In the Journals

National prevention program reduces CAUTIs, catheter use in non-ICUs

Data collected from hospital units participating in a national prevention campaign indicated significant reductions in catheter-associated urinary tract infection, or CAUTI, incidence and overall catheter use following the intervention.

This decline appeared to occur primarily among non-ICUs, according to the study, as there were no changes when researchers limited their analysis to the ICUs of participating hospitals.

Sanjay Saint

Sanjay Saint

“Preventing health care-associated infection in general, and [CAUTI] in particular, has emerged as a priority in the United States, with government agencies taking a lead role,” Sanjay Saint, MD, MPH, professor of internal medicine at the University of Michigan Medical School and the Veterans Affairs Ann Arbor Healthcare System, and colleagues wrote.

“The [National Action Plan’s] goal was to reduce the rates of [CAUTI] by 25% by 2013. Despite these efforts, national data indicate that the incidence of [CAUTI] increased by 6% from 2009 to 2013.”

Performance of a national collaborative program

The Comprehensive Unit-based Safety Program (CUSP) to reduce CAUTIs was an 18-month program launched in March 2011. Modeled on a previous campaign that successfully reduced bloodstream infections related to central venous catheters, the CAUTI program disseminated information and materials to organizations and hospitals; provided technical practice guidance; advocated correction of various socio-adaptive factors; and collected CAUTI data.

To gauge the program’s effectiveness, Saint and colleagues examined patient and program data collected from 926 units in 603 U.S. hospitals. They conducted analyses to identify any changes in the prevalence of CAUTIs or indwelling urinary catheter use throughout the program’s duration.\

Credit: University of Michigan

Source: University of Michigan

Approximately 40% of participating units were ICUs, which were significantly less likely than participating non-ICUs to be operating within rural or critical-access hospitals.

Among all units, unadjusted CAUTI rates decreased from 2.82 infections per 1,000 catheter-days to 2.19 per 1,000 catheter-days, while adjusted rates decreased from 2.4 infections per 1,000 catheter-days to 2.05 per 1,000 catheter-days (IRR = 0.86; 95% CI, 0.76-0.96). When examining adjusted CAUTI rates by unit type, the researchers found a larger decrease among non-ICUs (IRR = 0.68; 95% CI, 0.56-0.82) but no change among ICUs (IRR = 1.01; 95% CI, 0.87-1.17).

Trends in reported urinary catheter use were largely similar, with adjusted rates decreasing among non-ICUs (IRR = 0.93; 95% CI, 0.9-0.96), but remaining unchanged among ICUs (IRR = 0.98; 95% CI, 0.96-1.01). Sensitivity regression analysis indicated no significant differences between units that submitted all expected hospital characteristic information and those providing only partial data.

Saint and colleagues noted that the disparity between unit types also is reflected in CDC surveillance data, which showed a decrease in CAUTI rates from 2009 to 2012 in non-ICUs but a 9% increase among ICUs during the same time. Regardless, a comparative prevention program is currently planned for other settings.

“We found that a national collaborative program implemented in more than 10% of U.S. hospitals led to a decrease in rates of [CAUTI] in non-ICUs,” they wrote. “Our approach to preventing [CAUTIs] used both technical and cultural interventions. A similar collaborative effort is extending this program to long-term care settings, for which preventive data are more limited.”

Long-term efforts needed to maintain gains 

In a related editorial, Susan S. Huang, MD, MPH, of the division of infectious diseases at the University of California Irvine School of Medicine, discussed several potential explanations for the static CAUTI and catheter use rates reported by ICUs, such as more frequent fever or critical patients. Although Huang advocated further investigation into the program’s effectiveness, she also questioned whether the results and practices of this and other campaigns can be maintained by health care providers in the long term.

Susan huang

Susan S. Huang

“Does the focus on one campaign signal a trade-off of attention to other equally important processes?” Huang wrote. “The sheer number of documentation and medical-practice requirements in place today requires a breadth of technological advances, facility design, human-factors engineering, and implementation science to be able to maximally prevent human errors and omissions. Successful enduring methods to attend to all best-practice measures are needed if we are to continue to improve patient safety.” – by Dave Muoio

Disclosure: Saint reports receiving fees for serving on advisory boards from Doximity and Jvion.

