VA and Non-VA Nursing Homes Differ in CAUTI Prevention Methods

BACKGROUND:
VA nursing homes serve nearly 50,000 Veterans each year, and urinary tract infection (UTI) is the most commonly reported infection. To help reduce the incidence of healthcare-associated infections (HAIs) in nursing homes, the Agency for Healthcare Research and Quality (AHRQ) Safety Program for Long-term Care: HAIs/CAUTI aimed to reduce catheter-associated urinary tract infections (CAUTIs), enhance frontline healthcare professional knowledge about infection prevention, and improve the safety culture in nursing homes. This study sought to compare infection prevention resources and practices between VA (n=47) and non-VA nursing homes (n=306) from 41 states that were participating as part of this national initiative. Between January 2014 and June 2015 a needs assessment questionnaire was sent to the organizational leads responsible for managing project activities among a group of nursing home facilities. The questionnaire included 30 items about infection prevention, with a specific focus on CAUTI prevention. Investigators also collected information on nursing home characteristics such as number of residents, physicians, and nurses; information about the facility's infection preventionists; presence of a committee to review HAIs; and types of resident services delivered.

FINDINGS:

• VA and non-VA nursing homes differed in their approach to CAUTI prevention:
  • VA nursing homes reported more hours/week devoted to infection prevention-related activities (31 vs. 12 hours), and were more likely to have committees that reviewed HAIs.
  • VA nursing homes had substantially higher physician and nurse staffing to bed ratios compared with non-VA nursing homes (5.0 vs. 3.2 and 30.4 vs. 13.6 per 100 beds, respectively).
  • A higher percentage of VA nursing homes also reported having 24-hour registered nurse supervision compared to non-VA nursing homes (96% vs. 56%).
  • Most VA nursing home infection prevention programs were integrated within their VA acute care infection prevention programs, and they had more infection prevention related resources.
• A higher percentage of VA nursing homes reported tracking CAUTI rates (94% vs. 66%) and sharing CAUTI data with leadership and nursing personnel.
• Overall, a lower percentage of VA nursing homes reported having policies concerning appropriate catheter use or catheter insertion compared to non-VA nursing homes. For example, only 64% of VA nursing homes had policies specifying the appropriate indications for catheter use compared with 81% of non-VA nursing homes.

IMPLICATIONS:

• Authors suggest that best practices from both VA and non-VA nursing homes be universally adopted and promoted to reduce HAIs and improve resident safety in this setting.

LIMITATIONS:

• This study was conducted within a collaborative setting with voluntary participation, resulting in a self-selection bias.
• Investigators did not have information about resident demographics, diagnoses, or comorbidities.

AUTHOR/FUNDING INFORMATION:
This study was partly funded by HSR&D (RRP-12-443), and Dr. Krein was supported by an HSR&D Research Career Scientist Award. Drs. Greene, Saint, and Krein are part of HSR&D's Center for Clinical Management Research (CCMR) in Ann Arbor, MI.

Mody L, Greene M, Saint S, et al., and Krein S. Comparing Catheter-associated Urinary Tract Infection Prevention Programs between VA and Non-VA Nursing Homes. Infection Control and Hospital Epidemiology. December 5, 2016;e-pub ahead of print.