National Healthcare Quality and Disparities Report
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Search All Research Studies
Topics
- Adverse Events (3)
- Antibiotics (2)
- Antimicrobial Stewardship (2)
- Catheter-Associated Urinary Tract Infection (CAUTI) (3)
- Central Line-Associated Bloodstream Infections (CLABSI) (3)
- Clostridium difficile Infections (2)
- Critical Care (2)
- Evidence-Based Practice (1)
- Guidelines (1)
- (-) Healthcare-Associated Infections (HAIs) (11)
- Hospitals (3)
- Infectious Diseases (2)
- (-) Inpatient Care (11)
- Intensive Care Unit (ICU) (2)
- Medication (1)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (1)
- Mortality (1)
- Nursing (1)
- Nursing Homes (1)
- Patient-Centered Outcomes Research (1)
- Patient Safety (8)
- Pneumonia (1)
- Practice Patterns (1)
- Prevention (2)
- Provider (1)
- Provider: Nurse (2)
- Respiratory Conditions (1)
- Shared Decision Making (1)
- Teams (1)
- Urinary Tract Infection (UTI) (3)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 11 of 11 Research Studies DisplayedCohen B, Sanabria E, Liu J
Predicting healthcare-associated infections, length of stay, and mortality with the nursing intensity of care index.
The purpose of this study was to develop, validate, and utilize a simulation model to predict healthcare-associated infections (HAIs), length of stay (LOS), and patient mortality, as well as evaluate whether the variation in incidence of HAIs was dependent upon the adequacy of unit staffing levels. The researchers analyzed data from all patients discharged from four different types of New York City hospitals within a single healthcare network between 2012-2016 (N=562,435). The researchers developed a simulation model to estimate the daily probability rates of 5 different HAIs, length of stay, and mortality, and modeled staffing adequacy based on nursing care supply (as indicated by total nurse staffing) and nursing care demand (indicated using the Nursing Intensity of Care Index.) The study results indicated that the model predictions were within 95% confidence intervals of the actual outcomes. The authors reported that the incidence of HAI was the highest when total nurse staffing (supply) was lowest and nursing care intensity (demand) was highest.
AHRQ-funded; HS024915.
Citation: Cohen B, Sanabria E, Liu J .
Predicting healthcare-associated infections, length of stay, and mortality with the nursing intensity of care index.
Infect Control Hosp Epidemiol 2022 Mar;43(3):298-305. doi: 10.1017/ice.2021.114..
Keywords: Healthcare-Associated Infections (HAIs), Provider: Nurse, Inpatient Care, Mortality
Deshpande A, Richter SS, Haessler S
De-escalation of empiric antibiotics following negative cultures in hospitalized patients with pneumonia: rates and outcomes.
This study assessed antibiotic de-escalation practices across hospitals and their associations with outcomes in hospitalized patients diagnosed with pneumonia with negative cultures. The authors included 14,170 adults admitted with pneumonia in 2010-2015 to 164 US hospitals if they had negative blood and/or respiratory cultures and received both anti-MRSA and antipseudomonal agents other than quinolones. If empiric drugs were stopped on day 4 while continuing another antibiotic it was defined at de-escalation. Patients were propensity adjusted for de-escalation and compared on in-hospital 14-day mortality, late deterioration with ICU transfer, length-of-stay (LOS) and costs. Thirteen percent (1924 patients) had both initial empiric drugs stopped by hospital day 4. De-escalation rates at hospitals ranged from 2-35% and the established rate quartiles were not significantly associated with outcomes. Even at hospitals in the top quartile of de-escalation, the de-escalation rates were lower than 50%.
AHRQ-funded; HS025026; HS024277.
Citation: Deshpande A, Richter SS, Haessler S .
De-escalation of empiric antibiotics following negative cultures in hospitalized patients with pneumonia: rates and outcomes.
Clin Infect Dis 2021 Apr 26;72(8):1314-22. doi: 10.1093/cid/ciaa212..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Pneumonia, Respiratory Conditions, Methicillin-Resistant Staphylococcus aureus (MRSA), Healthcare-Associated Infections (HAIs), Inpatient Care
Meddings J, Greene MT, Ratz D
Multistate programme to reduce catheter-associated infections in intensive care units with elevated infection rates.
AHRQ’s Safety Program for ICUs aimed to reduce central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) in intensive care units with elevated rates. Included hospitals had at least one adult intensive care unit with elevated CLABSI or CAUTI rates. The investigators targeted intensive care units with elevated catheter infection rates but yielded no statistically significant reduction in CLABSI, CAUTI or catheter utilization in the first two of six planned cohorts. Improvements in the interventions based on lessons learned from these initial cohorts are being applied to subsequent cohorts.
