Ensuring the effective use of evidence-based practices in real-world clinical settings can be challenging. We believe that nurses play a key role in the implementation of such practices, especially practices aimed at preventing healthcare-associated infection. Catheter-related urinary tract infection} the most frequent healthcare-associated infection in the United States} is a costly and potentially lethal condition. The state of Michigan is initiating an ambitious patient safety project to ameliorate the burden of disease associated with indwelling catheterization. The overarching objective of this research is to identify and develop strategies to optimize the implementation of key practices in the field of patient safety and healthcare-associated infection prevention. This study has three aims: 1) To describe the adoption and implementation of a Catheter-Associated Urinary Tract Infection Prevention Bundle (Bladder Bundle) as part of a Michigan state-wide patient safety initiative and assess patient outcomes such as catheter utilization and infection rates;2) To identify and compare the barriers to and facilitators of implementing the Bladder Bundle across a diverse group of hospitals;and 3) To develop and evaluate strategies to facilitate implementation of the Bladder Bundle and assess patient outcomes including catheter utilization, discontinuation, re-insertion, and infection rates. This investigation includes the collection and analysis of both quantitative and qualitative data. We have assembled an interdisciplinary team that has already worked successfully together on a prior study to conduct this timely and innovative patient safety project. For the first aim we will use survey methods to describe the diffusion, adoption, and implementation of the Bladder Bundle and key patient outcomes. For the second aim we will use primarily qualitative methods, consisting of both phone interviews and site visits. This approach will allow us to examine in greater depth complex organizational factors that serve as either facilitators or barriers to implementing the Bladder Bundle. We will also develop implementation strategies and tools that will then be evaluated in collaboration with three hospitals that are in the process of implementing the Bladder Bundle. For the third aim we propose to collect qualitative data before, during, and after the implementation of the intervention in order to conduct a formative evaluation, including an evaluation of implementation process, attainment, and sustainability. We will also collect quantitative data on patient outcomes such as catheter use, discontinuation, and infection rates.

Public Health Relevance

Catheter-related urinary tract infection is a common, costly, and potentially lethal condition. The purpose of this research is to develop methods to help prevent catheter-related urinary tract infection. Our study will also provide insight on how to prevent other healthcare-associated infections, thereby creating a safer healthcare system.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Research Project (R01)
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Special Emphasis Panel (ZRG1-HOP-X (50))
Program Officer
Tigno, Xenia
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University of Michigan Ann Arbor
Internal Medicine/Medicine
Schools of Medicine
Ann Arbor
United States
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Saint, Sanjay; Gaies, Elissa; Fowler, Karen E et al. (2014) Introducing a catheter-associated urinary tract infection (CAUTI) prevention guide to patient safety (GPS). Am J Infect Control 42:548-50
Meddings, Jennifer; Rogers, Mary A M; Krein, Sarah L et al. (2014) Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review. BMJ Qual Saf 23:277-89
Harrod, Molly; Manojlovich, Milisa; Kowalski, Christine P et al. (2014) Unique factors rural Veterans' Affairs hospitals face when implementing health care-associated infection prevention initiatives. J Rural Health 30:17-26
Harrod, Molly; Kowalski, Christine P; Saint, Sanjay et al. (2013) Variations in risk perceptions: a qualitative study of why unnecessary urinary catheter use continues to be problematic. BMC Health Serv Res 13:151
Saint, Sanjay; Greene, M Todd; Kowalski, Christine P et al. (2013) Preventing catheter-associated urinary tract infection in the United States: a national comparative study. JAMA Intern Med 173:874-9
Krein, Sarah L; Kowalski, Christine P; Harrod, Molly et al. (2013) Barriers to reducing urinary catheter use: a qualitative assessment of a statewide initiative. JAMA Intern Med 173:881-6
Saint, Sanjay; Greene, M Todd; Olmsted, Russell N et al. (2013) Perceived strength of evidence supporting practices to prevent health care-associated infection: results from a national survey of infection prevention personnel. Am J Infect Control 41:100-6
Saint, Sanjay; Greene, M Todd; Damschroder, Laura et al. (2013) Is the use of antimicrobial devices to prevent infection correlated across different healthcare-associated infections? Results from a national survey. Infect Control Hosp Epidemiol 34:847-9
Fakih, Mohamad G; Watson, Sam R; Greene, M Todd et al. (2012) Reducing inappropriate urinary catheter use: a statewide effort. Arch Intern Med 172:255-60
Meddings, Jennifer A; Reichert, Heidi; Rogers, Mary A M et al. (2012) Effect of nonpayment for hospital-acquired, catheter-associated urinary tract infection: a statewide analysis. Ann Intern Med 157:305-12

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