A Program to Prevent Catheter-Associated Urinary Tract Infection in Acute Care

Sanjay Saint, an expert in the field of catheter associated UTIs or CAUTIs, and colleagues report on a CAUTI prevention program in acute care.  This was an Agency for Healthcare Research & Quality (AHRQ) funded study whose aim was to reduce catheter associated UTIs in both ICUs (40.3%) and non-ICUs (59.7%) in 603 hospitals in 32 states and the District of Columbia and Puerto Rico.  

The main program was dissemination of information to hospitals, collecting data and guidance on key technical and associated factors in the prevention of CAUTIs.  Staff were taught technical practices to prevent CAUTIs with an emphasis on associated adaptive behavior factors. Tools from CUSP (http://www.ahrq.gov/professionals/quality-patient-safety/cusp/cauti-interim/index.html) were used to support disassociated adaptive aspects of CAUTI prevention.  This program was modeled on a previous program that had successfully reduced blood stream infections due to central venous catheters. 

Some of the examples of the interventions included daily assessment of the presence and need for an indwelling urinary catheter (IUC).  Staff conducted daily nursing rounds that reviewed indications for continuing the IUC and ways to avoid the use of an IUC by considering alternative urine collection.  Alternative interventions promoted included the use of external catheters, bladder scanners, intermittent straight catheterization, and accurate measurement of daily weights.  Emphasizing was placed on aseptic technique during catheter insertion and proper maintenance after insertion. 

The hospital’s catheter insertion policies were all updated to include competencies for staff who insert catheters and periodic audits of actual catheter placement.  Additionally, feedback about CAUTI and device days was provided to the units.  Gaps in knowledge of urinary management was identified.  Over the 18 months of the study, this program saw an adjusted catheter CAUTI rate decrease from 2.82 to 2.19 infections per 1,000 catheter days.  Catheter use and CAUTI rates were largely unchanged in ICUs as the improvement was only seen in non-ICUs. 

The author’s conclusion was that non-ICUs benefited from participating in the program where as ICUs did not.  This is not surprising as ICU rates tend not to decrease, they actually may increase.  Why they are being less successful is really not clear but it may be related to the frequent recurrence of fever in critically ill patients with routine culturing of various body fluids and urine to identify possible sources of infection.  This is an interesting study and it shows the continuing frustration over trying to decrease CAUTI rates in all patient units.

Saint S, Greene MT, Krein SL, Rogers MA, Ratz D, Fowler KE, Edson BS, Watson SR, Meyer-Lucas B, Masuga M, Faulkner K, Gould CV, Battles J, Fakih MG. A Program to Prevent Catheter-Associated Urinary Tract Infection in Acute Care. N Engl J Med. 2016 Jun 2;374(22):2111-9. doi: 10.1056/NEJMoa1504906

Written by:
Diane K. Newman, DNP
Adjunct Professor of Urology in Surgery
Research Investigator Senior
Co-Director, Penn Center for Continence and Pelvic Health
University of Pennsylvania 
Division of Urology 
3400 Spruce Street, 3rd Floor Perelman Bldg
Philadelphia, PA. 19104