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Infect Control Hosp Epidemiol. 2017 Mar;38(3):287-293. doi: 10.1017/ice.2016.279. Epub 2016 Dec 5.

Comparing Catheter-Associated Urinary Tract Infection Prevention Programs Between Veterans Affairs Nursing Homes and Non-Veterans Affairs Nursing Homes.

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1Geriatric Research Education and Clinical Center Ann Arbor Veterans Affairs Healthcare System,Ann Arbor,Michigan.
2Center for Clinical Management Research Ann Arbor Veterans Affairs Healthcare System,Ann Arbor,Michigan.
3Medicine Service,Ann Arbor Veterans Affairs Healthcare System,Ann Arbor,Michigan.
9The Center for Innovations in Quality,Effectiveness, and Safety (IQuESt),Michael E. DeBakey Veterans Affairs Medical Center,Houston,Texas.
11Department of Medicine,University of Colorado School of Medicine,Aurora,Colorado.
12School of Medicine and Public Health,University of Wisconsin,Madison,Wisconsin.
8Institute of Gerontology,University of Michigan Medical School,Ann Arbor,Michigan.
5Division of Geriatric and Palliative Care Medicine,University of Michigan Medical School,Ann Arbor,Michigan.
4Veterans Affairs National Center for Patient Safety,Department of Veterans Affairs,Ann Arbor,Michigan.
15Health Research and Educational Trust,American Hospital Association, Chicago,Illinois.


OBJECTIVE The impact of healthcare system integration on infection prevention programs is unknown. Using catheter-associated urinary tract infection (CAUTI) prevention as an example, we hypothesize that US Department of Veterans Affairs (VA) nursing homes have a more robust infection prevention infrastructure due to integration and centralization compared with non-VA nursing homes. SETTING VA and non-VA nursing homes participating in the AHRQ Safety Program for Long-Term Care collaborative. METHODS Nursing homes provided baseline information about their infection prevention programs to assess strengths and gaps related to CAUTI prevention via a needs assessment questionnaire. RESULTS A total of 353 of 494 nursing homes from 41 states (71%; 47 VA and 306 non-VA facilities) responded. VA nursing homes reported more hours per week devoted to infection prevention-related activities (31 vs 12 hours; P<.001) and were more likely to have committees that reviewed healthcare-associated infections. Compared with non-VA facilities, a higher percentage of VA nursing homes reported tracking CAUTI rates (94% vs 66%; P<.001), sharing CAUTI data with leadership (94% vs 70%; P=.014) and with nursing personnel (85% vs 56%, P=.003). However, fewer VA nursing homes reported having policies for appropriate catheter use (64% vs 81%; P=.004) and catheter insertion (83% vs 94%; P=.004). CONCLUSIONS Among nursing homes participating in an AHRQ-funded collaborative, VA and non-VA nursing homes differed in their approach to CAUTI prevention. Best practices from both settings should be applied universally to create an optimal infection prevention program within emerging integrated healthcare systems. Infect Control Hosp Epidemiol 2017;38:287-293.

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