Safety program reduces catheter-related UTI in acute care

A study published by the New England Journal of Medicine has analyzed the rates for catheter-associated urinary tract infection (UTI) in hospitals and found that the national Comprehensive Unit-based Safety Program reduced both catheter use and catheter-associated UTI rates in non-intensive care units (ICUs).

In the past few years, there has a been a major emphasis on preventative medicine in the U.S. With catheter-associated UTI being the most common healthcare-associated infection worldwide, this study aimed at providing a way to stop the spread of infections.

When infection prevention practices are properly applied, 69 percent of catheter-associated UTIs are considered to be preventable. Using appropriate maintenance, aseptic insertion and timely removal of indwelling urinary catheters can lower this rate but have to be implemented in hospitals.

“Our program represented a national collaboration of professional societies, academic researchers, government agencies (including the Centers for Disease Control and Prevention) and state hospital associations,” wrote Sanjay Saint, MD, MPH, and colleagues. “The main features of the program were centralized coordination and dissemination of educational materials and tool kits to sponsor organizations and hospitals, data collection with the use of established definitions and approaches, guidance on technical practices that prevent catheter-associated UTI, and an emphasis on addressing socioadaptive factors.”

Using the national Comprehensive Unit-based Safety Program, which aimed to reduce catheter-associated UTI, the study’s main features included giving information to sponsor organizations and hospitals, data collection and guidance on key technical and socioadaptive factors in the prevention of catheter-associated UTI. Data was collected in three phases: baseline (three months), implementation (two months), and sustainability (12 months).

“The goals of the program were to reduce catheter-associated UTIs and improve attitudes and behavior with respect to safety in participating units; this analysis focuses on reducing catheter-associated UTIs,” wrote Saint and colleagues.

Analyzing data from 926 units (59.7% were non-ICUs, 40.3% were ICUs) in 603 hospitals, results found that the adjusted analysis catheter-associated UTI rates in decreased from 2.40 to 2.05 infections per 1,000 catheter-days. Catheter use in non-ICUs also decreased from 20.1 percent to 18.8 percent and catheter-associated UTI rates decreased from 2.28 to 1.54 infections per 1,000 catheter-days. Catheter use and catheter-associated UTI rates were largely unchanged in ICUs.

“We found that a collaborative effort focusing on both technical and socioadaptive interventions can reduce catheter-associated UTI rates in the non-ICU setting,” wrote Saint and colleagues. “Non-ICUs benefited from participating in the program, whereas ICUs did not.”

Even though rates of catheter-associated UTI in non-ICUs decreased by 14 percent between 2009 and 2012 the rates in ICUs increased by 9 percent. One explanation for this outcome is the belief that patients who are ill enough to warrant admission to the ICU require close monitoring of urine output, which is an appropriate criterion for indwelling urinary catheters suggests the authors.

“We found that a national collaborative program implemented in more than 10 percent of U.S. hospitals led to a decrease in rates of catheter-associated UTI in non-ICUs,” concluded Saint and colleagues.