A program addressing the technical and cultural aspects of catheter-associated urinary tract infection prevention has led to declines in urinary catheter use and infection rates.
Newly published results from a recent national effort to reduce CAUTI show it is possible to decrease urinary catheter use and UTIs by targeting the technical, behavioral, and cultural components of CAUTI prevention.
The push to decrease rates of catheter-associated urinary tract infections has been ongoing since 2008 when the Centers for Medicare and Medicaid Services picked CAUTI as the first hospital-acquired complication for which payment would be denied to hospitals.
Yet despite increased attention, national data shows that CAUTI rates rose 6% from 2009 to 2013.
But, according to data published June 2 in the New England Journal of Medicine, all hope should not be lost when it comes to improving CAUTI rates.
According to the study authors, at the end of the 18-month national effort, the eliminating CAUTI portion of the Comprehensive Unit-based Safety Program (CUSP), the first four cohorts of the program (926 units in 603 hospitals across the country) saw improvement in CAUTI rates, including:
- A 14% overall drop in CAUTI rates (after adjusting for differences in patients and hospitals)
- A 32% reduction in infections rates in non-ICUs
- Urinary catheter use dropped from 20.1% of patients to 18.8 % of patients in non-ICUs.
ICUs, however, did not see a substantial change in either urinary catheter use rates or CAUTI rates.
Lead author Sanjay Saint, MD, MPH, said in a media release that the program "shows we can make a difference in catheter-associated UTI rates," and acknowledged that "there's more work to be done."
Saint, who is the George Dock Professor of internal medicine at the University of Michigan Medical School and chief of medicine at the VA Ann Arbor Healthcare System, has studied catheter use and UTI prevention in hospital patients for two decades.
The development and implementation of the toolkit used in the Stop CAUTI national effort was based on some of that research which was initially tested in hospitals across Michigan, through the Michigan Hospital Association's Keystone Center for Patient Safety & Quality initiative.
The combination of protocols, checklists, training modules, and data sharing practices that teams can tailor for their hospital units is known as a "bladder bundle." The tools encourage:
- Daily checks on patients who have a catheter and assessment of whether they need it
- Less indwelling catheter use by implementing other urine collection means
- Training on urinary management for all care team members
- Regular use of infection-prevention techniques for catheter placement and maintenance
- Feedback to clinicians about their unit's catheter use and UTI rates