National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Events (3)
- Ambulatory Care and Surgery (2)
- Antibiotics (4)
- Antimicrobial Stewardship (2)
- Case Study (1)
- Catheter-Associated Urinary Tract Infection (CAUTI) (12)
- Central Line-Associated Bloodstream Infections (CLABSI) (6)
- Children/Adolescents (3)
- Clinical Decision Support (CDS) (1)
- Clostridium difficile Infections (1)
- Communication (1)
- Critical Care (2)
- Decision Making (2)
- Diagnostic Safety and Quality (3)
- Elderly (1)
- Electronic Health Records (EHRs) (1)
- Evidence-Based Practice (1)
- Healthcare-Associated Infections (HAIs) (14)
- Healthcare Costs (1)
- Health Information Technology (HIT) (1)
- Home Healthcare (1)
- Hospitals (2)
- Infectious Diseases (2)
- Inpatient Care (1)
- Intensive Care Unit (ICU) (1)
- Long-Term Care (2)
- Maternal Care (1)
- Medicare (1)
- Medication (4)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (1)
- Newborns/Infants (1)
- Nursing Homes (2)
- Patient-Centered Outcomes Research (3)
- Patient Safety (8)
- Practice Patterns (1)
- Pregnancy (1)
- Prevention (4)
- Quality Improvement (2)
- Quality of Care (4)
- Risk (2)
- Screening (1)
- Surgery (2)
- U.S. Preventive Services Task Force (USPSTF) (1)
- (-) Urinary Tract Infection (UTI) (21)
- Women (2)
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 21 of 21 Research Studies DisplayedClark AW, Durkin MJ, Olsen MA
Rural-urban differences in antibiotic prescribing for uncomplicated urinary tract infection.
This study examined rural-urban differences in temporal trends and risk of inappropriate antibiotic use by agent and duration among women with uncomplicated urinary tract infection (UTI). This observational cohort study identified US commercially insured women aged 18-44 coded for uncomplicated UTI and prescribed an antibiotic from the IBM MarketScan Commercial Database (2010-2015). Of the 670,450 women with uncomplicated UTIs, a large proportion received antibiotic prescriptions for inappropriate agents (46.7%) or durations (76.1%). Rural women were more likely to receive prescriptions with inappropriately long durations than urban women. There was a slight decline in patients who received inappropriate agents and durations from 2011 to 2015. Rural-urban differences varied over time by agent, geographic region, and provider specialty.
AHRQ-funded; HS019455.
Citation: Clark AW, Durkin MJ, Olsen MA .
Rural-urban differences in antibiotic prescribing for uncomplicated urinary tract infection.
Infect Control Hosp Epidemiol 2021 Dec;42(12):1437-44. doi: 10.1017/ice.2021.21..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Urinary Tract Infection (UTI), Practice Patterns
Butler AM, Durkin MJ, Keller MR
Risk of antibiotic treatment failure in premenopausal women with uncomplicated urinary tract infection.
This study compared treatment outcomes for various antibiotics in premenopausal women with uncomplicated urinary tract infections (UTIs). The authors compared treatment with fluoroquinolones (first-line), trimethoprim-sulfamethoxazole (TMP/SMX) (first-line), nitrofurantoin (first-line), narrow-spectrum β-lactams (non-first-line), and amoxicillin/ampicillin (non-recommended). Over 1.1 million patient outcomes were analyzed. The risk of treatment failure differed by the antibiotic type, with higher risk associated with TMP/SMX versus nitrofurantoin, and lower or similar risk associated with broad- versus narrow-spectrum β-lactams.
AHRQ-funded; HS019455.
Citation: Butler AM, Durkin MJ, Keller MR .
Risk of antibiotic treatment failure in premenopausal women with uncomplicated urinary tract infection.
Pharmacoepidemiol Drug Saf 2021 Oct;30(10):1360-70. doi: 10.1002/pds.5237..
Keywords: Antibiotics, Medication, Urinary Tract Infection (UTI), Women
Woo K, Adams V, Wilson P
Identifying urinary tract infection-related information in home care nursing notes.
Urinary tract infection (UTI) is common in home care but not easily captured with standard assessment. This study aimed to examine the value of nursing notes in detecting UTI signs and symptoms in home care. The investigators found that information in nursing notes was often overlooked by stakeholders and not integrated into predictive modeling for decision-making support. They indicate that their findings highlighted the value of nursing notes in early risk identification and care guidance.
AHRQ-funded; R01 HS024723.
Citation: Woo K, Adams V, Wilson P .
Identifying urinary tract infection-related information in home care nursing notes.
