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ProblemThe United States Healthcare Systems is burdened heavily by healthcare-associated infections (HAI), as they pose significant risks for increased mortality and morbidity. The most common type of HAI is urinary tract infection (UTI), and these infections are preventable (Strassle et al., 2019). According to the CDC (2021), 12-16% of hospitalized adults will at some point require catheterization; and each day an indwelling catheter remains in place increases the patient’s risks of adverse outcomes by 3-7%. CAUTIs have been linked to increased mortality and morbidity rates across the world. The Centers for Disease Control report urinary tract infections (UTI) lead to more than 13,000 deaths each year (Centers for Disease Control [cdc], 2021).ObjectiveThis quality improvement (QI) project will focus on the prevention of hospital-acquired UTIs, specifically those infections related to indwelling devices such as foley catheters. The purpose of this manuscript is to review the current evidence-based literature related to CAUTI prevention, trial an intervention that parallels the literature in a local hospital and evaluate those results.DesignThe researcher focused on the problem of CAUTI, analyzed current evidence-based practices related to prevention, developed a plan to execute a high-value improvement tool, and evaluated its effectiveness.SettingQI project took place in a local community hospital. The focus area was the medical-surgical ICU.ParticipantsThe participants were nursing staff and nursing managers on the medical surgical units, specifically those in positions with unique or direct involvement with insertion, removal, or monitoring of foley catheters. The subjects in this quality improvement project included adult patients hospitalized in the medical surgical intensive care unit (ICU).InterventionsA CAUTI GPS screening tool was used to identify current prevention practices and/or any roadblocks to the prevention of CAUTI within the facility. Then, TAP (targeted assessment for prevention) strategy was implemented, which prompted expedited removal of indwelling catheters and/or the use of external drainage devices where indicated.ResultsThere was a marked increase in attention to and prompt removal of indwelling foleys throughout the critical care unit. The facility had no hospital-acquired CAUTI during the project period.ConclusionsThere must be an impetus to inspire compliance. If healthcare workers adhere to prevention guidelines, CAUTIs are preventable. When leadership team members within hospital systems are enthusiastic about CAUTI prevention, the organization as a whole has increased motivation (Chenoweth et al., 2014).

Objective.To determine the effect of methotrexate (MTX) on relapse risk and glucocorticoid (GC) use in a large single-institution cohort of patients with giant cell arteritis (GCA).Methods.Patients diagnosed with GCA from 1998 to 2013 with confirmed evidence of temporal artery biopsy and/or radiographic evidence of large vessel vasculitis were identified. Each patient with GCA treated with adjunct MTX (case) was matched to a similar patient with GCA treated only with GC (control). GC requirements and relapse events before and after MTX initiation (or corresponding index date) were compared using rate ratios (RR).Results.Eighty-three cases and 83 controls were identified and compared. No significant differences in age, demographics, laboratory variables, baseline disease characteristics, or mean initial prednisone doses were observed. Median [interquartile range (IQR)] time from GCA diagnosis to MTX initiation in cases was 39 (13–80) weeks and the median (IQR) starting dose was 13.5 (10–15) mg/week. RR comparing relapse rates before and after MTX initiation/index date were significantly reduced in both cases (RR 0.32, 95% CI 0.24–0.41) and controls (RR 0.60, 95% CI 0.43–0.86). The decrease in relapse rate was significantly greater in patients taking MTX than in those taking GC alone (p = 0.004). Rates of GC discontinuation did not differ between groups.Conclusion.In this large single-institution cohort, the addition of MTX to GC decreased the rate of subsequent relapse by nearly 2-fold compared to patients taking GC alone. MTX may be considered as adjunct therapy in patients with GCA to decrease the risk of further relapse events.

Objective To compare temporal artery biopsy (TAB)-positive giant cell arteritis (GCA) to TAB-negative GCA and patients with GCA mimics Methods: Patients diagnosed with TAB-positive and TAB-negative GCA between 1/1/1998 and 12/31/2013 were retrospectively identified. These two groups were compared to a cohort of patients with TAB performed between 1/1/2009 and 12/31/2010 in which the TAB was negative and alternative diagnosis was provided after a minimum of 6-months of follow-up. Baseline characteristics were compared between groups using chi-square and rank sum tests. Results 591 study subjects were identified (286 TAB-positive, 110 TAB-negative GCA and 195 TAB-negative GCA mimics) during the respective study periods. Compared to TAB-negative GCA, GCA mimics had similar rates of headache and vision loss but significantly less frequent jaw/limb claudication, arterial bruits and constitutional symptoms, as well as lower platelet levels. Compared to TAB-positive GCA patients, TAB-negative GCA were younger, had shorter time to diagnosis, met fewer 1990 ACR classification criteria and had lower frequencies of polymyalgia rheumatica, jaw claudication and temporal artery abnormalities; but, higher frequency of arm claudication and constitutional symptoms. Among 61 TAB-negative patients with advanced arterial imaging, 43 (69%) had at least one abnormality consistent with GCA. Conclusion Consideration of alternative diagnoses is requisite in evaluating patients with negative TAB. Advanced imaging assists in identifying occult large-vessel vasculitis and should be employed in all TAB-negative patients with suspicion for GCA.

