title: A Trial of electronic surveillance feedback for quality improvement at Nurses Improving Care for Healthsystem Elders (NICHE) hospitals.
abstract: BACKGROUND
  Catheter-associated urinary tract infection (CAUTI) risk is directly related to duration of indwelling urinary catheters (IUCs), rising beyond 2 days of catheterization.
  
  
  METHODS
  We conducted a cluster randomized study in nonintensive care units of Nurses Improving Care for Healthsystem Elders (NICHE) hospitals. Electronic surveillance data were used in an audit and feedback intervention for frontline nurses to reduce IUC duration. Multivariable methods were used to identify the difference in average IUC duration and proportion of patients with IUC duration <3 days between patients in an early intervention group and a delayed intervention group, adjusting for patient, unit, and hospital characteristics.
  
  
  RESULTS
  A total of 24 units at 19 NICHE hospitals reported 13,499 adult patients with IUCs over 18 months. Early and delayed intervention groups had important baseline differences in IUC utilization. Use of evidence-based CAUTI prevention measures increased during study participation. In multivariable analysis, the average IUC duration and proportion of patients with IUC duration <3 days were not improved in the early intervention group compared with the delayed intervention group.
  
  
  CONCLUSIONS
  The impact of the audit and feedback intervention was not significant despite the uptake of evidence-based CAUTI prevention practices.
authors.affiliation: Division of Health Care Policy and Research, University of Colorado School of Medicine, Aurora, CO. Electronic address: Heidi.wald@ucdenver.edu.
authors.forename: Heidi L
authors.initials: HL
authors.lastname: Wald
authors.affiliation: Division of Health Care Policy and Research, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Brian
authors.initials: B
authors.lastname: Bandle
authors.affiliation: Division of Health Care Policy and Research, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Angela A
authors.initials: AA
authors.lastname: Richard
authors.affiliation: Division of Health Care Policy and Research, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Sung-Joon
authors.initials: SJ
authors.lastname: Min
authors.affiliation: Hunter-Bellevue School of Nursing, Hunter College of the City University of New York, New York, NY.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Capezuti
mesh_terms: D000368:Aged; D055499:Catheter-Related Infections / Q000453:epidemiology*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D003428:Cross Infection / Q000453:epidemiology*; D057286:Electronic Health Records; D005260:Female; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation*; D017063:Outcome Assessment, Health Care; D058996:Quality Improvement; D014546:Urinary Catheterization / Q000009:adverse effects; D062885:Urinary Catheters / Q000009:adverse effects / Q000706:statistics & numerical data; D014552:Urinary Tract Infections / Q000453:epidemiology*
keywords: Audit and feedback; Catheter-associated urinary tract infection; Electronic surveillance; Indwelling urinary catheters