Faculty Collaboration Database

Variability in catheter-associated asymptomatic bacteriuria rates among individual nurses in intensive care units: An observational cross-sectional study. PLoS One 2019;14(7):e0218755

Date

07/11/2019

Pubmed ID

31291280

Pubmed Central ID

PMC6619985

DOI

10.1371/journal.pone.0218755

Scopus ID

2-s2.0-85069609629 (requires institutional sign-in at Scopus site)   7 Citations

Abstract

Catheter-associated asymptomatic bacteriuria (CAABU) is frequent in intensive care units (ICUs) and contributes to the routine use of antibiotics and to antibiotic-resistant infections. While nurses are responsible for the implementation of CAABU-prevention guidelines, variability in how individual nurses contribute to CAABU-free rates in ICUs has not been previously explored. This study's objective was to examine the variability in CAABU-free outcomes of individual ICU nurses. This observational cross-sectional study used shift-level nurse-patient data from the electronic health records from two ICUs in a tertiary medical center in the US between July 2015 and June 2016. We included all adult (18+) catheterized patients with no prior CAABU during the hospital encounter and nurses who provided their care. The CAABU-free outcome was defined as a 0/1 indicator identifying shifts where a previously CAABU-free patient remained CAABU-free (absence of a confirmed urine sample) 24-48 hours following end of shift. The analytical approach used Value-Added Modeling and a split-sample design to estimate and validate nurse-level CAABU-free rates while adjusting for patient characteristics, shift, and ICU type. The sample included 94 nurses, 2,150 patients with 256 confirmed CAABU cases, and 21,729 patient shifts. Patients were 55% male, average age was 60 years. CAABU-free rates of individual nurses varied between 94 and 100 per 100 shifts (Wald test: 227.88, P<0.001) and were robust in cross-validation analyses (correlation coefficient: 0.66, P<0.001). Learning and disseminating effective CAABU-avoidance strategies from top-performers throughout the nursing teams could improve quality of care in ICUs.

Author List

Yakusheva O, Costa DK, Bobay KL, Parada JP, Weiss ME

Author

Marianne Weiss DNSc Associate Professor in the College of Nursing department at Marquette University

MESH terms used to index this publication - Major topics in bold

Aged
Asymptomatic Diseases
Bacteriuria
Catheter-Related Infections
Catheterization
Cross-Sectional Studies
Electronic Health Records
Female
Humans
Intensive Care Units
Male
Middle Aged
Nursing Staff, Hospital
Practice Guidelines as Topic
Retrospective Studies
Workload