Catheter-associated urinary tract infection (CAUTI) can be significantly reduced using a new program, a new study has shown.
The Agency for Healthcare Research and Quality's (AHRQ) national project, the Comprehensive Unit-based Safety Program (CUSP), greatly lowered the incidence of hospital-acquired urinary tract infection (UTI) secondary to catheter use.
UTIs rank [PDF] fourth among the most common health care-related infections, with an estimated 93,300 UTI cases reported in acute care hospitals. CAUTI can have many complications including epididymitis, prostatitis and orchitis in males. All patients can have vertebral osteomyelitis, endocarditis, septic arthritis and meningitis. Annually, about 13,000 deaths are associated with UTIs.
The drive toward preventing CAUTIs and other health care-related infections has many implications. Patients are saved from developing complications and the need to use antibiotics is lessened.
Reducing use of antibiotics help prevent the growth of antibiotic-resistant bacteria like the superbug reported recently.
"AHRQ's research shows that we can make significant progress in advancing patient safety and reducing costs in health care," said AHRQ Director Dr. Andy Bindman "Tools such as CUSP are an important part of our efforts to improve the way we deliver care, helping frontline clinicians make care safer, less expensive and better for public health."
For their study, the researchers analyzed information from 926 hospital units, including intensive care units and regular units, in 32 states, Puerto Rico and the District of Columbia that were involved in the early stages of the CUSP project, which ran for 4 years.
The results showed that the incidence rate of CAUTI was reduced by 32 percent in regular units - from 2.28 cases to 1.54 cases for every 1,000 days of catheter use. The said units also recorded a decline in the overall usage of catheters to 18.8 percent from a previous of 20.1 percent.
While there was a significant reduction of CAUTI in regular units, the rates did not change for intensive care units. This could be because a majority of patients in the intensive care units use in-dwelling catheters for urine output monitoring. Removing the catheters will not allow the caregivers to closely monitor the patient.
Study lead Dr. Sanjay Saint, the chief of medicine at the VA Ann Arbor Healthcare System in Michigan and a professor at the University of Michigan, said the results reflect the collaborative work that highlights interventions that can be done to significantly reduce the incidence rates of CAUTI. By involving many groups in the project, it would be easier to implement the program, prevent CAUTI and improve long-term care.
Clinicians can use the safety program and adjust it according to best practices. CUSP can be combined with other programs to ensure improvement in teamwork and communication. The tool was largely based from Saint's previous research on UTI and catheter use.
CUSP reduces the incidence of CAUTI by:
• conducting an assessment of whether catheter use is necessary
• monitoring patients on catheters daily
• exhausting other means of urine collection (other than the use of indwelling catheters)
• training all members of the team
• advocating for strict adherence to sterile catheter placement and maintenance
• encouraging open communication among doctors, nurses and other health care providers regarding a patient's catheter use
• disseminating information about latest data and best practices
"There's more work to be done, but all involved in this effort should take pride in knowing they helped move the needle on this important issue," said Saint.
The study is published in the New England Journal of Medicine on June 2.
