More than 600 hospitals participating in the national Comprehensive Unit-Based Safety Program (CUSP), funded by the Agency for Healthcare Research and Quality, reduced catheter-associated urinary tract infections by 32% in non-intensive care units (non-ICUs) between March 2011 and November 2013, according to a study published in the New England Journal of Medicine. The program also reduced catheter use by 1.3 percentage points, to 18.8%, by avoiding unnecessary or prolonged use of catheters and by using alternative urinary collection methods.
“One possible explanation is the belief that patients who are ill enough to warrant admission to the ICU require close monitoring of urine output, which is an appropriate criterion for indwelling urinary catheters,” the authors observed.
The main features of the program included the dissemination of educational materials and tool kits to sponsor organizations and hospitals; data collection with the use of established definitions and approaches; guidance on technical practices that prevent catheter-associated UTI; and an emphasis on addressing socioadaptive factors (both general issues and those specific to catheter-associated UTI). Tools from CUSP were used to support the socioadaptive aspects of catheter-associated UTI prevention.
Key interventions included the following: conducting a daily assessment of the presence and necessity of an indwelling urinary catheter; avoiding the use of an indwelling urinary catheter by considering alternative urine-collection methods, such as intermittent straight catheterization; and emphasizing the importance of aseptic technique during the insertion of a catheter and proper maintenance after insertion.
Data on catheter use and catheter-associated urinary tract infection (UTI) rates were obtained from 926 units (40% ICUs and 60% non-ICUs) in 603 hospitals in 32 states, the District of Columbia, and Puerto Rico. The information was collected in three phases: baseline (three months), implementation (two months), and sustainability (12 months).
Across all participating units, the unadjusted rates of catheter-associated UTI decreased by 22.3%, from 2.82 infections per 1,000 catheter-days at the end of baseline to 2.19 per 1,000 catheter-days at the end of the sustainability period. In an adjusted analysis, the rates decreased from 2.40 infections per 1,000 catheter-days at the end of baseline to 2.05 per 1,000 catheter-days at the end of the sustainability period (incidence rate ratio [IRR], 0.86; P = 0.009).
Reductions occurred mainly in non-ICUs, where catheter-associated UTI rates decreased from 2.28 to 1.54 infections per 1,000 catheter-days (IRR, 0.68; P < 0.001). The rates did not change significantly in ICUs: 2.48 infections per 1,000 catheter-days at the end of baseline and 2.50 per 1,000 catheter-days at the end of the sustainability period (IRR, 1.01; P = 0.90).
The authors concluded that the CUSP national prevention program appears to reduce catheter use and catheter-associated UTI rates in non-ICUs.
Source: NEJM; June 2, 2016.