Download idweek 2015 poster abstracts - Oxford Academic

IDWEEK 2015
POSTER ABSTRACTS
299. Emergency Department Catheter-Associated Urinary Tract Infection
Prevention: Role of the Clinical Nurse
Eileen J. Carter, PhD, RN1,2; Corine Sinnette, MA, MPH3; Leslie Mandel, PhD, MA,
MS4; Jeremiah Schuur, MD, MHS3; 1Columbia University School of Nursing,
New York, New York; 2Office of Evidence-Based Practice, Research and Innovation,
NewYork-Presbyterian Hospital, New York, New York; 3Brigham and Women’s
Hospital, Boston, Massachusetts; 4School of Nursing, Science, and Health Professions,
Regis College, Weston, Massachusetts
Session: 50. HAI: Device Associated Infections
Thursday, October 8, 2015: 12:30 PM
Background. The emergency department (ED) is a major setting of urinary catheter placement. ED nurses play a large role in urinary catheter use. We aimed to describe ED nurses’ roles in catheter-associated urinary tract infection (CAUTI)
prevention programs.
Methods. Nationwide qualitative study of early adopting EDs, defined as those
using criteria for urinary catheter placement and tracking a decrease in ED-placed
catheters. We screened over 400 EDs identified from a nationwide survey and national
publicity. Among 6 EDs, we conducted 52 semi-structured interviews and 9 focus
groups with 102 participants (nurses, doctors, infection control staff ). Interviews
and focus groups were audio-recorded and transcribed verbatim. Study authors used
a conventional content analysis to code transcripts in NVivo9.
Results. Several themes emerged concerning ED nurses’ roles in CAUTI prevention. Nurses were the principal champions of CAUTI prevention efforts. ED nurses
reported that they felt ownership of urinary catheters as they historically initiated
most urinary catheters and were responsible for catheters’ placement and care. Close
examination of ED workflow by nurses identified local opportunities to: minimize
catheter use, ensure proper insertion technique and maintain catheters post-insertion.
To minimize use, nurses affixed indications for urinary catheter to insertion kits, questioned urinary catheter orders for appropriateness and championed the use of alternatives e.g. unisex urinals. To improve aseptic technique during catheter placement,
nurses developed protocols to improve perineal care and implemented a two-person
insertion practice where a helper provided technical assistance, allowing the primary
operator to focus on sterility. To maintain catheters post-insertion, nurses collaborated
with supply personnel to fasten urinary catheter hooks onto mobile equipment, which
prevented the backflow of urine in the urinary catheter drainage system.
Conclusion. Among early-adopting EDs, CAUTI prevention efforts were largely
nurse-driven and the interventions nurse-centric. Nursing examination of workflow
was the key common feature that led to novel strategies that redesigned workflow.
Nurse engagement and empowerment are critical to ED CAUTI prevention.
Disclosures. All authors: No reported disclosures.
Open Forum Infectious Diseases 2015;2:71–536
© The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases
Society of America. This is an Open Access article distributed under the terms of the Creative
Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/
by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any
medium, provided the original work is not altered or transformed in any way, and that the work
is properly cited. For commercial re-use, please contact [email protected].
DOI: 10.1093/ofid/ofv133
Poster Abstracts
•
OFID 2015:2 (Suppl 1)
•
S71