Despite national efforts to decrease the rates of incidence, catheter-associated urinary tract infections have remained a persistent issue in hospitals across the country.
In fact, the rate of catheter-associated UTIs (CAUTI) increased by 6% from 2009 to 2013 even as HHS issued related guidance and the CMS began to penalize hospitals that are frequent offenders.
But results from a national study may have found an effective solution.
Data and teamwork helped drop the rate of CAUTI by 14% overall in 603 hospitals over an 18-month period, according to a study published in the New England Journal of Medicine. Most of the decrease was in non-intensive care settings like general medicine, which saw infections drop by 32%. The intensive care units experienced minimal change at less than 1%.
Dr. Sanjay Saint, lead author of the study and professor of internal medicine at the University of Michigan, said the ICU likely didn't experience much infection decline because physicians prioritize treating more serious ailments than the symptoms associated with a UTI infection.
Most ICU patients, approximately 60%, will have a urinary catheter placed. This is compared to 10-15% of general medicine and surgical patients on average, Saint said. “The culture in most ICUs is that if the patient is sick enough for an ICU bed, they are sick enough for a catheter.”
The study was the result of the Comprehensive Unit-based Safety Program, a collaborative effort with the Agency for Healthcare Research and Quality and the Health Research and Educational Trust to reduce CAUTIs.
The program, also known as CUSP, worked with state hospital associations to recruit inpatient hospital units to participate in the study. Each participating hospital unit was tasked with forming a team focused on the prevention of CAUTIs. The participating hospital units were mostly general medicine, surgery and ICUs.
From March 2011 to November 2013, the hospital unit teams followed CUSP program recommendations which included prevention techniques like developing or updating catheter-insertion policy and providing monthly catheter UTI data to nurses and physicians.
CUSP also sought to decrease the number of urinary catheters used overall. The program recommended daily nursing rounds to consider alternative urine collection methods like condom catheters. During the program, catheter use decreased from 19.8% to 18.2% in non-intensive care settings and from 61.1% to 57.6% in ICUs.
Dr. Susan Huang, medical director of Epidemiology and Infection Prevention at UC Irvine Health, said she was impressed by the study's results but points out the difficulties in maintaining team-based approaches. Nurses and physicians are juggling multiple patient safety activities at once so maintaining detailed team initiatives can be difficult, she said.
Saint acknowledged the challenge in maintaining quality improvement approaches, but said urinary catheters should be a high priority for physicians and nurses. Catheter urinary infections can lead to substantial discomfort for the patient, and sepsis and even death in the most extreme circumstances, he added.
Despite the pain it causes patients, catheters are common because they're easier than encouraging patients to use the restroom on their own or assisting them to the facilities, Saint said. “In many ways, (the urinary catheter) is a window into how well an organization functions,” he said.