Background Temporal artery biopsy (TAB) plays a key role in diagnosis of giant cell arteritis (GCA). However, approximately 15%–20% of patients ultimately diagnosed with GCA have negative biopsies. Among patients with negative TAB, it is often challenging to identify patients with GCA from those with an alternate (non-GCA) diagnosis. Objectives To compare TAB-negative GCA with patients receiving a non-GCA alternate diagnosis. Methods Two cohorts were retrospectively identified through direct medical record review. The first cohort consisted of patients with TAB-negative GCA diagnosed between 1/1/1998 and 12/31/2013. The second cohort included all patients with a negative TAB performed between 1/1/2009 and 12/31/2010 in which a non-GCA alternate diagnosis was provided after a minimum of 6 months of follow up. Final diagnoses were confirmed by consensus among two rheumatologists and a physician abstractor. Baseline characteristics were compared between the two cohorts using chi-square and rank sum tests. Results 110 patients with TAB-negative GCA and 195 non-GCA patients with a negative TAB were identified. Alternate diagnoses for non-GCA patients are listed in table 1. Age, sex, number of days on glucocorticoids prior to biopsy, and biopsy length were similar in both groups. Time from first symptom to diagnosis was longer in non-GCA patients [mean (SD); 2.6 (2.5) vs 1.5 (2.1) months; p Conclusions In this cohort, neither headache nor vision loss at presentation were associated with an ability to discriminate between diagnosis of TAB-negative GCA compared to patients without GCA. ACR criteria may be helpful in identifying patients with TAB-negative GCA. Among patients with negative TAB, constitutional symptoms and claudication (jaw/limb) were more frequently associated with an ultimate diagnosis of TAB-negative GCA. Disclosure of Interest None declared

Background Giant cell arteritis (GCA) is the most common systemic vasculitis in patients aged 50 years or older. The presence of cranial features and an abnormal temporal artery biopsy have historically been the primary focus for diagnosis of this condition. A notable percentage of patients with symptoms of GCA have negative temporal artery biopsies, however, few cohort studies exist comparing the presentation and outcome of patients based on temporal artery positivity. Objectives To establish a large, single institution cohort of patients with temporal artery biopsy-negative GCA. To identify differences in presentation and outcome among patients with temporal artery biopsy-negative and temporal artery biopsy-positive GCA. Methods Patients with temporal artery biopsy-negative GCA diagnosed between 1/1/1998 and 12/31/2013 were identified retrospectively. Final diagnosis was confirmed by consensus among two rheumatologists and a physician abstractor. Baseline characteristics and outcomes were compared to a previously established biopsy-positive GCA cohort (n=286) from the same institution. Results 110 patients with temporal artery biopsy-negative GCA were identified. Unilateral biopsies were performed in 73, bilateral-sequential in 10, and bilateral same day in 27 cases. Median duration between steroid initiation and biopsy was 3 days. Median length of first biopsy was 14mm and second biopsy (if performed) was 22mm. Among biopsy-negative patients with advanced imaging within 6-months of diagnosis, 67% (41/61) had evidence of large vessel vasculitis. Patients with biopsy-negative GCA were younger (72.0±9.0 vs 75.0±7.6; p=0.001), met fewer ACR criteria (≥3 criteria 64% vs 95%; p Initial prednisone dose was similar among both cohorts. Although cumulative glucocorticoid (GC) was lower in biopsy-negative patients at 1 year (6.3±2.6 vs 7.2±2.7 g; p=0.004), cumulative GC doses at 2-years and 5-years were equivalent. Biopsy-positive patients (5-years, 56±3%) were able to discontinue GC sooner than biopsy-negative patients (5-years, 30±5%; p Conclusions While similarities are present, notable differences are observed at diagnosis in patients with biopsy-negative GCA. Further research is needed to confirm and understand the variability in GC duration. Disclosure of Interest None declared