A national project called the Comprehensive Unit-based Safety Program, funded by the Agency for Healthcare Research and Quality, has significantly helped to reduce catheter-associated urinary tract infections in hospitals, according to a study published Thursday in the New England Journal of Medicine.
About 250,000 catheter-associated urinary tract infections take place in hospitals each year, costing about $250 million, the report said -- and CAUTIs, which are among the most common healthcare-associated infections, are largely preventable. Halting them spares patients an infection that can have serious complications, such as bloodstream infection, and it also reduces the need for antibiotics, according to the report. This decreases the chance that bacteria will develop resistance to these medications.
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The Comprehensive Unit-based Safety Program, or CUSP, is a customizable safety program in which clinicians use a checklist of best practices and combine it with improvement in safety culture, teamwork and communications.
The study, "A Program to Prevent Catheter-Associated Urinary Tract Infection in Acute Care," was led by Sanjay Saint, MD, chief of medicine at the U.S. Department of Veterans Affairs Ann Arbor Healthcare System, and George Dock, a professor at the University of Michigan. They examined data from 926 hospital units (intensive care units and non- ICUs alike) in 32 states, the District of Columbia, and Puerto Rico, which all participated in the early stages of the 4-year CUSP project.
Saint and Dock found that CAUTI rates decreased by 32 percent in non-ICUs, from 2.28 to 1.54 infections per 1,000 days of catheter use. These units were also able to reduce the overall use of catheters from 20.1 percent to 18.8 percent by avoiding unnecessary or needlessly prolonged catheterizations and using alternative urinary collection methods.
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Although CAUTI rates and catheter use decreased in non-ICUs, the study showed that rates of CAUTIs and catheter use in participating ICUs were unchanged; reducing the use of catheters, the study found, is one of the main ways to prevent CAUTI. The authors suggest that differences in routine care processes between ICUs and other hospital units could be a reason why CAUTIs did not decrease in ICUs. For example, ICU patients are sicker than other hospital patients and may require closer monitoring. ICU clinicians, authors said, must balance the need to monitor urine output closely by means of a catheter with the increased risk of CAUTI that comes with catheter use.
"These results demonstrate that a collaborative effort focusing on both technical and socio-adaptive interventions can reduce CAUTI rates in non-ICU settings," said Saint in a statement. "Importantly, we learned how to scale up the intervention when going from a single hospital and region to a broader group encompassing about 10 percent of all U.S hospitals. The overall experience in this project should help us implement methods to reduce CAUTI in other settings such as long-term care."
AHRQ Director Andy Bindman, MD, said in a statement that the research "shows that we can make significant progress in advancing patient safety and reducing costs in healthcare."
Twitter: @JELagasse