title: Emergency Department Catheter-Associated Urinary Tract Infection Prevention: Multisite Qualitative Study of Perceived Risks and Implemented Strategies.
abstract: BACKGROUND
  Existing knowledge of emergency department (ED) catheter-associated urinary tract infection (CAUTI) prevention is limited. We aimed to describe the motivations, perceived risks for CAUTI acquisition, and strategies used to address CAUTI risk among EDs that had existing CAUTI prevention programs.
  
  
  METHODS
  In this qualitative comparative case study, we enrolled early-adopting EDs, that is, those using criteria for urinary catheter placement and tracking the frequency of catheters placed in the ED. At 6 diverse facilities, we conducted 52 semistructured interviews and 9 focus groups with hospital and ED participants.
  
  
  RESULTS
  All ED CAUTI programs originated from a hospitalwide focus on CAUTI prevention. Staff were motivated to address CAUTI because they believed program compliance improved patient care. ED CAUTI prevention was perceived to differ from CAUTI prevention in the inpatient setting. To identify areas of ED CAUTI prevention focus, programs examined ED workflow and identified 4 CAUTI risks: (1) inappropriate reasons for urinary catheter placement; (2) physicians' limited involvement in placement decisions; (3) patterns of urinary catheter overuse; and (4) poor insertion technique. Programs redesigned workflow to address risks by (1) requiring staff to specify the medical reason for catheter at the point of order entry and placement; (2) making physicians responsible for determining catheter use; (3) using catheter alternatives to address patterns of overuse; and (4) modifying urinary catheter insertion practices to ensure proper placement.
  
  
  CONCLUSIONS
  Early-adopting EDs redesigned workflow to minimize catheter use and ensure proper insertion technique. Assessment of ED workflow is necessary to identify and modify local practices that may increase CAUTI risk.
authors.affiliation: 1Columbia University School of Nursing,NewYork-Presbyterian Hospital,New York,New York.
authors.forename: Eileen J
authors.initials: EJ
authors.lastname: Carter
authors.affiliation: 2Brigham and Women's Hospital,Department of Emergency Medicine,Boston,Massachusetts.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Pallin
authors.affiliation: 4Regis College,School of Nursing and Health Sciences,Weston,Massachusetts.
authors.forename: Leslie
authors.initials: L
authors.lastname: Mandel
authors.affiliation: 2Brigham and Women's Hospital,Department of Emergency Medicine,Boston,Massachusetts.
authors.forename: Corine
authors.initials: C
authors.lastname: Sinnette
authors.affiliation: 2Brigham and Women's Hospital,Department of Emergency Medicine,Boston,Massachusetts.
authors.forename: Jeremiah D
authors.initials: JD
authors.lastname: Schuur
mesh_terms: D001291:Attitude of Health Personnel; D055499:Catheter-Related Infections / Q000209:etiology / Q000517:prevention & control / Q000523:psychology; D002408:Catheters, Indwelling / Q000009:adverse effects; D003428:Cross Infection / Q000209:etiology / Q000517:prevention & control / Q000523:psychology; D004636:Emergency Service, Hospital; D006282:Health Personnel / Q000523:psychology*; D006761:Hospitals; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D015337:Multicenter Studies as Topic; D036301:Qualitative Research; D012307:Risk Factors; D014481:United States; D014546:Urinary Catheterization / Q000009:adverse effects* / Q000523:psychology; D062885:Urinary Catheters / Q000009:adverse effects; D014552:Urinary Tract Infections / Q000209:etiology / Q000517:prevention & control / Q000523:psychology