New research shows that a leading cause of infection in hospital patients could be reduced if reminders are placed in medical records to encourage staff to assess and remove catheters, and if nurses are given the opportunity to remove urinary catheters.
Urinary catheters are the most frequent cause of hospital-associated infections (HAIs) in the United States. Up to 50 percent of those catheterizations are not medically necessary, and the presence of bacteria in urine increases five percent for every day that a catheter remains in place. In many cases, overworked hospital staff fail to adequately assess a patient's need for catheterization, or a physician simply forgets to assess a patient and the catheter remains in place much longer than necessary.
In most hospitals, according to Infection Control Today, removing a catheter is a complicated process. First, the physician must see that the catheter is there. Next, the physician must recognize it is unnecessary and write an order for removal. Finally, a nurse must remove the catheter according to the order.
The study, published in a July edition of Clinical Infectious Diseases, examined the effect of placing a reminder in a catheterized patient's chart that encourages physicians to assess the need for a catheter, or that automatically directs nurses to remove a catheter after a specific time period unless a physician orders otherwise. The study also looked at the effect of allowing nurses to remove catheters without a physician's stop order.
Study results showed that reminder systems reduced catheter-associated UTIs by 52 percent, and that implementing such systems should be a "no brainer" for hospitals.
"Because catheter reminders and stop orders are beneficial regardless of the technology used — from verbal bedside reminders to computer-generated stop orders — these interventions appear to be low-cost strategies that could be implemented in any healthcare system," wrote study author Dr. Jennifer Meddings of the University of Michigan Health System.
If you or a loved one is catheterized or returns home from the hospital with a catheter still inserted, the CDC offers guidelines for patients:
- Make sure to ask questions so as to understand how to care for a catheter once home from the hospital
- Contact a doctor or nurse immediately if any symptoms of a urinary tract infection develop, such as a burning pain in the lower abdomen, fever, or an increase in the frequency of urination
- Always clean hands before and during catheter care
- Keep urine bags below bladder level
- Do not tug or pull on the tubing, or twist or kink the tubing
Catheters remain one of the primary causes of hospital associated infections in the US. Patients with catheters or those caring for loved ones who have been catheterized should ask questions of health care providers to determine whether a catheterization remains necessary.
Hospitals that offer private rooms to patients recovering in an intensive care unit (ICU) find up to a 51 percent decrease in healthcare-associated infections (HAIs).
According to the study, published in the January 10th issue of the Archives of Internal Medicine, up to 30 percent of ICU patients acquire an HAI during recovery.
"An ICU environment with private rooms may facilitate better infection control practices, therefore reducing the transmission of infectious organisms," study authors wrote. "Conversion to single rooms can substantially reduce the rate at which patients acquire infectious organisms while in the ICU."
The study compared two Canadian hospitals operated by the same university in the same city with similar caregivers. In one hospital, multi-bed ICUs were changed to private rooms. In the other, the multi-bed ICU was left alone.
After nearly 20,000 ICU admissions, researchers found that the hospital with private rooms in the ICU showed a decrease of 47 percent in methicillin-resistant Staphylococcus aureus (MRSA) infections, a 43 percent decrease in Clostridium difficile infection and a 51 percent decrease in yeast infections.
Patients in private rooms also benefited from a ten percent shorter length of stay, which Infection Control Today reports may be due to an average potential 8 to 9 day additional hospitalization required after acquisition of an HAI.
While there is expense in renovating hospital ICUs to allow for private care, there may be long-term savings. The potential cost savings to the healthcare system of eliminating those additional days in the hospital may be as high as $3.5 billion each year in the United States.
Don’t be surprised if your primary care physician starts asking you or a loved one to take a long walk around the office after a 65th birthday. A study reported on in this month’s Journal of the American Medical Association shows that how fast older adults walk can predict how many years of life they have left.
The University of Pittsburgh study, which analyzed data from over 34,000 individuals over the age of 65 collected between 1986 and 2000, found that there is an association with gait speed and survival, with a quicker gait signifying a longer life.
The Boston Globe’s Daily Dose blog analyzed the study and found that only 19 percent of 75-year-old men who were in the slowest-walking group lived until their 85th birthday, compared with 87 percent of the fastest walking men. For women, the numbers increased to 35 percent and 91 percent, respectively.
Gait speed was found to be as accurate in predicting survival as measures of age, sex, use of mobility aids, self-reported function, chronic conditions, smoking history, blood pressure, body mass index, and hospitalization.
Before you strain to put a spring in your step, however, consider that many signs of poor health also contribute to a slower walking speed. Circulation problems, diabetes, obesity, Parkinson’s and poor lung function may all result in a slower gait in addition to being indicators of poor health. Also, a quicker gait may be the result of having lived a healthy life full of exercise – which may also explain longevity.
There is help for seniors and caregivers who are worried about the speed of their gait! Older adults and caregivers should talk with a physician about ways to treat conditions that may be slowing their walk. Exercise, yoga, and managing chronic conditions are all important ways to keep older adults on their feet.