Novel low-resource intervention reduces urinary catheter use and associated urinary tract infections: Role of outcome measure bias? - Abstract

BACKGROUND: Previous interventions targeting nosocomial urinary tract infections have reduced catheterization and infections, but they require significant resources and may be susceptible to misclassification and surveillance bias.

We sought to determine the effectiveness of a novel intervention at reducing catheterization and infections while exploring the potential for bias.

METHODS: We conducted a prospective study of a brief monthly in-person educational intervention focusing on appropriate urinary catheter use.

RESULTS: We studied 1,335 patients (13,753 patient days) on 1 control and 1 intervention ward. After the intervention, the device utilization rate was significantly reduced, with a relative risk of 0.49 (95% confidence interval [CI], 0.32-0.76; P = .001) versus 1.02 (95% CI, 0.58-1.82; P = .93) for controls. Both wards demonstrated a reduction in catheter-associated infections after intervention, with an intervention relative risk of 0.42 (95% CI, 0.16-1.08; P = .07) and 0.51 (95% CI, 0.22-1.20; P = .12) for controls. There was no change in the rate of all nosocomial urine infections, with an intervention relative risk of 0.79 (95% CI, 0.38-1.65; P = .53) and 0.89 (95% CI, 0.48-1.67; P = .72) for controls.

CONCLUSION: Our study demonstrates that our novel educational intervention significantly reduces urinary catheter use in hospitalized patients. The trend towards reduced catheter-associated infections after intervention, coupled with the absence of an improvement in all nosocomial infections supports a potential role of misclassification bias. We suggest that future prospective investigations explore this phenomenon using more robust outcome measures.

Written by:
Schwartz BC, Frenette C, Lee TC, Green L, Jayaraman D.   Are you the author?
Division of General Internal Medicine, Department of Medicine, McGill University, Montreal, QC, Canada; Division of Infectious Diseases, Infection Prevention and Control Service, Department of Medicine, McGill University Health Center, Montreal, QC, Canada; Division of Infectious Diseases, Department of Medicine, McGill University, Montreal, QC, Canada; Division of General Internal Medicine, Department of Medicine, McGill University, Montreal, QC, Canada.  

Reference: Am J Infect Control. 2015 Feb 10. pii: S0196-6553(14)01376-5.
doi: 10.1016/j.ajic.2014.12.006


PubMed Abstract
PMID: 25681304

email news signup