Meet the Expert - Diane K. Newman

Diane Kaschak Newman, DNP, FAAN, BCB-PMD
Co-Director, Penn Center for Continence and Pelvic Health Director, Clinical Trials
Division of Urology, University of Pennsylvania Medical Center

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Diane K. Newman

Diane K. Newman

Diane K. Newman, DNP, FAAN, BCB-PMD, is Research Investigator Senior at the Perelman School of Medicine, University of Pennsylvania. She is Co-Director of the Penn Center for Continence and Pelvic Health, Division of Urology, University of Pennsylvania Medical Center, in Philadelphia. 
Dr. Newman received a Doctor of Nursing Practice program from Thomas Jefferson University, a Bachelor of Science degree in nursing from LaSalle University, and a Master of Science degree in nursing from the University of Pennsylvania, all in Philadelphia. She is certified as an adult nurse practitioner by the American Nurses Credentialing Center and is a Fellow of the American Academy of Nursing.
Dr. Newman is the Principal Investigator, University of Pennsylvania, Translating Unique Learning for Incontinence Prevention: The TULIP Project, R01NR012011, National Institute of Nursing Research, National Institutes of Health. Dr. Newman has served as co-principal investigator on research studies on the treatment and management of urinary incontinence, overactive bladder, interstitial cystitis, prostate cancer and erectile dysfunction. She was a member of the planning committee of the State-of-the-Science Conference on Prevention of Fecal and Urinary Incontinence in Adults, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Office of Medical Applications of Research (OMAR) of the National Institutes of Health (NIH) and presented at the December 2007 meeting. She was the Chairperson of the 2nd, 3rd, 4th and 5th Committee on Continence Promotion, Education & Primary Prevention for the International Consultation on Incontinence. She was the Chair of the International Continence Society (ICS) Continence Promotion Committee (2003-2009).
Dr. Newman was a member of the panel of experts of the Center for Medicare and Medicaid Service’s Scope and Severity of Nursing Care Deficiencies in long term care on “Guidance to Surveyors on Incontinence and Catheters-Tag F315.” She was the Co-chair of the 1996 Agency for Healthcare Research and Quality Clinical Practice Guideline on Urinary Incontinence: Acute and Chronic Management. She served as a member of the Gastroenterology and Urology Devices Panel of the FDA. In 2002, the National Association for Continence (NAFC) presented her with the Continence Care Champion Award.
Dr. Newman is an internationally known speaker on the topic of urinary incontinence and the use of devices and products for the management of incontinence. She has been invited to speak in Hong Kong, Dubai, Singapore, Manila, Sapporo, Yokohama, Florence, Monaco, Edinburgh, Monte Carlo, Halifax, Montreal and Bournemouth.
She holds editorial positions on several journals, including the International Urogynecology Journal, Neurourology and Urodynamics and Ostomy/Wound Management. A prolific writer, Dr. Newman has written and presented more than 100 scientific papers, chapters, and articles on the assessment, treatment, and management of incontinence with an emphasis on the nurse’s role. She is the author of the books The Urinary Incontinence Sourcebook and Managing and Treating Urinary Incontinence. She is the recipient of the American Journal of Nursing 2002 Gerontologic Nursing Book Award for the 1st Edition of Managing and Treating Urinary Incontinence. She is the co-author with Dr. Alan Wein of Overcoming Overactive Bladder, the 2nd edition of Managing and Treating Urinary Incontinence and co-author of Fast Facts: Bladder Disorders.
She has extensive experience in informing consumers about pelvic floor disorders and with continence promotion. Her “Incontinence Center” (www.seekwellness.com) is a resource website for the lay public. Her AJN article on “Stress Urinary Incontinence in Women” was cited by the New York Times Personal Health Column, September 2003. She was interviewed in the August 2007 issue of Oprah Winfrey’s O magazine and the January 2009 issue ofLadies Home Journal. Dr. Newman’s clinical practice was featured in the June 5, 2008 issue of USA Today. She was been appointed to WebMD’s Moderated Health Exchange on Incontinence and OAB(http://exchanges.webmd.com/incontinence-and-oab-exchange).
New Initiatives UroToday is pleased to announce a new initiative with Diane K. Newman to create content for the readers of UroToday with a focus on the urinary incontinent (UI), overactive bladder (OAB) and painful bladder syndrome (PBS) patients.
World Continence Week The Continence Promotion Committee (CPC) was formed following a workshop at International Continence Society (ICS) meeting in Rome in 1995, where it was agreed that the ICS should act as a facilitator for various international continence organisations to meet and address relevant issues to do with continence promotion, awareness and prevention. The principle aims were:
To look at opportunities for networking across various countries;
To increase awareness amongst ICS members of continence related issues;
To facilitate development of continence organisations
To facilitate interchange of information about continence awareness and promotion;
To identify opportunities for continence prevention strategies.
The CPC became an official committee of the new Board of the ICS in 1998, and has the important role of providing input into the important areas of continence awareness, promotion and prevention.
Annual workshops have been held each year at the ICS meetings.
Diane Newman authored: 
Managing and Treating Urinary Incontinence, Second Edition (Coming soon!)
The Urinary Incontinence Sourcebook
Managing and Treating Urinary Incontinence
Diane Newman co-authored with Alan Wein, MD:
Overcoming Overactive Bladder
Awards Received American Journal of Nursing 2002 Gerontologic Nursing Book Award for Managing and Treating Urinary Incontinence

