Enhancing Patient Safety By Preventing Catheter-associated Urinary Tract Infection
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nfections that occur during a hospital stay are called hospital-acquired infections. These infections are common, costly and potentially life threatening. Preventing
hospital-acquired infection is an important patient safety issue.
The Centers for Disease Control and Prevention (CDC) estimate that hospital-acquired infections affect approximately two
Spring 2012
million patients hospitalized annually in the United States and lead to at least $26 billion in direct costs per year. Researchers www.customercarenews.com
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estimate that at least 20 percent of all hospital-acquired infections can be prevented, and more than half of those associated with
catheter use are considered preventable. Our research team from
the University of Michigan and Ann Arbor VA Medical Center has been working on preventing these infections.
Catheter-associated urinary tract infection prevention
Urinary catheters are used when a person cannot empty his
or her bladder either because something is blocking the urine flow or the bladder does not feel the need to empty; unfor-
tunately, urinary catheters can be harmful. Patients often find them uncomfortable, and they can cause a urinary tract infection (UTI), called a catheter-
associated UTI. Almost 25 percent of patients will
have a urinary catheter at some point during their
hospital stay. Despite the
Research is key to preventing hospital-acquired infections.
Unfortunately, this is not enough. In addition to creating and
sharing new knowledge about hospital-acquired infections, we
have been committed to making sure that our findings are used in practice. For example, we have been involved in national efforts to better understand the adoption of infection-prevention prac-
tices by individual hospitals and the factors that may promote or
inhibit the effective use of these practices. We have already identified several important facilitators (such as the use of collaboratives and the importance of committed champions) and barriers (such
as the presence of “active resisters” and “organizational constipa-
tors”) that leaders should consider when implementing new safety practices in hospitals.
UTI, several studies have
CatheterOut.org, which outlines options for reducing catheter-
third of the days that a
more than a decade ago by conducting numerous studies that
patient is catheterized, the
catheter is unnecessary. In a multicenter study, we found that
approximately 30 percent of doctors were unaware their patients were catheterized. Our findings may help explain why patients are catheterized for unjustified reasons: physicians are often unaware
the catheter is in place and therefore do not write an order to have the catheter removed.
Some interventions have been found to decrease the inci-
dence of catheter-associated UTI. The best strategy to prevent hospital-acquired, catheter-associated UTI is to avoid catheter-
ization itself. In those patients who truly require catheterization, however, the use of aseptic (sterile) insertion and proper maintenance of the catheter and drainage bag remain essential in pre-
venting catheter-associated UTI. Once placed, urinary catheters should be removed as soon as possible. Rather than rely on busy
physicians to remember which patients have urinary catheters, our research team has found that a reminder system significantly
One of the products of our efforts is an online tool,
associated UTI and urinary catheter use. We began our work helped define what should be done to prevent catheterassociated UTI. We then
investigated how hospitals are using research findings in everyday clinical practice. For example, in 2009 we surveyed more than
800 hospitals across the United States to learn more about which infection prevention practices have been implemented. We have studied approximately a dozen U.S. hospitals in-depth (from Maine to California) through detailed site visits to find out what
worked for them in reducing indwelling urinary catheter use and catheter-associated UTI, what did not work, and why. In the
course of our work, we have interviewed more than 150 health-
care workers from all levels of the organization, including chief executive officers (CEOs), chief nurse executives, chief medical
officers, infection preventionists, hospital epidemiologists, frontline nurses and doctors, nurse managers, and urologists.
While the website contains sections targeted to many types
decreases urinary catheter use. Also, alternatives to indwelling
of healthcare workers, the page “For Patients” gathers in a single
also published a study comparing condom catheters with indwell-
patients and their families. This includes:
catheters should be considered in appropriate patients. We have ing urinary catheters in male Veterans requiring short-term
urinary collection. We found that the use of condom catheters
Spring 2012
Translating research into practice
Catheterout.org
catheter-associated
found that about one-
reduces infection, and they were reported to be more comfortable and less painful than indwelling catheters. Clinicians and
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catheter-associated UTI.
often severe consequences of
Condom Catheter
administrators should consider using these practices to prevent
place the information on the website that is of most interest to • A “Definitions” page, defining key catheter-associated UTI terms
• General background information on infectious complications of urinary catheters
Customer Care News
Catheter Placement
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Catheter Re-insertion
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Catheter Care
3 Catheter Removal • A list of “Key Prevention Strategies,” such as only using
Sanjay Saint, MD, MPH, a Professor of Internal Medicine
nary catheter; inserting the catheter aseptically; maintaining
University of Michigan Patient Safety Enhancement Program
urinary catheters when needed; avoiding the indwelling urithe catheter properly; removing unnecessary catheters; and using antimicrobial catheters
The site also provides patient and family education materi-
als. These include a brochure titled “What Patients and Family Members Need to Know About the Risks Associated with Urinary Catheters” for use in situations where there are patient or family requests for a urinary catheter without an appropriate
indication. Educating patients and their family members about urinary catheter risks can be an important way to reduce the
unnecessary use of urinary catheters. There is also a one-page
“FAQs about Catheter-Associated Urinary Tract Infections,” which provides patients with an overview of urinary catheters as
at the University of Michigan, is the Director of the VA/
and the Associate Chief of Medicine at the Ann Arbor VA
Medical Center. His research focuses on enhancing patient safety by preventing healthcare-associated infection and translating
research findings into practice. He has authored more than 200
peer-reviewed papers with more than 60 appearing in the New England Journal of Medicine, JAMA, or the Annals of Internal Medicine. Dr. Saint can be reached at saint@umich.edu. References
• Scott RD. The direct medical costs of healthcare-associated
Infections in U.S. hospitals and the benefits of prevention. Available at: http://www.cdc.gov/HAI/pdfs/hai/Scott_ CostPaper.pdf. Cited January 17, 2012.
well as catheter-associated UTI and how patients can safely care
• Meddings J, Rogers MA, Macy M, Saint S. Systematic review
Since it launched in early 2011, CatheterOut.org has attract-
associated urinary tract infections and urinary catheter use in
for their urinary catheter.
ed nearly 5,500 visits from more than 4,200 unique visitors in 87
countries. We have responded to queries from multiple organi-
zations via our online contact form, and recently ventured into social media, launching our Facebook page in fall 2011. We are
continually updating and adding to the website, and welcome any comments or questions visitors may have.
CatheterOut.org has helped us share our research about the
most common hospital-acquired infection in the United States. investigations will be able to help hospitals across the nation enhance their catheter-associated UTI prevention efforts. CCN
www.customercarenews.com
hospitalized patients. Clin Infect Dis. 2010;51(5):550-60.
• Saint S, Kaufman SR, Rogers MA, Baker PD, Ossenkop K, Lipsky BA. Condom versus indwelling urinary catheters: a randomized trial. J Am Geriatr Soc. 2006;54(7):1055-61.
• Chenoweth CE, Saint S. Urinary tract infections. Infect Dis Clin North Am. 2011;25(1):103-15.
• S aint
S,
Kowalski
CP,
Banaszak-Holl
J,
Forman
J, Damschroder L, Krein SL. How active resisters and
organizational constipators affect health care-acquired
Spring 2012
We hope that the information we have gathered through these
and meta-analysis: reminder systems to reduce catheter-
infection prevention efforts. Jt Comm J Qual Patient Saf. 2009;35(5):239-46.
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