Some Progress Seen in Move to Reduce Catheter-Associated UTIs

Preventing catheter-associated urinary tract infections (CAUTI) and unnecessary urinary catheter use not only spares patients the infection, but also reduces the risk of more serious complications such as bloodstream infection, according to the results of a study published in the New England Journal of Medicine. It also decreases the need for antibiotics, often misused for treating asymptomatic bacteriuria.

The study was part of a national initiative to reduce CAUTI in the hospital setting, including intensive care units and non-ICUs. St. John Hospital and Medical Center, part of Ascension Michigan, participated in the national project called “On the CUSP: Stop CAUTI.”

The judicious use of antibiotics reduces the chance that bacteria will develop resistance to these life-saving medications, according to researchers. By the end of the first four cohorts, researchers found no significant reduction in use of catheters or rate of CAUTI in the ICU setting, whereas CAUTI rates decreased by 32 percent and catheter use by 7 percent in non-ICUs.

Based upon previous research, leaders of the national project team developed a combination of protocols, checklists, training modules and data sharing practices to address catheterization use. Researchers found that a collaborative approach effort focused on both technical and socioadaptive interventions (behavior and culture change) can reduce catheter-associated UTI rates in the non-ICU setting. The study also allowed researchers to scale interventions intended for a single hospital to a broader group. 

Mohamad Fakih, MD, MPH, Karen Jones, RN, MPH, and St. John Hospital and Medical Center faculty, served on the national project team providing project implementation advice, expertise in infection prevention, leadership in content development, and educational support over the project’s span of 4 years.

Fakih, senior medical director, Ascension Center of Excellence for Antimicrobial Stewardship and Infection Prevention, co-authored findings of the first 4 (of 9) cohorts that participated in the initiative, which encompassed 926 units in 603 hospitals across 32 states, the District of Columbia, and Puerto Rico.

A study published in 2014 in the Annals of Emergency Medicine highlighted the collaborative work of 18 Ascension emergency departments to reduce unnecessary urinary catheter use. The Ascension Health study was led by Fakih and initiated under the Partnership for Patients program, an initiative of the Centers for Medicare and Medicaid Services (CMS). Through standardizing the process, the program resulted in a 30 percent reduction in use of newly placed catheters, which was sustained during a six-month period.

“Ascension continues to demonstrate its longstanding commitment to patient safety through efforts such as our ongoing participation with Partnership for Patients and AHRQ (Agency for Healthcare Research and Quality),” said Ann Hendrich RN, PhD, FAAN, senior VP, chief quality/safety and nursing officer for Ascension Health. “Our hospitals are leading the transformation of healthcare through implementing strategies that protect patients from avoidable harm and improve outcomes.”

The study was funded by AHRQ and coordinated by the Health Research and Educational Trust, with the support of faculty from the University of Michigan, St. John Hospital and Medical Center, the MHA Keystone Center, and Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality.

As the largest non-profit health system in the U.S. and the world’s largest Catholic health system, Ascension in FY2015 provided nearly $2 billion in care of persons living in poverty and other community benefit programs. Approximately 160,000 associates and 36,000 aligned providers serve in 2,500 sites of care – including 142 hospitals and more than 30 senior living facilities – in 24 states and the District of Columbia.