Blog entries categorized under Uncategorized

The Center for Disease Control and Prevention (CDC) estimates that 1 of every 10 to 20 patients hospitalized in the United States develops a healthcare-associated infection (HAI). Urinary tract infection (UTI), a type of HAI, accounts for approximately 32% of infections reported by acute care hospitals and approximately 18% to 25% of all nosocomial bacteremia. The majority of hospital-associated UTIs are caused by instrumentation of the urinary tract, mainly from an indwelling urinary catheter (IUC). Catheter-associated urinary tract infections (CAUTIs) can result in increased morbidity, mortality, hospital cost, and length of stay.
Hospital staffs, particularly nursing staffs, are developing clinical pathways for removal of IUCs and for bladder monitoring, to ensure patient safety and evidence-based practice (EBP) at a lower cost. This website was created in part to create a single place for accessibility of the evidence, perspectives on implementing CAUTI prevention strategies and tools that can be shared to assist all of us in achieving sustainable prevention goals.
We have heard from many readers who are actively engaged in implementing CAUTI prevention programs for their hospitals.  They have raised opportunities to update the algorithm which is truly a living pathway.  The latest algorithm is located: http://www.cautichallenge.com/images/stories/site_images/foley3132012.jpg

This living algorithm is a tool for all of us and will continue to evolve as you provide your feedback.  Thank you for your participation in this Challenge! 

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I have noticed that recently there has been a significant increase in publications on the prevention of CAUTI.  This is encouraging as we many of us are working to implement programs in our hospitals towards reducing and preventing catheter-associated UTI's.  I am now providing our readers of this site with brief commentaries on a selection of the publications.  In this updated CAUTI CHALLENGE resource you can easily locate the abstracts of the articles from throughout multiple journals in the Publications area of this site. 

I wanted to share the most recent posting with you as it highlights an electronic tool that was developed for validation at a 413-bed university-affiliated urban teaching hospital in Seattle Washington.  Choudhuri and colleagues developed an electronic surveillance tool for CAUTI and urinary catheter utilization based on the objective components of the National Healthcare Safety Network (NHSN) definitions including fever, urinalysis, and urine culture. Results were compared to manual chart review by an infection preventionist (IP).  The tool provided objective criteria to determine UTI surveillance. The tool captured urinary catheter days by unit and service. They were also able to document discrete start and stop times for the device, resulting in improved detection.
The results reported indicate that the tool was successful as it helped increase surveillance and reporting demands, so they could focus more on implementing best practice preventing efforts at the bedside.  This seems to also provide a necessary component to the electronic health record.  Are others of you using this or another similar tool to automate surveillance?  I look forward to hearing from you on this novel approach or on other methods you are using. 