AHRQ-funded; 233201500016I.
Citation: Meddings J, Greene MT, Ratz D .
Multistate programme to reduce catheter-associated infections in intensive care units with elevated infection rates.
BMJ Qual Saf 2020 May;29(5):418-29. doi: 10.1136/bmjqs-2019-009330..
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Infectious Diseases, Patient Safety, Urinary Tract Infection (UTI), Intensive Care Unit (ICU), Hospitals, Evidence-Based Practice, Patient-Centered Outcomes Research, Inpatient Care, Critical Care
Krein SL, Kuhn L, Ratz D
Use of designated nurse PICC teams and CLABSI prevention practices among U.S. hospitals: a survey-based study.
The authors identified the prevalence of and factors associated with having a designated nurse peripherally inserted central catheter (PICC) team among U.S. acute care hospitals. They found that nurse PICC teams inserted PICCs in more than 60% of U.S. hospitals during the study period. Moreover, certain practices to prevent central line-associated bloodstream infection, including maximum sterile barrier precautions, chlorhexidine gluconate for insertion site antisepsis, and facility-wide insertion checklists were regularly used by a higher percentage of hospitals with nurse PICC teams compared with those without. They concluded that nurse PICC teams play an integral role in PICC use at many hospitals and that use of such teams may promote key practices to prevent complications.
AHRQ-funded; HS022835.
Citation: Krein SL, Kuhn L, Ratz D .
Use of designated nurse PICC teams and CLABSI prevention practices among U.S. hospitals: a survey-based study.
J Patient Saf 2019 Dec;15(4):293-95. doi: 10.1097/pts.0000000000000246..
Keywords: Nursing, Teams, Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Inpatient Care, Hospitals, Patient Safety, Prevention, Provider: Nurse, Provider
Hsu HE, Wang R, Jentzsch MS
Association between value-based incentive programs and catheter-associated urinary tract infection rates in the critical care setting.
This letter discussed a study which was done on value-based incentive programs to reduce the number of catheter-associated urinary tract infections (CAUTI) in intensive care units (ICUs). The study used data from 592 hospitals in the District of Columbia and 49 states. Researchers found these incentive programs did not significantly reduce CAUTI.
AHRQ-funded; HS000063; HS025008; HS018414.
Citation: Hsu HE, Wang R, Jentzsch MS .
Association between value-based incentive programs and catheter-associated urinary tract infection rates in the critical care setting.
JAMA 2019 Feb 5;321(5):509-11. doi: 10.1001/jama.2018.18997.
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Keywords: Adverse Events, Catheter-Associated Urinary Tract Infection (CAUTI), Critical Care, Healthcare-Associated Infections (HAIs), Inpatient Care, Patient Safety, Urinary Tract Infection (UTI)
Govindan S, Snyder A, Flanders SA
Peripherally inserted central catheters in the ICU: a retrospective study of adult medical patients in 52 hospitals.
This study quantified use of peripherally inserted central catheters in the ICU versus the general ward in 52 Michigan hospitals. Variation in complications and outcomes of use were compared. Use in the ICU produced worse outcomes than those inserted in the general ward.
AHRQ-funded; HS022835.
Citation: Govindan S, Snyder A, Flanders SA .
Peripherally inserted central catheters in the ICU: a retrospective study of adult medical patients in 52 hospitals.
Crit Care Med 2018 Dec;46(12):e1136-e44. doi: 10.1097/ccm.0000000000003423..
Keywords: Adverse Events, Healthcare-Associated Infections (HAIs), Inpatient Care, Intensive Care Unit (ICU), Patient Safety
Anderson DJ, Moehring RW, Weber DJ
Effectiveness of targeted enhanced terminal room disinfection on hospital-wide acquisition and infection with multidrug-resistant organisms and Clostridium difficile: a secondary analysis of a multicentre cluster randomised controlled trial with crossover
In this study, the investigators aimed to assess the effectiveness of four disinfection strategies on hospital-wide incidence of multidrug-resistant organisms and Clostridium difficile in the Benefits of Enhanced Terminal Room (BETR) Disinfection study. The investigators found that enhanced terminal room disinfection with ultraviolet (UV) in a targeted subset of high-risk rooms led to a decrease in hospital-wide incidence of C difficile and vancomycin-resistant enterococci.
AHRQ-funded; HS023866.
Citation: Anderson DJ, Moehring RW, Weber DJ .
