The Influence of an Electronic Medical Record Embedded Best Practice Alert on Rate of Hospital Acquired Catheter Associated Urinary Tract Infections: Do Best Practice Alerts Reduce CAUTIs?

OBJECTIVE: To understand if an electronic medical record embedded best practice alert decreased our hospital's Catheter-associated urinary tract infections (CAUTIs) and catheter utilization (CU) rates. METHODS: Data from our inpatient prospective CAUTI database, spanning 2011 to 2016, were utilized for our analysis with the Best Practice Alert (BPA) starting in 2013. Using generalized linear models we compared the CU and CAUTI rates between pre- and post-BPA periods in different patient subpopulations. RESULTS: We identified no decrease in the CU rate and no effect on the CAUTI rates as a result of the BPA. However, there was an increase in CAUTI rates in our adult intensive care unit (ICU) population from 0.2 to 1.8 CAUTIs per 1,000 catheter days (P <.01) despite a significant decrease in CU rate within this population after the BPA (pre-BPA odds ratio [OR] 0.93 vs post-BPA OR 0.89; P <0.01). In contrast, our non-ICU adult population had a decrease in CAUTI rate from 2.8 to 1.7 CAUTIs per 1,000 catheter days (P <.01) despite no significant decrease after the BPA (pre-BPA OR 0.90 vs post-BPA OR 0.95; P <.1). CONCLUSION: CAUTI rates are exceedingly low, with or without the use of a BPA. Such an alert appears to have limited success in lowering CU rates in populations where catheter use is already low and may not always lead to an improvement in CAUTI rates as there appears to be some populations that may be more prone to CAUTI development secondary to possible intrinsic or co-morbid conditions.

Methicillin-resistant Staphylococcus aureus prevention practices in hospitals throughout a rural state.

BACKGROUND: The Institute for Healthcare Improvement (IHI) created an evidence-based bundle to help reduce methicillin-resistant Staphylococcus aureus (MRSA) health care-associated infections. The study aim was to identify which components of the IHI's MRSA bundle that rural hospitals have implemented and to identify barriers that hindered implementation of bundle components. METHODS: Four surveys about the IHI's MRSA bundle were administered at the Iowa Statewide Infection Prevention Seminar between 2007 and 2011. Surveys were mailed to infection preventionists (IPs) who did not attend the meetings. RESULTS: The percentage of IPs reporting that their hospital implemented a hand hygiene program (range by year, 87%-94%) and used contact precautions for patients infected (range by year, 97%-100%) or colonized (range by year, 77%-92%) with MRSA did not change significantly. The number of hospitals that monitored the effectiveness of environmental cleaning significantly increased from 23%-71% (P < .01). Few hospitals assessed daily if central lines were necessary (range by year, 22%-26%). IPs perceived lack of support to be a major barrier to implementing bundle components. CONCLUSION: Most IPs reported that their hospitals had implemented most components of the MRSA bundle. Support within the health care system is essential for implementing each component of an evidence-based bundle.

The epidemiology of methicillin-resistant Staphylococcus aureus on a burn trauma unit.

OBJECTIVE: We assessed the frequency and relatedness of methicillin-resistant Staphylococcus aureus (MRSA) isolates to determine whether healthcare workers, the environment, or admitted patients could be a reservoir for MRSA on a burn trauma unit (BTU). We also assessed risk factors for MRSA colonization among BTU patients. DESIGN: Prospective cohort study and surveillance for MRSA carriage. SETTING: BTU of a Midwestern academic medical center. PATIENTS AND PARTICIPANTS: Patients admitted to a BTU from February 2009 through January 2010 and healthcare workers on this unit during the same time period. METHODS: Samples for MRSA culture were collected on admission from the nares and wounds of all BTU patients. We also had collected culture samples from the throat, axilla, antecubital fossa, groin, and perianal area of 12 patients per month. Samples collected from healthcare workers' nares and from environmental sites were cultured quarterly. MRSA isolates were typed by pulsed-field gel electrophoresis. RESULTS: Of 144 patients, 24 (17%) carried MRSA in their nares on admission. Male sex (odds ratio [OR], 5.51; 95% confidence interval [95% CI], 1.25-24.30), admission for necrotizing fasciitis (OR, 7.66; 95% CI, 1.64-35.81), and MRSA colonization of a site other than the nares (OR, 23.40; 95% CI, 6.93-79.01) were independent predictors of MRSA nasal carriage. Cultures of samples collected from 4 healthcare workers and 4 environmental cultures had positive results. Two patients were colonized with strains that were indistinguishable from strains collected from a healthcare worker or the environment. CONCLUSIONS: Patients were a major reservoir for MRSA. Infection control efforts should focus on preventing transmission of MRSA from patients who are MRSA carriers to other patients on the unit.