Jim Kling

May 26, 2011

May 26, 2011 (Dallas, Texas) — A new initiative, highlighted by a nurse-driven catheter removal protocol, significantly reduced the use of indwelling urinary catheter and associated infections, according to a study presented here at the Society for Healthcare Epidemiology of America 20th Annual Scientific Meeting.

Catheter-associated urinary tract infections (CAUTIs) are the most common cause of hospital-acquired infections. CAUTI rates have not fallen in the past 5 years, despite education, hand hygiene, and environmental cleaning initiatives.

The initiative to reduce the use of urinary catheters and associated infections involved a nurse-driven catheter removal protocol, a requirement to document catheter-insertion criteria, a device-specific charting module added to physician electronic progress notes, and biweekly feedback on the use rates of catheters and infection rates.

The program achieved a 32% reduction in the use of catheters (from 0.22 to 0.15 catheters/patient-day) and a 45% reduction in CAUTI (from 4.78 to 2.64 infections/1000 catheter-days). In the intensive care unit, which reported its data to the National Healthcare Safety Network (NHSN), catheter use dropped 50% (from 0.78 to 0.39 catheters/patient-day).

Paradoxically, when measured by catheter-days, as required by the NHSN, the intensive care unit saw a 40% increase in the CAUTI rate. "We postulate that this is due to the ease of removing a low-risk catheter, leaving high-risk catheters as the denominator. Therefore, perhaps patient-days is a better denominator than device-days," said Michael Parry, MD, director of infectious diseases and microbiology at Stamford Hospital in Connecticut, and professor of clinical medicine at the Columbia University College of Physicians and Surgeons in New York City, during his presentation.

The results suggest that reporting infection rates will become more challenging with increased success. "As we do a better job of preventing infections, we will have to look at different ways to express how we are measuring the number of infections. We may need to look at different measures than we've looked at in the past," Arjun Srinivasan, MD, associate director for healthcare-associated infection prevention programs at the Centers for Disease Control and Prevention in Atlanta, Georgia, told Medscape Medical News.

The study did not receive commercial support. Dr. Parry and Dr. Srinivasan have disclosed no relevant financial relationships.

Society for Healthcare Epidemiology of America (SHEA) 20th Annual Scientific Meeting: Abstract 357. Presented April 3, 2011.

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