 

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Welcome to the Newly Updated CAUTI Challenge website.   We have listened to our users comments and many have been integrated to the elements of this new site to improve navigation, search functionality, as well as an improved blog and area for sharing best practices.  

We have also recently updated the paper Indwelling Urinary Catheters in Acute Care: A step-by-Step Clinical Pathway for Nurses to provide the most current evidence-based clinical information on managing Foley catheters. The article notes that the Joint Commission has made CAUTIs a 2012 National Patient Safety Goal. The CDC has noted that the total expense of these infections is $450,000,000 per year.   The article emphasizes quality improvement initiatives and provides suggestions for implementation. Minimizing catheterization and insuring early Foley catheter removal are key components of such a program. The literature supporting the use of bladder scanning technology to avoid unnecessary catheterizations has also grown.

We look forward to your comments and engagement in the onging challenge of preventing CAUTI. 

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I have been in discussions with CAUTI Challenge users
Another area of gray for me surrounds removal of a urinary catheter / re-insertion of a new catheter before a urine culture is obtained. As you know, APIC guidelines state cultures from "recently inserted" catheters yield reliable results...suggest changing out urinary catheters, but does not give guidance as to a time frame. You mention in your pp that catheters should be changed if in longer than 10 days. Univ of CO Denver requires a urinary catheter be changed before culture if it has been in > 72 hrs.

I appreciate your guidance and expertise in helping me develop an accurate Computer Based Training (CBT) module for Memorial Health System's staff.
I am glad you have found the information on the CAUTI center on UroToday helpful.  It gets lots of traffic and many inquiries, similar to yours.

There is no information or evidence-based recommendations on when a catheter should be removed/changed in a hospital patient.  If a urinary tract infection is suspected and a urine C&S is to be obtained, it is strongly suggested that a new catheter and collection system be placed and the urine C&S obtained from the new system.  But the evidence on this is very little.  Look at this one reference:

Raz, R. (2000). Chronic indwelling catheter replacement before antimicrobial therapy for symptomatic urinary tract infection, Urol. 164:1254-58.

If it’s not possible or may cause the patient harm or burden to change the system then it is recommended that staff obtain the urine sample from the established system by clamping tubing distal to the collection port for short time to allow urine to accumulate, disinfect port with alcohol or chloroprep and allow to dry and use sampling port to draw samples.

As most experts believe that the course of treatment will be improved if the catheter and collection system is changed prior to or along with starting antibiotics, we will always change the system before starting antibiotics on a pt who has a CAUTI.

I hope this is helpful.

Diane

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William B. Munier, MD, Director of the Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality (AHRQ), presented AHRQ’s projects to eliminate health care-acquired conditions (HACs) at the Academy Health Annual Research Meeting on June 12, 2011. Dr. Muniers presentation included information on Secretary Sibelius program aiming to reduce costs while improving patient safety. The Partnership for Patients program is a nationwide public-private partnership to reduce preventable harm to patients. The focus on catheter-associated urinary tract infections was included in this presentation. Since catheters are used in nearly all major surgeries and in many other hospitalized patients, it has been estimated that more than 560,000 health-care associated UTI’s have occurred annually. The Partnership for Patients estimates that 40% of CAUTIs are preventable, the goal set for hospitals is to cut the number of these preventable events in half by 2013. The updated 2009 CDC guidelines for caUTI prevention encourage the assessment if a catheter is necessary. This is a critical question and as they include in the guideline, a Bladder Scan may be indicated. The Bladder scan quickly, accurately, and noninvasively measures bladder volume. The bladder scan helps assess urinary retention and post-operative urinary retention (POUR). As such it helps prevent unnecessary catheterization. As such the bladder scan helps reduce rates of catheter-associated urinary tract infection (caUTI) and helps improve efficiency, reduce costs and save staff time. It is easy for the staff to use and does not require a sonographer. Considering alternatives to catheterization is a major first step in preventing caUTI.

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