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

Saint S, Greene M, Kowalski CP, et al. — Mon, 25 Mar 2013 00:00:00 GMT

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.

Barriers to Reducing Urinary Catheter Use A Qualitative Assessment of a Statewide Initiative Barriers to Reducing Urinary Catheter Use

Krein SL, Kowalski CP, Harrod M, et al. — Mon, 25 Mar 2013 00:00:00 GMT

Importance

Preventing catheter-associated urinary tract infection (CAUTI), a common health care–associated infection, is important for improving the care of hospitalized patients and in meeting the goals for reduction of health care–associated infections set by the US Department of Health and Human Services.

Objective

To identify ways to enhance CAUTI prevention efforts based on the experiences of hospitals participating in the Michigan Health and Hospital Association Keystone Center for Patient Safety statewide program to reduce unnecessary use of urinary catheters (the Bladder Bundle).

Design

Qualitative assessment of data collected through semistructured telephone interviews with key informants at 12 hospitals and in-person interviews and site visits at 3 of the 12 hospitals. The analysis focused on perceptions and key issues identified by hospitals as influencing implementation of CAUTI prevention practices as recommended by the Bladder Bundle initiative.

Setting

Twelve purposefully sampled hospitals in Michigan.

Participants

Key informants including infection preventionists, clinical personnel, and senior executives.

Results

Common barriers to Bladder Bundle implementation and appropriate urinary catheter use included (1) difficulty with nurse and physician engagement, (2) patient and family request for indwelling catheters, and (3) catheter insertion practices and customs in the emergency department. Strategies to address these barriers were also identified by several of the participating hospitals, including (1) incorporating urinary management (eg, planned toileting) as part of other patient safety programs, such as a fall reduction program, (2) explicitly discussing the risks of indwelling urinary catheters with patients and families, and (3) engaging with emergency department nurses and physicians to implement a process that ensures that appropriate indications for catheter use are followed.

Conclusions and Relevance

The Bladder Bundle program provides a model for implementing strategies to reduce CAUTI. These findings provide actionable information to inform CAUTI prevention-related activities in hospitals throughout the country.

JAMA Internal Medicine: UTI/Pyelonephritis Topic Collection

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

Barriers to Reducing Urinary Catheter Use A Qualitative Assessment of a Statewide Initiative Barriers to Reducing Urinary Catheter Use