UTI: Clinical and System Reviews, Incident Analyses

Given the broad range of potential causes of hospital associated UTI, clinical and system reviews should be conducted to identify latent causes and determine appropriate recommendations.

Occurrences of harm are often complex with many contributing factors. Organizations need to:

1. Measure and monitor the types and frequency of these occurrences.
2. Use appropriate analytical methods to understand the contributing factors.
3. Identify and implement solutions or interventions that are designed to prevent recurrence and reduce risk of harm.
4. Have mechanisms in place to mitigate consequences of harm when it occurs.

To develop a more in-depth understanding of the care delivered to patients, chart audits, incident analyses and prospective analyses can be helpful in identifying quality improvement opportunities. Links to key resources for conducting chart audits and analysis methods are included in the section Resources for Conducting Incident and/or Prospective Analyses section of the Hospital Harm Improvement Resources Introduction.

If your review reveals that your cases of UTI are linked to specific processes or procedures, you may find these resources helpful:

• ACTT - Accelerating Change Transformation Team https://actt.albertadoctors.org/CPGs
• Toward Optimized Practice (TOP). Diagnosis and Management of Urinary Tract Infection in Long Term Care Facilities: Clinical Practice Guideline. TOP; 2015. https://actt.albertadoctors.org/CPGs/Pages/Urinary-Tract-Infection---Long-Term-Care-Facilities.aspx

• Association of Medical Microbiology and Infectious Disease Canada (AMMI Canada) ammi.ca
• Association of Medical Microbiology and Infectious Disease Canada. Asymptomatic Bacteriuria. https://www.ammi.ca/?ID=127

• Association for Professionals in Infection Control and Epidemiology (APIC) apic.org
• Association for Professionals in Infection Control and Epidemiology. APIC Implementation Guide: Guide to Preventing Catheter-Associated Urinary Tract Infections. APIC; 2014. a rel="noopener" href="https://apic.org/professional-practice/implementation-guides/#implementaion-guide-7454" target="_blank">https://apic.org/professional-practice/implementation-guides/#implementaion-guide-7454
• Canadian Urological Association Journal cuaj.ca
• Hill TC, Baverstock R, Carlson KV, et al. Best practices for the treatment and prevention of urinary tract infection in the spinal cord injured population. CUAJ. 2013;7(3-4):122-130. doi:10.5489/cuaj.337. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3650772/
• Centers for Disease Control and Prevention (CDC). www.cdc.gov
• Centers for Disease Control and Prevention. Urinary Tract Infection (Catheter-Associated Urinary TractInfection [CAUTI] and Non-Catheter-Associated Urinary TractInfection [UTI]) Events. CDC; 2021.https://www.cdc.gov/nhsn/pdfs/pscmanual/7psccauticurrent.pdf
• Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA, Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for Prevention of Catheter-Associated Urinary Tract Infections 2009. Centers for Disease Control and Prevention (CDC); 2010. http://www.cdc.gov/hicpac/pdf/cauti/cautiguideline2009final.pdf
• Cochrane Library https://www.cochranelibrary.com/
• Flodgren G, Conterno L, Mayhew A, Omar O, Pereira C, Shepperd S. Interventions to improve professional adherence to guidelines for prevention of device‐related infections. Cochrane Database of Systematic Reviews. 2013;(3). doi:10.1002/14651858.CD006559.pub2 https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006559.pub2/full
• Heart & Lung - The Journal of Cardiopulmonary and Acute Care https://www.heartandlung.org/
• Conway LJ, Larson EL. Guidelines to prevent catheter-associated urinary tract infection: 1980 to 2010. Heart & Lung: The Journal of Cardiopulmonary and Acute Care. 2012;41(3):271-283. doi:10.1016/j.hrtlng.2011.08.001 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3362394/
• Infectious Diseases Society of America www.idsa.org
• Hooton TM, Bradley SF, Cardenas DD, et al. Diagnosis, Prevention, and Treatment of Catheter-Associated Urinary Tract Infection in Adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clinical Infectious Diseases. 2010;50(5):625-663. doi:10.1086/650482 http://cid.oxfordjournals.org/content/50/5/625.long
• Infection Prevention and Control Canada (IPAC CANADA) ipac-canada.org
• Happe J, Stoll F, Biluk L, et al. Surveillance Definitions of Infections in Canadian Long Term Care Facilities. Can J Infect Control. 2017;(Suppl):10-17.
  https://ipac-canada.org/photos/custom/pdf/LTCSurveillanceToolkit_AppendixA_CaseDefinitions.pdf
• Institute for Healthcare Improvement (IHI) www.ihi.org
• Institute for Healthcare Improvement. How-to Guide: Prevent catheter-associated urinary tract infections. Cambridge, MA: IHI; 2011. http://www.ihi.org/resources/Pages/Tools/HowtoGuidePreventCatheterAssociatedUrinaryTractInfection.aspx
• International Journal for Quality Health Care https://academic.oup.com/intqhc
• Clarke K, Tong D, Pan Y, et al. Reduction in catheter-associated urinary tract infections by bundling interventions. International Journal for Quality in Health Care. 2013;25(1):43-49. doi:10.1093/intqhc/mzs077 http://intqhc.oxfordjournals.org/content/25/1/43
• Journal of Nursing Care Quality https://journals.lww.com/jncqjournal/pages/default.aspx
• Andreessen L, Wilde MH, Herendeen P. Preventing Catheter-Associated Urinary Tract Infections in Acute Care: The Bundle Approach. Journal of Nursing Care Quality. 2012;27(3). doi:10.1097/NCQ.0b013e318248b0b1 https://journals.lww.com/jncqjournal/Fulltext/2012/07000/Preventing_Catheter_Associated_Urinary_Tract.4.aspx
• New England Journal of Medicine www.nejm.org
• Magill SS, Edwards JR, Bamberg W, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med. 2014;370(13):1198-1208. doi:10.1056/NEJMoa1306801 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4648343/

• Society of Obstetricians and Gynaecologists of Canada www.sogc.org
• Epp A, Larochelle A, Lovatsis D, et al. Recurrent Urinary Tract Infection. Journal of Obstetrics and Gynaecology Canada. 2010;32(11):1082-1090. doi:10.1016/S1701-2163(16)34717-X http://sogc.org/guidelines/recurrent-urinary-tract-infection/
• Government of Saskatchewan –eHealth www.ehealthsask.ca
• Government of Saskatchewan Ministry of Health. Guidelines for the Prevention and Treatment of Urinary Tract Infections (UTIs) in Continuing Care Settings. Government of Saskatchewan; 2013. https://www.ehealthsask.ca/services/resources/Resources/UTI-guidelines-april2013.pdf

• The Joint Commission www.jointcommission.org
• The Joint Commission. Surgical Care Improvement Project (SCIP). SCIP-Inf-9: Urinary catheter removed on postoperative day 1 (POD 1) or postoperative day 2 (POD 2) with day or surgery being day zero. Specifications manual for national hospital inpatient quality measures. Joint Commission; 2013. http://www.hospitalsafetyscore.org/media/file/SCIPINF9.pdf