts, (P = .02). The mean number of catheter day's during the study was 1.4 days, compared to 9.5 and 5.6 days in the historical cohorts (P = .004). Catheter hours (OR 1.010 95% CI 1.005 - 1.015 P < .0001.) was a predictor of catheter reinsertion during the pilot. CONCLUSIONS: Our protocol resulted in a reduction of catheter reinsertion rates and number of catheter days. Expansion of this protocol to a larger patient cohort is required.

Coalescent theory for age-structured random mating populations with two sexes.

Consider a population that develops over units of time labelled by zero and the negative integers. It is assumed that at any time r≤0 there are respectively N(m,a) males of age a and N(f,b) of females of age b, where a=1,…,A(m) and b=1,…,A(f). At time 0 a sample of n copies of a gene are assumed to be observed, where n≪min(ab)(N(m,a),N(f,b)). It is assumed that at any particular time r any possible mating is equally probable and that numbers of gametes contributed to offspring of age 1 and sex u by parents of sex v are exchangeable within age groups and independently distributed among age-groups. Coalescent theory is then derived, with time measured in multiples 2N(eC) of the effective population size N(eC), which depends on a measure T of the generation interval. Theory is developed for both autosomal and sex-linked loci in two special cases.

Coalescent theory for a completely random mating monoecious population.

Consider a large random mating monoecious diploid population that has N individuals in each generation. Let us assume that at time 0 a random sample of n<infinity. It is then possible to obtain a generalization of coalescent theory for haploid populations if the distribution of G1 has a finite second moment and E[G(1)(3)]/N-->0 as N-->infinity.

Genealogical theory for random mating populations with two sexes.

Consider a random mating population that has N(m) males and N(f) females in each generation. Let us assume that at time 0 a random sample of n copies of a gene is taken from this population. Then, for models introduced by Wright [Evolution in Mendelian populations, Genetics 16 (1931) 97; Inbreeding and homozygosis, Proc. Nat. Acad. Wash. 19 (1933) 420; Evolution and the Genetics of Populations, The Theory of Gene Frequencies, vol. II, The University of Chicago, Chicago and London, 1969.], it is possible to obtain generalizations of the haploid theory of genealogical processes developed by Felsenstein . It is conjectured that these hold generally, regardless of the effective population size, if n<

Malthusian parameters, reproductive values and change under selection in self fertilizing age-structured populations.

A population, reproducing wholly by selfing, is assumed to be observed at times 0,1,.... Individuals between x-1 and x units of age at time t are said to be in age class x at that time. The rate of increase in the long run of individuals of type A(iA)(j) is denoted by m(ij)+1= m(ji)+1. For each genotype there is also a set of reproductive values, corresponding to all age classes and genotypes of individuals having descendants of that genotype. Then, if the number of individuals of each sort of ancestor is multiplied by its reproductive value and the products are summed, the result is the total value, which is V(ij)( t) for genotype A(iA)(j). Then V(ij)( t+1)- V(ij)( t) is equal to m(ij) V(ij)( t), where m(ij) is the Malthusian parameter for A(iA)(j). Furthermore, if the mean and variance at time t of the m(ij)'s, weighted by their corresponding reproductive values, are respectively ( t) and Sigma(m)(2)( t), then m( t+1)-m( t)=Sigma(m)(2)( t)/(1+m( t)).

The effective number of a population that varies cyclically in size. II. Overlapping generations.

We consider haploid and dioecious age-structured populations that vary over time in cycles of length k. Results are obtained for both autosomal and sex-linked loci if the population is dioecious. It is assumed that k is small in comparison with numbers of haploid individuals (or of numbers of males and females) in any generation of a cycle. The inbreeding effective population size N(e) is then approximately given by the expression [T summation operator (k-1)(j=0)1/[N(e)(j)T(j)]](-1), where N(e)(j) and T(j) are, respectively, the effective population size and generation interval that would hold if the population was at all times generated in the same way as at time j. The constant T, which is the effective overall generation interval, is defined to be k times the harmonic mean of the quantities T(j). Our expressions for T and N(e), in terms of N(e)(j) and T(j), are general, but the N(e)(j)s are derived under the assumption that offspring are produced according to Poisson distributions.

Eigenvalue effective population numbers for populations that vary cyclically in size.

Four types of effective population numbers have been discussed in the literature on population genetics. It was shown by Wang and Pollak [Math. Biosci. 166 (2000) 1] that if a large random mating dioecious population varies cyclically in size and the population is followed over a whole cycle, the variance, inbreeding and mutation effective numbers are equal. It was also shown, in a special case, that the variance effective number, N(eV), is equal to the eigenvalue effective number, N(eE). The former is related to the long-term rate at which the variance between lines increases and the latter is computed from the largest non-unit eigenvalue of the matrix of transition probabilities governing the change with time of frequencies of an allele among males and females. It is shown in this paper that N(eE) is quite generally at least approximately the same as N(eV) if the numbers of males and females are always large. Both autosomal and sex-linked loci are considered and the theory allows for reproduction partially by a regular system of inbreeding.