Data collected from hospital units participating in a national prevention campaign indicated significant reductions in catheter-associated urinary tract infection, or CAUTI, incidence and overall catheter use following the intervention.

This decline appeared to occur primarily among non-ICUs, according to the study, as there were no changes when researchers limited their analysis to the ICUs of participating hospitals.

Sanjay Saint

Sanjay Saint

“Preventing health care-associated infection in general, and [CAUTI] in particular, has emerged as a priority in the United States, with government agencies taking a lead role,” Sanjay Saint, MD, MPH, professor of internal medicine at the University of Michigan Medical School and the Veterans Affairs Ann Arbor Healthcare System, and colleagues wrote.

“The [National Action Plan’s] goal was to reduce the rates of [CAUTI] by 25% by 2013. Despite these efforts, national data indicate that the incidence of [CAUTI] increased by 6% from 2009 to 2013.”

Performance of a national collaborative program

The Comprehensive Unit-based Safety Program (CUSP) to reduce CAUTIs was an 18-month program launched in March 2011. Modeled on a previous campaign that successfully reduced bloodstream infections related to central venous catheters, the CAUTI program disseminated information and materials to organizations and hospitals; provided technical practice guidance; advocated correction of various socio-adaptive factors; and collected CAUTI data.

To gauge the program’s effectiveness, Saint and colleagues examined patient and program data collected from 926 units in 603 U.S. hospitals. They conducted analyses to identify any changes in the prevalence of CAUTIs or indwelling urinary catheter use throughout the program’s duration.\

Credit: University of Michigan

Source: University of Michigan

Approximately 40% of participating units were ICUs, which were significantly less likely than participating non-ICUs to be operating within rural or critical-access hospitals.

Among all units, unadjusted CAUTI rates decreased from 2.82 infections per 1,000 catheter-days to 2.19 per 1,000 catheter-days, while adjusted rates decreased from 2.4 infections per 1,000 catheter-days to 2.05 per 1,000 catheter-days (IRR = 0.86; 95% CI, 0.76-0.96). When examining adjusted CAUTI rates by unit type, the researchers found a larger decrease among non-ICUs (IRR = 0.68; 95% CI, 0.56-0.82) but no change among ICUs (IRR = 1.01; 95% CI, 0.87-1.17).

Trends in reported urinary catheter use were largely similar, with adjusted rates decreasing among non-ICUs (IRR = 0.93; 95% CI, 0.9-0.96), but remaining unchanged among ICUs (IRR = 0.98; 95% CI, 0.96-1.01). Sensitivity regression analysis indicated no significant differences between units that submitted all expected hospital characteristic information and those providing only partial data.

Saint and colleagues noted that the disparity between unit types also is reflected in CDC surveillance data, which showed a decrease in CAUTI rates from 2009 to 2012 in non-ICUs but a 9% increase among ICUs during the same time. Regardless, a comparative prevention program is currently planned for other settings.

“We found that a national collaborative program implemented in more than 10% of U.S. hospitals led to a decrease in rates of [CAUTI] in non-ICUs,” they wrote. “Our approach to preventing [CAUTIs] used both technical and cultural interventions. A similar collaborative effort is extending this program to long-term care settings, for which preventive data are more limited.”

Long-term efforts needed to maintain gains 

In a related editorial, Susan S. Huang, MD, MPH, of the division of infectious diseases at the University of California Irvine School of Medicine, discussed several potential explanations for the static CAUTI and catheter use rates reported by ICUs, such as more frequent fever or critical patients. Although Huang advocated further investigation into the program’s effectiveness, she also questioned whether the results and practices of this and other campaigns can be maintained by health care providers in the long term.

Susan huang

Susan S. Huang

“Does the focus on one campaign signal a trade-off of attention to other equally important processes?” Huang wrote. “The sheer number of documentation and medical-practice requirements in place today requires a breadth of technological advances, facility design, human-factors engineering, and implementation science to be able to maximally prevent human errors and omissions. Successful enduring methods to attend to all best-practice measures are needed if we are to continue to improve patient safety.” – by Dave Muoio

Disclosure: Saint reports receiving fees for serving on advisory boards from Doximity and Jvion.