Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
Center for Clinical Management Research, Veterans' Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
Infect Control Hosp Epidemiol. 2024 Jan;45(1):40-47. doi: 10.1017/ice.2023.127. Epub 2023 Aug 17.
US policies require robust nursing home (NH) infection prevention and control (IPC) programs to ensure safe care. We assessed IPC resources and practices related to catheter and non-catheter-associated urinary tract infection (CAUTI and UTI) prevention among NHs.
We conducted a mixed-methods study from April 2018 through November 2019. Quantitative surveys assessed NH IPC program resources, practices, and communication during resident transfer. Semistructured qualitative interviews focused on IPC programs, CAUTI and UTI prevention practices, and resident transfer processes. Using a matrix as an analytic tool, findings from the quantitative survey data were combined with the qualitative data in the form of a joint display.
Representatives from 51 NHs completed surveys; interviews were conducted with 13 participants from 7 NHs. Infection preventionists (IPs) had limited experience and/or additional roles, and in 36.7% of NHs, IPs had no specific IPC training. IP turnover was often mentioned during interviews. Most facilities were aware of their CAUTI and UTI rates and reported using prevention practices, such as hydration (85.7%) or nurse-initiated catheter discontinuation (65.3%). Qualitative interviewees confirmed use of these practices and expressed additional concerns about overuse of urine testing and antibiotics. Although transfer sheets were used by 84% to communicate about infections, the information received was described as suboptimal.
NHs identified IP challenges related to turnover, limited education, and serving multiple roles. However, most NHs reported awareness of their CAUTI and UTI rates as well as their use of prevention practices. Importantly, we identified opportunities to enhance communication between NHs and hospitals to improve resident care and safety.
美国的政策要求养老院（NH）建立强有力的感染预防和控制（IPC）计划，以确保安全护理。我们评估了与导管和非导管相关的尿路感染（CAUTI 和 UTI）预防相关的 IPC 资源和实践在 NH 中的应用。
我们进行了一项混合方法研究，从 2018 年 4 月至 2019 年 11 月。定量调查评估了 NH IPC 计划资源、实践和居民转移期间的沟通情况。半结构定性访谈侧重于 IPC 计划、CAUTI 和 UTI 预防实践以及居民转移过程。使用矩阵作为分析工具，将定量调查数据的发现与定性数据以联合展示的形式结合起来。
51 家 NH 的代表完成了调查；对 7 家 NH 的 13 名参与者进行了访谈。感染预防员（IP）经验有限且/或有其他角色，36.7%的 NH 中 IP 没有特定的 IPC 培训。在访谈中经常提到 IP 的更替。大多数机构都知道自己的 CAUTI 和 UTI 率，并报告使用预防措施，如补液（85.7%）或护士主动停止导尿（65.3%）。定性访谈者证实了这些措施的使用，并对尿液检测和抗生素的过度使用表示了额外的担忧。尽管 84%的机构使用转科表来沟通感染情况，但收到的信息被描述为不理想。
NH 确定了与更替、教育有限和多角色有关的 IP 挑战。然而，大多数 NH 报告了对自己的 CAUTI 和 UTI 率以及预防措施的使用意识。重要的是，我们确定了加强 NH 和医院之间沟通的机会，以改善居民的护理和安全。
