Surveyed hospitals: Only 10-30 percent use successful CA-UTI prevention practices
MedSun: Newsletter #23, April 2008

Safety Share Newsletter, Premier Inc.

A recent national survey of urinary tract prevention infection practices revealed that more than 50 percent of hospitals did not have a monitoring system for patients with indwelling catheters and greater than 70 percent did not monitor the duration the catheter was in place.

VA study

Ann Arbor VA researchers conducted a national survey in order to characterize the current practices in use in hospitals today to prevent hospital-associated UTIs. Results of the survey sent to infection control specialists in over 700 hospitals nationwide yielded a response rate of 72 percent. Hospitals included Veterans Affairs (VA) hospitals as well as non-federal hospitals.

Survey results

The survey indicated that monitoring practices across VA and non-VA hospitals were similar. Over 50 percent of hospitals did not have a monitoring system for patients with indwelling catheters, greater than 70 percent did not monitor the duration the catheter was in place, and almost 30 percent of reporting hospitals did not have any CA-UTI surveillance. Prevention practices included 30 percent of hospitals reporting the use of antimicrobial urinary catheters and portable bladder scanners, 14 percent reported using condom catheters in men, with only nine percent using catheter reminders and suprapubic catheters.

Important findings

The findings indicate that despite evidence that links indwelling catheters to UTIs, only a small minority of hospitals actually track their hospitalized patients with indwelling catheters and there are no common widely used strategies to prevent hospital acquired UTIs. The two most commonly reported prevention practices – use of antimicrobial catheters and bladder ultrasounds – were used in fewer than one-third of surveyed hospitals.
VA hospitals were more likely to use bladder scanners but less likely to use antimicrobial catheters. Another important finding: less than 10 percent of hospitals used urinary catheter reminders despite the evidence indicating the success of this practice. In an accompanying editorial, Lindsay Nicolle, MD, reinforces the idea that to optimize patient safety, monitoring the use of and duration of indwelling urinary catheters is necessary. "There seems no reasonable argument against expecting facilities to collect, distribute, and act on this information for indwelling urethral catheters," Dr. Nicolle stated.

UTI in post-op, older patients

In another recent study that monitored postoperative indwelling urinary catheters in older patients, researchers found those patients have poorer outcomes. The main purpose of this study was to characterize the relationship between the extended postoperative use of indwelling urinary catheters and outcomes for older patients who have undergone cardiac, vascular, gastrointestinal, or orthopedic surgery in skilled nursing facilities, and to describe patient and hospital characteristics associated with the extended use of indwelling urinary catheters. Twenty three percent of more than 170,000 Medicare patients over the age of 65 included in the study were discharged to a skilled nursing facility with and indwelling catheter in place. These patients were found to have a higher risk of re-hospitalization for UTIs and death within 30 days than those patients who did not have catheters. Patients from hospitals in the northeastern or southern regions of the United States had a lower likelihood of having an indwelling urinary catheter, compared with hospitalized in the western region. This disparity led researchers to conclude that there are geographic variations in practice that should be the focus of further study.

The use or non-use of preventive practices for hospital acquired UTIs may soon have major implications for all hospitals. The Centers for Medicare and Medicaid (CMS) has decided that for all discharges occurring on or after October 1, 2008, hospitals will not receive reimbursement for cases in which certain hospital acquired conditions (HAC) were not present on admission. This includes the additional costs associated with treating hospital acquired CA-UTIs.

Downloads and links [located online at Safety Share Newsletter, Premier Inc.]

•Saint S. et al, CID, January 2008 Survey abstract.
•Nicolle, CID, Editorial January 2008
•ICHE, Wald, ICHE Post op study January 2008
•Hospital-acquired conditions (HAC) information available; Premier Safety Institute’s CMS standards, HAC

Additional Information:

Surveyed hospitals: Only 10-30 percent use successful CA-UTI prevention practices. Safety Share Newsletter, Premier Inc.
http://www.premierinc.com/quality-safety/tools-services/safety/safety-share/02-08-full-txt.jsp#story-06

Hospital-acquired conditions (HAC) information available; Premier Safety Institute’s CMS standards, HAC
http://www.premierinc.com/quality-safety/tools-services/safety/topics/guidelines/cms-guidelines-4-infection.jsp#HAC


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