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Urinary tract infections can be prevented when hospitals emphasize proper catheter use

U-M researchers demonstrate successful improvement effort could limit complications related to urinary catheterization

ANN ARBOR, Mich. - A collaborative study between the University of Michigan Health System, Michigan Health & Hospital Association (MHA) Keystone Center for Patient Safety & Quality, and St. John Hospital and Medical Center shows less is more in the effort to reduce urinary tract infections among hospitalized patients.

Researchers evaluated the use of urinary catheters at 71 Michigan hospitals that launched educational programs that emphasized using catheters only when needed.

Twenty weeks through the intervention, the average urinary catheter utilization rate decreased from 18.1 percent to 14.8 percent, while the rate of appropriate catheter use increased from 44.3 percent to 53.5 percent, according to the study published online Jan. 9 ahead of print in the Archives of Internal Medicine.

“Avoiding initial catheter use and reducing how long a patient is catheterized can mean fewer infection complications,” says senior study author Sanjay Saint, M.D., M.P.H., director of the VA/UM Patient Safety Enhancement Program, and U-M professor of internal medicine.

“In addition to reducing infection risk, promoting proper catheter use can lead to fewer non-infection complications, such as urethral injury. Patients also might experience less discomfort and be free of the restraints brought by the catheter.”

Hospitals can reduce their overall catheter use – and potentially prevent urinary tract infections, according to the study in which Mohamad G. Fakih, M.D., M.P.H., at the St. John Hospital and Medical Center and Wayne State University School of Medicine, collaborated as lead author.

In 2007, the MHA Keystone Center started statewide intervention programs in 163 inpatient units at 71 hospitals. The MHA Keystone Center initiative was based on the success of a pilot intervention at St. John Hospital and Medical Center in Detroit that saw a 45 percent reduction in inappropriate catheter use.

Hospital staffs involved in the interventions participated in webinars that highlighted the risk of improper catheterization and emphasized daily evaluation of a patient’s urinary catheter need.

Appropriate indications for catheter use include urinary tract obstruction, neurogenic bladder dysfunction and urinary retention, and end-of-life care.

The results of the study show that educational interventions and increasing urinary catheter awareness can help reduce improper catheterization and such initiatives can have success on a broad scale.

“These findings continue to empower and guide hospitals across the country to use similar programs to reduce inappropriate catheter use,” says co-author Sam R. Watson, MSA, MT, Senior Vice President for Patient Safety and Quality of the MHA and the Executive Director of the MHA Keystone Center.

Resources: For more information about how hospitals can prevent catheter-associated urinary tract infections as well as information for patients and families, visit www.catheterout.org.

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Additional authors: From U-M: M. Todd Greene, Edward H. Kennedy, Sarah L. Krein; From Saint Joseph Mercy Health System: Russ N. Olmsted.

Citation: Archives of Internal Medicine, DOI:10.1001/archinternmed.2011.627; published online Jan. 9, 2012. “Reducing Inappropriate Urinary Catheter Use: A Statewide Effort”

Disclosures: Dr. Fakih has a subcontract to implement multi-state catheter-associated urinary tract infection (CAUTI) prevention with the Agency for Healthcare Research and Quality/Health Educational and Research Trust.  Mr. Watson has a contract to implement statewide CAUTI prevention with the Agency for Healthcare Research and Quality/Health Educational and Research Trust.  Dr. Greene is a project manager on a multi-state CAUTI prevention project with the Agency for Healthcare Research and Quality/Health Educational and Research Trust.  Mr. Kennedy has no potential conflicts of interest to disclose.   Mr. Olmsted has provided professional consulting services to Arizant Healthcare, Bard Medical Division, ECOLAB, and Mintie.  He has also served as faculty for presentations sponsored by Advanced Sterilization Products, Baxter Healthcare, BD, CareFusion, Ethicon, and several not-for-profit organizations.  Mr. Olmsted is also serving as an expert consultant on an extended faculty group for a multi-state CAUTI prevention project with the Agency for Healthcare Research and Quality/Health Educational and Research Trust.  Dr. Krein has a subcontract to implement multi-state CAUTI prevention with the Agency for Healthcare Research and Quality/Health Educational and Research Trust.  Dr. Saint has a subcontract to implement multi-state CAUTI prevention with the Agency for Healthcare Research and Quality/Health Educational and Research Trust.  He has also received numerous honoraria and travel reimbursement from hospitals, academic medical centers, specialty societies, state societies (including the Michigan Health & Hospital Association), and other non-profit organizations (including the Institute for Healthcare Improvement) for speaking about healthcare-associated infection prevention

Funding: The CAUTI prevention intervention was funded through a donation from Blue Cross Blue Shield of Michigan.

 

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