Enhancing Patient Safety ByPreventing Catheter-associatedUrinary Tract Infection

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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4

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

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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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