Hostname: page-component-8448b6f56d-c47g7 Total loading time: 0 Render date: 2024-04-18T08:50:39.263Z Has data issue: false hasContentIssue false
  • English
  • Français

Regional Variation in Urinary Catheter Use and Catheter-Associated Urinary Tract Infection: Results from a National Collaborative

Published online by Cambridge University Press:  10 May 2016

M. Todd Greene ,
Mohamad G. Fakih ,
Karen E. Fowler ,
Jennifer Meddings ,
David Ratz ,
Nasia Safdar ,
Russell N. Olmsted  and
Sanjay Saint
M. Todd Greene
Affiliation:
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor, Michigan
Mohamad G. Fakih
Affiliation:
St. John Hospital and Medical Center, Detroit, Michigan
Karen E. Fowler
Affiliation:
Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor, Michigan Hospital Outcomes Program of Excellence, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
Jennifer Meddings
Affiliation:
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor, Michigan
David Ratz
Affiliation:
Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor, Michigan Hospital Outcomes Program of Excellence, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
Nasia Safdar
Affiliation:
William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin; and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Russell N. Olmsted
Affiliation:
Saint Joseph Mercy Health System, Ann Arbor, Michigan
Sanjay Saint
Affiliation:
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor, Michigan Hospital Outcomes Program of Excellence, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
Rights & Permissions [Opens in a new window]

Extract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective.

To examine regional variation in the use and appropriateness of indwelling urinary catheters and catheter-associated urinary tract infection (CAUTI).

Design and Setting.

Cross-sectional study.

Participants.

US acute care hospitals.

Methods.

Hospitals were divided into 4 regions according to the US Census Bureau. Baseline data on urinary catheter use, catheter appropriateness, and CAUTI were collected from participating units. The catheter utilization ratio was calculated by dividing the number of catheter-days by the number of patient-days. We used the National Healthcare Safety Network (NHSN) definition (number of CAUTIs per 1,000 catheter-days) and a population-based definition (number of CAUTIs per 10,000 patient-days) to calculate CAUTI rates. Logistic and Poisson regression models were used to assess regional differences.

Results.

Data on 434,207 catheter-days over 1,400,770 patient-days were collected from 1,101 units within 726 hospitals across 34 states. Overall catheter utilization was 31%. Catheter utilization was significantly higher in non-intensive care units (ICUs) in the West compared with non-ICUs in all other regions. Approximately 30%–40% of catheters in non-ICUs were placed without an appropriate indication. Catheter appropriateness was the lowest in the West. A total of 1,099 CAUTIs were observed (NHSN rate of 2.5 per 1,000 catheter-days and a population-based rate of 7.8 per 10,000 patient-days). The population-based CAUTI rate was highest in the West (8.9 CAUTIs per 10,000 patient-days) and was significantly higher compared with the Midwest, even after adjusting for hospital characteristics (P = .02).

Conclusions.

Regional differences in catheter use, appropriateness, and CAUTI rates were detected across US hospitals.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue S3: Preventing Healthcare–Associated Infections: Results and Lessons Learned from AHRQ's HAI Program , October 2014 , pp. S99 - S106
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