J Am Med Dir Assoc 2021 May;22(5):1015-21.e2. doi: 10.1016/j.jamda.2020.12.010..
Keywords: Urinary Tract Infection (UTI), Home Healthcare, Diagnostic Safety and Quality
McAlearney AS, Gaughan AA, DePuccio MJ
Management practices for leaders to promote infection prevention: lessons from a qualitative study.
This study looked at the management practices around prevention of catheter-associated urinary tract infections (CAUTIs) and central line-associated bloodstream infections (CLABSI) that hospital leaders can take to promote healthcare associated infection (HAI) prevention efforts. Interviews were conducted with 420 managers and frontline staff in 18 hospitals across the United States. The three management practices characterized as important facilitators of HAI prevention were 1) engagement of executive leadership; 2) information sharing; and 3) manager coaching.
AHRQ-funded; HS024958.
Citation: McAlearney AS, Gaughan AA, DePuccio MJ .
Management practices for leaders to promote infection prevention: lessons from a qualitative study.
Am J Infect Control 2021 May;49(5):536-41. doi: 10.1016/j.ajic.2020.09.001..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Catheter-Associated Urinary Tract Infection (CAUTI), Urinary Tract Infection (UTI), Healthcare-Associated Infections (HAIs), Prevention, Communication
Hanlon JT, Perera S, Schweon S
Improvements in antibiotic appropriateness for cystitis in older nursing home residents: a quality improvement study with randomized assignment.
This study evaluated the impact of an educational quality improvement initiative on the appropriateness of antibiotic prescribing restricted to uncomplicated cystitis in older noncatheterized nursing home residents. This 1-year case-control study used 25 participating nursing homes that were randomized to the intervention or usual care group by strata that included state, urban/rural status, bed size, and geographic separation. A total of 75 cases of cystitis were found in the intervention groups and 92 in the control groups. The intervention group had a nonsignificant 21% reduction in the risk of antibiotic prescribing. There was a favorable comparison in appropriateness of duration. However, the intervention group had more problems with drug-drug interactions than the control group (8% vs 1%). There were also more problems with dosage in the intervention group. Both groups had similar rates of problems with choice or effectiveness (44% vs 45%). The most common antibiotic class that was prescribed inappropriately was quinolones.
AHRQ-funded; R18 HS023779.
Citation: Hanlon JT, Perera S, Schweon S .
Improvements in antibiotic appropriateness for cystitis in older nursing home residents: a quality improvement study with randomized assignment.
J Am Med Dir Assoc 2021 Jan;22(1):173-77. doi: 10.1016/j.jamda.2020.07.040..
Keywords: Elderly, Nursing Homes, Long-Term Care, Antibiotics, Medication, Quality Improvement, Quality of Care, Urinary Tract Infection (UTI), Decision Making
Beeber AS, Kistler CE, Zimmerman S
Nurse decision-making for suspected urinary tract infections in nursing homes: potential targets to reduce antibiotic overuse.
This study’s goal was to determine what information is most important to registered nurses (RNs) decisions to call clinicians about suspected urinary tract infections (UTIs) in nursing home residents. An online survey was conducted with a convenience sample of 881 RNs recruited from a health care research panel. Clinical scenarios from 10 categories of resident characteristics were used: UTI risk, resident type, functional status, mental status, lower urinary tract status, body temperature, physical exam, urinalysis, antibiotic request, and goals of care. Participants were randomized into 2 deliberation conditions: self-paced (n=437) and forced deliberation (n=444). Painful or difficult urinary, obvious blood in urine and temperature at 101.5° had the highest odds of a RN calling a clinician by the forced-deliberation group. For the self-paced group, painful or difficult urination had the highest odds.
AHRQ-funded; HS024519.
Citation: Beeber AS, Kistler CE, Zimmerman S .
Nurse decision-making for suspected urinary tract infections in nursing homes: potential targets to reduce antibiotic overuse.
J Am Med Dir Assoc 2021 Jan;22(1):156-63. doi: 10.1016/j.jamda.2020.06.053..
Keywords: Urinary Tract Infection (UTI), Antibiotics, Antimicrobial Stewardship, Medication, Nursing Homes, Long-Term Care, Decision Making, Diagnostic Safety and Quality
Yankova LC, Neuman MI, Wang ME
Febrile infants ≤60 days old with positive urinalysis results and invasive bacterial infections.
In this study, the investigators aimed to describe the clinical and laboratory characteristics of febrile infants ≤60 days old with positive urinalysis results and invasive bacterial infections (IBI). The investigators concluded that the sensitivity of high-risk PMH, ill appearance, and/or abnormal WBC count was suboptimal for identifying febrile infants with positive urinalysis results at low risk for IBI.
