In 2012, officials at Ascension Health noticed that catheter-associated urinary tract infection rates across the 101-hospital system were about even with national rates. They discovered the opportunity for improvement when they examined benchmarking data after St. Louis-based Ascension was named a hospital engagement network under the federal Partnership for Patients safety initiative.
“We were able to zero in on something that we really thought was preventable,” said Ann Hendrich, Ascension Health's chief quality, safety and nursing officer.
Catheter-associated UTIs are the most common type of healthcare-associated infection in hospitals, accounting for more than 30% of infections reported to the Centers for Disease Control and Prevention's online infection surveillance system. Such infections cost the U.S. healthcare system more than half a billion dollars and lead to more than 8,000 deaths annually, according to federal data.
Efforts to reduce these infections typically focus on removing catheters as soon as possible. But Dr. Mohamad Fakih, Ascension Health's national infectious disease physician leader, said concentrating on appropriate catheter use in the emergency department helps avoid placing urinary catheters in the first place. “Others say, 'Let's get rid of it quickly.' We say, 'Let's stop before we even put it in,'” he said.
The ED is a logical place to start because it's the entry point to the hospital, often admitting more than half of patients, and it's often the place where urinary catheters are placed, said Russ Olmsted, director of infection prevention and control services at St. Joseph Mercy Hospital, Ypsilanti, Mich., and past president of the Association for Professionals in Infection Control and Epidemiology.
Beginning in June 2012, Fakih led a six-month improvement project at 18 Ascension Health hospital EDs, including 673-bed St. John Hospital and Medical Center, Detroit, where he serves as medical director of infection prevention and control.
Fakih and his team drafted clear guidelines for urinary-catheter use, customized for ED patients. For instance, catheters were deemed appropriate for patients with urinary obstruction or hip fractures, and for patients who were scheduled for certain surgical procedures. But they were categorized as inappropriate for incontinent patients and patients with dementia. They also named a physician and nurse champion at each site and tasked them with promoting the project, explaining the clinical benefits and assisting with staff education.