Effectiveness of targeted enhanced terminal room disinfection on hospital-wide acquisition and infection with multidrug-resistant organisms and Clostridium difficile: a secondary analysis of a multicentre cluster randomised controlled trial with crossover
Lancet Infect Dis 2018 Aug;18(8):845-53. doi: 10.1016/s1473-3099(18)30278-0..
Keywords: Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Hospitals, Infectious Diseases, Inpatient Care, Patient Safety, Prevention
Paje D, Conlon A, Kaatz S
Patterns and predictors of short-term peripherally inserted central catheter use: a multicenter prospective cohort study.
The goal of this study was to identify patient, provider, and device characteristics and the clinical outcomes associated with short-term peripherally inserted central catheters (PICCs). Trained abstractors collected data from the medical records of adults that received PICCs during hospitalization; patients were prospectively followed until PICC removal, death, or 70 days after insertion. Complications associated with short-term use were assessed. Major complications included venous thromboembolism or central line associated bloodstream infection. Common minor complications were catheter occlusion and tip migration.
AHRQ-funded; HS022835.
Citation: Paje D, Conlon A, Kaatz S .
Patterns and predictors of short-term peripherally inserted central catheter use: a multicenter prospective cohort study.
J Hosp Med 2018 Feb;13(2):76-82. doi: 10.12788/jhm.2847..
Keywords: Adverse Events, Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Inpatient Care, Patient Safety, Practice Patterns
Seidelman J, Dicks KV, Durkin MJ
Using clinical scenarios to understand preventability of Clostridium difficile infections by inpatient antibiotic stewardship programs.
The authors of this research brief designed a 2-phase study (1) to define the types of clostridium difficile infections (CDI) that clinicians consider unlikely preventable by inpatient antibiotic stewardship programs and (2) to estimate the relative proportion of inpatient CDI cases at a tertiary-care hospital that belongs to this category of “nonpreventable” CDI.
AHRQ-funded; HS023866.
Citation: Seidelman J, Dicks KV, Durkin MJ .
Using clinical scenarios to understand preventability of Clostridium difficile infections by inpatient antibiotic stewardship programs.
Infect Control Hosp Epidemiol 2017 Jun;38(6):747-49. doi: 10.1017/ice.2017.32..
Keywords: Antibiotics, Antimicrobial Stewardship, Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Healthcare-Associated Infections (HAIs), Inpatient Care
Mody L, Meddings J, Edson BS
Enhancing resident safety by preventing healthcare-associated infection: a national initiative to reduce catheter-associated urinary tract infections in nursing homes.
The authors describe a new initiative based on lessons learned from a recent multimodal Targeted Infection Prevention program in a group of nursing homes as well as a national initiative to prevent catheter-associated urinary tract infections in over 950 acute care hospitals. This initiative will now be implemented in nearly 500 nursing homes through a project funded by AHRQ. It will emphasize professional development in catheter utilization, catheter care and maintenance, and antimicrobial stewardship.
AHRQ-funded; 2902010000251; HS019979; HS019767.
Citation: Mody L, Meddings J, Edson BS .
Enhancing resident safety by preventing healthcare-associated infection: a national initiative to reduce catheter-associated urinary tract infections in nursing homes.
Clin Infect Dis 2015 Jul 1;61(1):86-94. doi: 10.1093/cid/civ236..
Keywords: Nursing Homes, Healthcare-Associated Infections (HAIs), Urinary Tract Infection (UTI), Patient Safety, Inpatient Care
Meddings J, Saint S, Fowler KE
The Ann Arbor criteria for appropriate urinary catheter use in hospitalized medical patients: results obtained by using the RAND/UCLA Appropriateness Method.
A 15-member multidisciplinary panel used the RAND/UCLA Appropriateness Method to assess the appropriateness of using Foley catheters, intermittent straight catheters, and external condom catheters for hospitalized adults on medical services in 299 scenarios, including urinary retention, incontinence, and wounds. The panel concluded that these new appropriateness criteria can inform large-scale collaborative and bedside efforts to reduce inappropriate urinary catheter use.
AHRQ-funded; 290201000025I; HS019767
Citation: Meddings J, Saint S, Fowler KE .
The Ann Arbor criteria for appropriate urinary catheter use in hospitalized medical patients: results obtained by using the RAND/UCLA Appropriateness Method.
Ann Intern Med. 2015 May 5;162(9 Suppl):S1-34. doi: 10.7326/m14-1304..
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Shared Decision Making, Guidelines, Healthcare-Associated Infections (HAIs), Inpatient Care, Patient Safety