AHRQ-funded; HS026006.
Citation: Yankova LC, Neuman MI, Wang ME .
Febrile infants ≤60 days old with positive urinalysis results and invasive bacterial infections.
Hosp Pediatr 2020 Dec;10(12):1120-25. doi: 10.1542/hpeds.2020-000638..
Keywords: Newborns/Infants, Urinary Tract Infection (UTI), Diagnostic Safety and Quality
Rinke ML, Oyeku SO, Ford WJH
Costs of ambulatory pediatric healthcare-associated infections: Central-line-associated bloodstream infection (CLABSIs), catheter-associated urinary tract infection (CAUTIs), and surgical site infections (SSIs).
Ambulatory healthcare-associated infections (HAIs) occur frequently in children and are associated with morbidity. Less is known about ambulatory HAI costs. This retrospective case control study estimated additional costs associated with pediatric ambulatory central-line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTI), and surgical site infections (SSIs) following ambulatory surgery. The authors concluded that ambulatory HAI in pediatric patients were associated with significant additional costs.
AHRQ-funded; HS024432.
Citation: Rinke ML, Oyeku SO, Ford WJH .
Costs of ambulatory pediatric healthcare-associated infections: Central-line-associated bloodstream infection (CLABSIs), catheter-associated urinary tract infection (CAUTIs), and surgical site infections (SSIs).
Infect Control Hosp Epidemiol 2020 Nov;41(11):1292-97. doi: 10.1017/ice.2020.305..
Keywords: Children/Adolescents, Healthcare-Associated Infections (HAIs), Central Line-Associated Bloodstream Infections (CLABSI), Catheter-Associated Urinary Tract Infection (CAUTI), Urinary Tract Infection (UTI), Ambulatory Care and Surgery, Healthcare Costs, Surgery
Zachariah P, Sanabria E, Liu J
Novel strategies for predicting healthcare-associated infections at admission: implications for nursing care.
Accurate, real-time models to predict hospital adverse events could facilitate timely and targeted interventions to improve patient outcomes. Advances in computing enable the use of supervised machine learning (SML) techniques to predict hospital-onset infections. The purpose of this study was to trial SML methods to predict urinary tract infections (UTIs) during inpatient hospitalization at the time of admission.
AHRQ-funded; HS024915.
Citation: Zachariah P, Sanabria E, Liu J .
Novel strategies for predicting healthcare-associated infections at admission: implications for nursing care.
Nurs Res 2020 Sep/Oct;69(5):399-403. doi: 10.1097/nnr.0000000000000449..
Keywords: Urinary Tract Infection (UTI), Healthcare-Associated Infections (HAIs), Adverse Events, Patient Safety, Risk
De Roo AC, Hendren S, Ameling JM
Using appropriateness criteria to identify opportunities to improve perioperative urinary catheter use.
Researchers applied Michigan Appropriate Perioperative criteria to statewide registry data to identify improvement targets for urinary catheter use. They found that perioperative urinary catheter use was appropriate for most simple abdominal procedures, but duration of use varied in all categories.
AHRQ-funded; HS019767; HS024385; HS018334; HS000053.
Citation: De Roo AC, Hendren S, Ameling JM .
Using appropriateness criteria to identify opportunities to improve perioperative urinary catheter use.
Am J Surg 2020 Sep;220(3):706-13. doi: 10.1016/j.amjsurg.2020.01.008..
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Urinary Tract Infection (UTI), Healthcare-Associated Infections (HAIs), Patient Safety, Surgery, Prevention, Adverse Events
Rinke ML, Oyeku SO, Heo M
Pediatric ambulatory catheter-associated urinary tract infections (CAUTIs): incidence, risk factors, and patient outcomes.
Catheter-associated urinary tract infections (CAUTIs) occur frequently in pediatric inpatients, and they are associated with increased morbidity and cost. Few studies have investigated ambulatory CAUTIs, despite at-risk children utilizing home urinary catheterization. This retrospective cohort and case-control study determined incidence, risk factors, and outcomes of pediatric patients with ambulatory CAUTI. The investigators concluded that pediatric ambulatory CAUTIs occurred in 18% of patients with catheters; they were associated with morbidity and healthcare utilization. Ambulatory indwelling catheter CAUTI incidence exceeded national inpatient incidence.
AHRQ-funded; HS024432.
Citation: Rinke ML, Oyeku SO, Heo M .
Pediatric ambulatory catheter-associated urinary tract infections (CAUTIs): incidence, risk factors, and patient outcomes.
