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. 2013 May 27;173(10):874-9.
doi: 10.1001/jamainternmed.2013.101.

Preventing catheter-associated urinary tract infection in the United States: a national comparative study

Sanjay Saint  1 , M Todd Greene, Christine P Kowalski, Sam R Watson, Timothy P Hofer, Sarah L Krein
Affiliations

Preventing catheter-associated urinary tract infection in the United States: a national comparative study

Sanjay Saint et al. JAMA Intern Med. .

Abstract

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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Conflict of interest statement

Potential Conflicts of Interest: Dr. Saint has received numerous honoraria and speaking fees from academic medical centers, hospitals, group-purchasing organizations (e.g., VHA, Premier), specialty societies, state-based hospital associations and non-profit foundations (e.g., Michigan Health and Hospital Association, Institute for Healthcare Improvement) for lectures about CAUTI and implementation science. Mr. Watson is employed by the Michigan Health and Hospital Association. No other potential conflict of interest is noted.

Figures

Figure 1
Figure 1
Cauti Prevention Practices -Michigan Vs. Non-Michigan
See this image and copyright information in PMC

Comment in

References

    1. Burke JP. Patient safety: infection control - a problem for patient safety. N Engl J Med. 2003;348:651–6. - PubMed
    1. Gerberding JL. Hospital-onset infections: a patient safety issue. Ann Int Med. 2002;137:665–70. - PubMed
    1. Saint S, Howell JD, Krein SL. Implementation science: how to jump-start infection prevention. Infect Control Hosp Epidemiol. 2010;31(Suppl 1):S14–7. - PMC - PubMed
    1. Pronovost PJ, Goeschel CA, Wachter RM. The wisdom and justice of not paying for “preventable complications. JAMA. 2008;299:2197–9. - PubMed
    1. Saint S, Meddings JA, Calfee DP, Kowalski CP, Krein SL. Catheter-associated urinary tract infection and the Medicare rules changes. Ann Int Med. 2009;150:877–85. - PMC - PubMed

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