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Original Investigation |

Preventing Catheter-Associated Urinary Tract Infection in the United States:  A National Comparative Study

Sanjay Saint, MD, MPH; M. Todd Greene, PhD, MPH; Christine P. Kowalski, MPH; Sam R. Watson, MSA, MT; Timothy P. Hofer, MD, MSc; Sarah L. Krein, PhD, RN
JAMA Intern Med. 2013;173(10):874-879. doi:10.1001/jamainternmed.2013.101.
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Importance Despite the national goal to reduce catheter-associated urinary tract infection (CAUTI) by 25% by 2013, limited data exist describing prevention practices for CAUTI in US hospitals and none associate national practice use to CAUTI-specific standardized infection ratios (SIRs).

Objectives To identify practices currently used to prevent CAUTI and to compare use and SIRs for a national sample of US hospitals with hospitals in the state of Michigan, which launched a CAUTI prevention initiative in 2007 (“Keystone Bladder Bundle Initiative”).

Design and Setting In 2009, we surveyed infection preventionists at a sample of US hospitals and all Michigan hospitals. CAUTI rate differences between Michigan and non-Michigan hospitals were assessed using SIRs.

Participants A total of 470 infection preventionists.

Main Outcome Measures Reported regular use of CAUTI prevention practices and CAUTI-specific SIR data.

Results Michigan hospitals, compared with hospitals in the rest of the United States, more frequently participated in collaboratives to reduce health care–associated infection (94% vs 67%, P < .001) and used bladder scanners (53% vs 39%, P = .04), as well as catheter reminders or stop orders and/or nurse-initiated discontinuation (44% vs 23%, P < .001). More frequent use of preventive practices coincided with a 25% reduction in CAUTI rates in the state of Michigan, a significantly greater reduction than the 6% overall decrease observed in the rest of the United States.

Conclusions and Relevance We observed more frequent use of key prevention practices and a lower rate of CAUTI in Michigan hospitals relative to non-Michigan hospitals. This may be related to Michigan's significantly higher use of practices aimed at timely removal of urinary catheters, the key focus area of Michigan's Keystone Bladder Bundle Initiative.

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Figure. Catheter-associated urinary tract infection prevention practices, Michigan vs non-Michigan.

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