Infect Control Hosp Epidemiol 2020 Aug;41(8):891-99. doi: 10.1017/ice.2020.204..
Keywords: Children/Adolescents, Catheter-Associated Urinary Tract Infection (CAUTI), Urinary Tract Infection (UTI), Healthcare-Associated Infections (HAIs), Risk, Ambulatory Care and Surgery, Adverse Events
Hsu HE, Wang R, Broadwell C
Association between federal value-based incentive programs and health care-associated infection rates in safety-net and non-safety-net hospitals.
The authors assessed the association of Hospital-Acquired Condition Reduction Program (HACRP) and Hospital Value-Based Purchasing (HVBP) implementation with changes in rates of targeted health care-associated infections and disparities in rates among safety-net and non-safety-net hospitals. They found that HACRP and HVBP implementation was not associated with any improvements in targeted health care-associated infections among safety-net or non-safety-net hospitals or with changes in disparities in infection rates. They concluded that, given the persistent health care-associated infection rate disparities, these programs appear to function as a disproportionate penalty system for safety-net hospitals that offer no measurable benefits for patients.
AHRQ-funded; HS018414.
Citation: Hsu HE, Wang R, Broadwell C .
Association between federal value-based incentive programs and health care-associated infection rates in safety-net and non-safety-net hospitals.
JAMA Netw Open 2020 Jul;3(7):e209700. doi: 10.1001/jamanetworkopen.2020.9700..
Keywords: Healthcare-Associated Infections (HAIs), Hospitals, Central Line-Associated Bloodstream Infections (CLABSI), Catheter-Associated Urinary Tract Infection (CAUTI), Urinary Tract Infection (UTI), Medicare, Patient Safety
Luzum M, Sebolt J, Chopra V
Catheter-associated urinary tract infection, Clostridioides difficile colitis, central line-associated bloodstream infection, and methicillin-resistant Staphylococcus aureus.
This article provides summaries of the background, epidemiology, diagnosis, and treatment of central line-associated bloodstream infection, catheter-associated urinary tract infection, Clostridioides difficile, and methicillin-resistant Staphylococcus aureus colonization and infections. Additional prevention strategies, including those related to recent national interventions, are also reviewed.
AHRQ-funded; HS022835.
Citation: Luzum M, Sebolt J, Chopra V .
Catheter-associated urinary tract infection, Clostridioides difficile colitis, central line-associated bloodstream infection, and methicillin-resistant Staphylococcus aureus.
Med Clin North Am 2020 Jul;104(4):663-79. doi: 10.1016/j.mcna.2020.02.004..
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Urinary Tract Infection (UTI), Clostridium difficile Infections, Methicillin-Resistant Staphylococcus aureus (MRSA), Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Infectious Diseases
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
Mills J, Hulse S
AHRQ Author: Mills J
Screening for asymptomatic bacteriuria in adults.
This case study poses three questions concerning a 33-year-old woman presenting for a first prenatal visit at 8 weeks' gestation. The woman reported morning nausea and breast tenderness. A review of systems and physical examination were consistent with early pregnancy but were otherwise unremarkable.
AHRQ-authored.
Citation: Mills J, Hulse S .
Screening for asymptomatic bacteriuria in adults.
Am Fam Physician 2020 Apr 15;101(8):493-94..
Keywords: U.S. Preventive Services Task Force (USPSTF), Screening, Prevention, Urinary Tract Infection (UTI), Pregnancy, Maternal Care, Women, Case Study
Quinn M, Ameling JM, Forman J
Persistent barriers to timely catheter removal identified from clinical observations and interviews.
Indwelling urinary and vascular catheters are valuable devices in patient care, but prolonged or unnecessary use increases the risk of infectious and noninfectious catheter harms. To understand persistent barriers to detecting and removing unnecessary catheters, the researchers conducted a multimethod qualitative study that included observations and in-person interviews with clinicians working on a progressive care unit of a large hospital.
AHRQ-funded; HS024385; HS019767.
Citation: Quinn M, Ameling JM, Forman J .
Persistent barriers to timely catheter removal identified from clinical observations and interviews.
Jt Comm J Qual Patient Saf 2020 Feb;46(2):99-108. doi: 10.1016/j.jcjq.2019.10.004..
Keywords: Patient Safety, Quality of Care, Catheter-Associated Urinary Tract Infection (CAUTI), Healthcare-Associated Infections (HAIs), Urinary Tract Infection (UTI)
Patrick SW, Kawai AT, Kleinman K
Health care-associated infections among critically ill children in the US, 2007-2012.