References

1. Klevens, RM, Edwards, JR, Richards, CL Jr, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep 2007;122:160–166.CrossRefGoogle ScholarPubMed
2. Foxman, B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med 2002;113(suppl 1A): 5S–13S.Google Scholar
3. Saint, S. Clinical and economic consequences of nosocomial catheter-related bacteriuria. Am J Infect Control 2000;28:68–75.Google Scholar
4. Hollingsworth, JM, Rogers, MA, Krein, SL, et al. Determining the noninfectious complications of indwelling urethral catheters: a systematic review and meta-analysis. Ann Intern Med 2013;159: 401–410.Google Scholar
5. Saint, S, Lipsky, BA, Baker, PD, McDonald, LL, Ossenkop, K. Urinary catheters: what type do men and their nurses prefer? J Am Geriatr Soc 1999;47:1453–1457.Google Scholar
6. Saint, S, Lipsky, BA, Goold, SD. Indwelling urinary catheters: a one-point restraint? Ann Intern Med 2002;137:125–127.Google Scholar
7. Centers for Medicare and Medicaid Services. Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 2008 rates. Fed Regist 2007;72:47129–48175.Google Scholar
8. Gould, CV, Umscheid, CA, Agarwal, RK, Kuntz, G, Pegues, DA; Healthcare Infection Control Practices Advisory Committee. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol 2010;31:319–326.CrossRefGoogle ScholarPubMed
9. Meddings, J, Rogers, MA, Krein, SL, Fakih, MG, Olmsted, RN, Saint, S. Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review. BMJ Qual Saf 2014;23:277–289.CrossRefGoogle ScholarPubMed
10. Dudeck, MA, Horan, TC, Peterson, KD, et al. National Healthcare Safety Network report, data summary for 2011, device-associated module. Am J Infect Control 2013;41:286–300.Google Scholar
11. Huang, WC, Wann, SR, Lin, SL, et al. Catheter-associated urinary tract infections in intensive care units can be reduced by prompting physicians to remove unnecessary catheters. Infect Control Hosp Epidemiol 2004;25:974–978.Google Scholar
12. Topal, J, Conklin, S, Camp, K, Morris, V, Balcezak, T, Herbert, P. Prevention of nosocomial catheter-associated urinary tract infections through computerized feedback to physicians and a nurse-directed protocol. Am J Med Qual 2005;20:121–126.Google Scholar
13. Saint, S, Kaufman, SR, Thompson, M, Rogers, MA, Chenoweth, CE. A reminder reduces urinary catheterization in hospitalized patients. Jt Comm J Qual Patient Saf 2005;31:455–462.Google ScholarPubMed
14. Crouzet, J, Bertrand, X, Venier, AG, Badoz, M, Husson, C, Talon, D. Control of the duration of urinary catheterization: impact on catheter-associated urinary tract infection, J Hosp Infect 2007; 67:253–257.CrossRefGoogle ScholarPubMed
15. Loeb, M, Hunt, D, O'Halloran, K, Carusone, SC, Dafoe, N, Walter, SD. Stop orders to reduce inappropriate urinary catheterization in hospitalized patients: a randomized controlled trial. J Gen Intern Med 2008;23:816–820.Google Scholar
16. Goetz, AM, Kedzuf, S, Wagener, M, Muder, RR. Feedback to nursing staff as an intervention to reduce catheter-associated urinary tract infections. Am J Infect Control 1999;27:402–404.Google Scholar
17. Fakih, MG, Dueweke, C, Meisner, S, et al. Effect of nurse-led multidisciplinary rounds on reducing the unnecessary use of urinary catheterization in hospitalized patients. Infect Control Hosp Epidemiol 2008;29:815–819.CrossRefGoogle ScholarPubMed
18. Saint, S, Kowalski, CP, Kaufman, SR, et al. Preventing hospital-acquired urinary tract infection in the United States: a national study. Clin Infect Dis 2008;46:243–250.Google Scholar
19. Krein, SL, Kowalski, CP, Hofer, TP, Saint, S. Preventing hospital-acquired infections: a national survey of practices reported by U.S. Hospitals in 2005 and 2009. J Gen Intern Med 2012;27: 773–779.Google Scholar
20. Saint, S, Greene, M, Kowalski, S, Watson, S, Hofer, T, Krein, S. Preventing catheter-associated urinary tract infection in the United States: a national comparative study. JAMA Intern Med 2013;173:874–879.Google Scholar
21. Weber, DJ, Sickbert-Bennett, EE, Gould, CV, Brown, VM, Huslage, K, Rutala, WA. Incidence of catheter-associated and non-catheter-associated urinary tract infections in a healthcare system. Infect Control Hosp Epidemiol 2011;32:822–823.Google Scholar
22. Lewis, SS, Knelson, LP, Moehring, RW, Chen, LF, Sexton, DJ, Anderson, DJ. Comparison of non-intensive care unit (ICU) versus ICU rates of catheter-associated urinary tract infection in community hospitals. Infect Control Hosp Epidemiol 2013;34:744–747.Google Scholar
23. Wald, H, Epstein, A, Kramer, A. Extended use of indwelling urinary catheters in postoperative hip fracture patients. Med Care 2005;43:1009–1017.Google Scholar
24. Wald, HL, Epstein, AM, Radcliff, TA, Kramer, AM. Extended use of urinary catheters in older surgical patients: a patient safety problem? Infect Control Hosp Epidemiol 2008;29:116–124.Google Scholar
25. Wald, HL, Ma, A, Bratzier, DW, Kramer, AM. Indwelling urinary catheter use in the postoperative period: analysis of the national surgical infection prevention project data. Arch Surg 2008;143: 551–557.Google Scholar
26. Rogers, MA, Mody, L, Kaufman, SR, Fries, BE, McMahon, LF Jr, Saint, S. Use of urinary collection devices in skilled nursing facilities in five states. J Am Geriatr Soc 2008;56:854–861.Google Scholar
27. Fakih, MG, George, C, Edson, BS, Goeschel, CA, Saint, S. Implementing a national program to reduce catheter-associated urinary tract infection: a quality improvement collaboration of state hospital associations, academic medical centers, professional societies, and governmental agencies. Infect Control Hosp Epidemiol 2013;34:1048–1054.Google Scholar
28. Fakih, MG, Greene, MT, Kennedy, EH, et al. Introducing a population-based outcome measure to evaluate the effect of interventions to reduce catheter-associated urinary tract infection. Am J Infect Control 2012;40:359–364.Google Scholar
29. US Census Bureau. Statistical Abstract of the United States. Washington, DC: US Census Bureau, 2012. http://www.census.gov/compendia/statab/. Accessed November 27, 2013.Google Scholar
30. Centers for Disease Control and Prevention (CDC), National Center for Health Statistics. National Hospital Discharge Survey, 2010. Atlanta: CDC, 2010. http://www.cdc.gov/nchs/data/nhds/lgeneral/2010genl_agesexalos.pdf. Accessed November 28, 2013.Google Scholar
31. Daniels, KR, Lee, GC, Frei, CR. Trends in catheter-associated urinary tract infections among a national cohort of hospitalized adults, 2001-2010. Am J Infect Control 2014;42:17–22.Google Scholar
32. Conway, LJ, Pogorzelska, M, Larson, E, Stone, PW. Adoption of policies to prevent catheter-associated urinary tract infections in United States intensive care units. Am J Infect Control 2012; 40:705–710.Google Scholar
33. Centers for Medicare and Medicaid Services. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and FY 2012 rates; hospitals' FTE resident caps for graduate medical education payment. Final rules. Fed Regist 2011; 76:51476–51846.Google Scholar
34. Centers for Medicare and Medicaid Services. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and Fiscal Year 2014 rates; quality reporting requirements for specific providers; hospital conditions of participation; payment policies related to patient status. Final rules. Fed Regist 2013;78:50495–51040.Google Scholar