Heather M. Gilmartin

Indwelling urinary catheter management and catheter-associated urinary tract infection prevention practices in Nurses Improving Care for Healthsystem Elders hospitals

BACKGROUND Indwelling urinary catheters (IUCs) are commonly used in hospitalized patients, especially elders. Catheter-associated urinary tract infections (CAUTIs) account for 34% of all health care associated infections in the United States, associated with excess morbidity and health care costs. Adherence to CAUTI prevention practices has not been well described. METHODS This study used an electronic survey to examine IUC care practices for CAUTI prevention in 3 areas-(1) equipment and alternatives and insertion and maintenance techniques; (2) personnel, policies, training, and education; and (3) documentation, surveillance, and removal reminders-at 75 acute care hospitals in the Nurses Improving the Care of Healthsystem Elders (NICHE) system. RESULTS CAUTI prevention practices commonly followed included wearing gloves (97%), handwashing (89%), maintaining a sterile barrier (81%), and using a no-touch insertion technique (73%). Silver-coated catheters were used to varying degrees in 59% of the hospitals; 4% reported never using a catheter-securing device. Urethral meatal care was provided daily by 43% of hospitals and more frequently that that by 41% of hospitals. Nurses were the most frequently reported IUC inserters. Training in aseptic technique and CAUTI prevention at the time of initial nursing hire was provided by 64% of hospitals; however, only 47% annually validated competency in IUC insertion. Systems for IUC removal were implemented in 56% of hospitals. IUC documentation and routine CAUTI surveillance practices varied widely. CONCLUSIONS Although many CAUTI prevention practices at NICHE hospitals are in alignment with evidence-based guidelines, there is room for improvement. Further research is needed to identify the effect of enhanced compliance with CAUTI prevention practices on the prevalence of CAUTI in NICHE hospitals.

Infection prevention workforce: Potential benefits to educational diversity

Background: Nurses have historically occupied the infection preventionist (IP) role. As the knowledge and skills needed to advance the field expand, professionals from public health and the laboratory sciences have become IPs. Our study describes the characteristics of current IPs and assesses for relationships between background, certification, experience, and type of work performed. Methods: The data were drawn from an existing dataset collected in the conduct of the Association for Professionals in Infection Control and Epidemiology (APIC) MegaSurvey. Descriptive statistics were computed. Associations were calculated using χ2 or Cochran‐Mantel‐Haenszel tests. Characteristics of IPs were stratified by work‐related activities to allow for comparisons between groups. Results: Of the 13,050 active APIC members, 4,079 participated in the survey (31% response rate). The primary job activity for nurses (97.9%; n = 2,434) was preventing and controlling the transmission of infectious agents or health care–associated infections, for laboratory scientists (97.5%; n = 307) it was the interpretation of surveillance data, and for public health professionals (96.1%; n = 136) it was management and communication: feedback. Conclusions: Infection control departments would benefit from hiring IPs with diverse education and training to address the expanding roles and responsibilities of IPs. This may facilitate the implementation of novel and innovative processes that will impact patient care.

Education methods for maintaining nursing competency in low-volume, high-risk procedures in the rural setting: bridging the theory to practice gap.

Nurses practicing in the rural setting have faced a unique challenge in maintaining competency in low-volume, high-risk procedures. This study assessed the effectiveness of a focused, multifaceted educational intervention on the retention of nursing knowledge related to central venous access devices care and maintenance. A pretest-posttest intervention study design was used at a 58-bed rural healthcare facility in a Western state. This study demonstrates a statistically significant increase in functional nursing knowledge in the postintervention period.

Simulation to the rescue! Caring for a pediatric patient in the rural setting.

Rural nurses are expected to be competent and confident caregivers for patients of all ages and disease states. Rural nurse educators are challenged with creating appropriate learning environments to assess and maintain nursing competencies in resource-limited areas. This project describes and evaluates the utilization of a simulation manikin from a local community college to provide a hands-on learning environment for rural nurses working with pediatric patients in respiratory distress.

Does nurse job satisfaction influence adherence to the central line insertion checklist and central line–associated bloodstream infections in the Veterans Health Administration?

HighlightsWe conducted an analysis using 4 years of data from intensive care nurses in Veterans Health Administration hospitals.Rates of global job satisfaction were assessed for a relationship with reported adherence to the central line insertion checklist and central line–associated bloodstream infections.Higher job satisfaction was related to a decreased relative risk of central line–associated bloodstream infections, but not an increase in reported checklist adherence. &NA; Nurses satisfied with their jobs report less job stress, more effective nurse‐physician collaboration, and higher patient satisfaction scores. It is unknown if job satisfaction influences adherence to best practices or patient outcomes. This secondary data analysis investigated the relationship between job satisfaction, adherence to the central line insertion checklist, and central line–associated bloodstream infections (CLABSIs). Results showed a decreased risk of CLABSI with higher job satisfaction, on average. No relationship was observed with checklist adherence.

Capturing the Central Line Bundle Infection Prevention Interventions: comparison of Reflective and Composite Modeling Methods

BackgroundThe central line (CL) bundle interventions are important for preventing central line-associated bloodstream infections (CLABSIs), but a modeling method for testing the CL bundle interventions within a health systems framework is lacking. ObjectivesGuided by the Quality Health Outcomes Model (QHOM), this study tested the CL bundle interventions in reflective and composite, latent, variable measurement models to assess the impact of the modeling approaches on an investigation of the relationships between adherence to the CL bundle interventions, organizational context, and CLABSIs. MethodsA secondary data analysis study was conducted using data from 614 U.S. hospitals that participated in the Prevention of Nosocomial Infection and Cost-Effectiveness Refined study. The sample was randomly split into exploration and validation subsets. ResultsThe two CL bundle modeling approaches resulted in adequate fitting structural models (RMSEA = .04; CFI = .94) and supported similar relationships within the QHOM. Adherence to the CL bundle had a direct effect on organizational context (reflective = .23; composite = .20; p = .01) and CLABSIs (reflective = −.28; composite = −.25; p = .01). The relationship between context and CLABSIs was not significant. Both modeling methods resulted in partial support of the QHOM. DiscussionThere were little statistical, but large, conceptual differences between the reflective and composite modeling approaches. The empirical impact of the modeling approaches was inconclusive, for both models resulted in a good fit to the data. Lessons learned are presented. The comparison of modeling approaches is recommended when initially modeling variables that have never been modeled or with directional ambiguity to increase transparency and bring confidence to study findings.

Improving school immunization rates may be as basic as record reconciliation and policy enforcement: a report from a rural Colorado public health/school district initiative.

The aim of this report was to assess the coverage rate of required immunizations for kindergarten-12 students in the Eagle County School District and to create a process for annual, district-wide immunization assessments to inform immunization campaigns. All kindergarten-12 student records were reviewed, and immunization rates during the 2012-2014 years were compiled. At baseline, only 2096 (34%) were in compliance with the Colorado School Immunization Law. After reconciliation of records and instituting a recall system in year 1 and enforcement of the Colorado School Immunization Law suspension rule in year 2, a total of 5862 (98.8%; P < .001) students were in compliance. Immunization rates for Eagle County School District students were unknown due to the lack of a process to assess a compliance rate and the lack of reconciliation of records. Although initially time-intensive, the project has impacted the community through the creation of a sustainable process of collecting and reporting student immunization records through a centralized state immunization registry.