The researchers examined trends in central line-associated blood stream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and ventilator-associated pneumonia (VAP) incidence rates between 2007 and 2012 based on standardized surveillance data from pediatric intensive care units (PICUs) and neonatal intensive care units (NICUs) in the United States. They found that incidence rates of CLABSIs and VAPs decreased among critically ill neonates and children during this period.
AHRQ-funded; HS018414.
Citation: Patrick SW, Kawai AT, Kleinman K .
Health care-associated infections among critically ill children in the US, 2007-2012.
Pediatrics 2014 Oct;134(4):705-12. doi: 10.1542/peds.2014-0613..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Urinary Tract Infection (UTI), Critical Care, Children/Adolescents, Healthcare-Associated Infections (HAIs)
Greene MT, Fakih MG, Fowler KE
Regional variation in urinary catheter use and catheter-associated urinary tract infection: results from a national collaborative.
The researchers explored nationwide variation in the use of urinary catheters and catheter-associated urinary tract infections (CAUTI) across a diverse set of units within acute care U.S. hospitals. Using data from 1,101 units in 726 hospitals across 34 States, they found regional differences in catheter use, appropriateness, and CAUTI rates, with possibly 30-40 percent of urinary catheters placed in non-ICU settings lacking an appropriate indication.
AHRQ-funded; HS018334; HS019767; 290201000025I; 29032001T
Citation: Greene MT, Fakih MG, Fowler KE .
Regional variation in urinary catheter use and catheter-associated urinary tract infection: results from a national collaborative.
Infect Control Hosp Epidemiol. 2014 Oct;35 Suppl 3:S99-S106. doi: 10.1086/677825..
Keywords: Urinary Tract Infection (UTI), Healthcare-Associated Infections (HAIs), Patient Safety, Quality of Care, Catheter-Associated Urinary Tract Infection (CAUTI)
Greene MT, Kiyoshi-Teo H, Reichert H
Urinary catheter indications in the United States: results from a national survey of acute care hospitals.
The researchers sought to determine how often various indications for catheter use were reported among a nationally representative sample of acute care hospitals. They found that many hospitals were using several indications deemed in appropriated by CAUTI prevention guidelines such as urinary incontinence without outlet obstruction and patient/family request.
AHRQ-funded; 290201000025I; 29032001T
Citation: Greene MT, Kiyoshi-Teo H, Reichert H .
Urinary catheter indications in the United States: results from a national survey of acute care hospitals.
Infect Control Hosp Epidemiol. 2014 Oct;35 Suppl 3:S96-8. doi: 10.1086/677823..
Keywords: Urinary Tract Infection (UTI), Patient Safety, Healthcare-Associated Infections (HAIs), Quality of Care, Catheter-Associated Urinary Tract Infection (CAUTI)
Baillie CA, Epps M, Hanish A
Usability and impact of a computerized clinical decision support intervention designed to reduce urinary catheter utilization and catheter-associated urinary tract infections.
The researchers evaluated the usability and effectiveness of a computerized clinical decision support (CDS) intervention aimed at reducing the duration of urinary tract catheterizations. They found that usability improved to 15% with the revised reminder. The catheter utilization ratio declined over the 3 time periods, as did CAUTIs per 1,000 patient-days. They concluded that the usability of the reminder was highly dependent on its user interface, with a homegrown version of the reminder resulting in higher impact than a stock reminder.
AHRQ-funded; HS016946.
Citation: Baillie CA, Epps M, Hanish A .
Usability and impact of a computerized clinical decision support intervention designed to reduce urinary catheter utilization and catheter-associated urinary tract infections.
Infect Control Hosp Epidemiol 2014 Sep;35(9):1147-55. doi: 10.1086/677630.
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Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Clinical Decision Support (CDS), Electronic Health Records (EHRs), Health Information Technology (HIT), Healthcare-Associated Infections (HAIs), Patient-Centered Outcomes Research, Urinary Tract Infection (UTI)
Meddings J, Rogers MA, Krein SL
Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review.
The authors updated a prior systematic review and a meta-analysis regarding interventions prompting urinary catheter (UC) removal by reminders or stop orders. They found that UC reminders and stop orders appear to reduce catheter-associated urinary tract infection rates and should be used to improve patient safety.
AHRQ-funded; 290200710062I; HS019767; HS018344.
Citation: Meddings J, Rogers MA, Krein SL .
Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review.
BMJ Qual Saf 2014 Apr;23(4):277-89. doi: 10.1136/bmjqs-2012-001774.
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Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Healthcare-Associated Infections (HAIs), Patient Safety, Patient-Centered Outcomes Research, Prevention, Quality Improvement, Urinary Tract Infection (UTI)