Skip to main content Accessibility help
×
Home

Regional Variation in Urinary Catheter Use and Catheter-Associated Urinary Tract Infection: Results from a National Collaborative

  • M. Todd Greene (a1) (a2), Mohamad G. Fakih (a3), Karen E. Fowler (a2) (a4), Jennifer Meddings (a1) (a2), David Ratz (a2) (a4), Nasia Safdar (a5), Russell N. Olmsted (a6) and Sanjay Saint (a1) (a2) (a4)...

Extract

Objective.

To examine regional variation in the use and appropriateness of indwelling urinary catheters and catheter-associated urinary tract infection (CAUTI).

Design and Setting.

Cross-sectional study.

Participants.

US acute care hospitals.

Methods.

Hospitals were divided into 4 regions according to the US Census Bureau. Baseline data on urinary catheter use, catheter appropriateness, and CAUTI were collected from participating units. The catheter utilization ratio was calculated by dividing the number of catheter-days by the number of patient-days. We used the National Healthcare Safety Network (NHSN) definition (number of CAUTIs per 1,000 catheter-days) and a population-based definition (number of CAUTIs per 10,000 patient-days) to calculate CAUTI rates. Logistic and Poisson regression models were used to assess regional differences.

Results.

Data on 434,207 catheter-days over 1,400,770 patient-days were collected from 1,101 units within 726 hospitals across 34 states. Overall catheter utilization was 31%. Catheter utilization was significantly higher in non-intensive care units (ICUs) in the West compared with non-ICUs in all other regions. Approximately 30%–40% of catheters in non-ICUs were placed without an appropriate indication. Catheter appropriateness was the lowest in the West. A total of 1,099 CAUTIs were observed (NHSN rate of 2.5 per 1,000 catheter-days and a population-based rate of 7.8 per 10,000 patient-days). The population-based CAUTI rate was highest in the West (8.9 CAUTIs per 10,000 patient-days) and was significantly higher compared with the Midwest, even after adjusting for hospital characteristics (P = .02).

Conclusions.

Regional differences in catheter use, appropriateness, and CAUTI rates were detected across US hospitals.

    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Regional Variation in Urinary Catheter Use and Catheter-Associated Urinary Tract Infection: Results from a National Collaborative
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Regional Variation in Urinary Catheter Use and Catheter-Associated Urinary Tract Infection: Results from a National Collaborative
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Regional Variation in Urinary Catheter Use and Catheter-Associated Urinary Tract Infection: Results from a National Collaborative
      Available formats
      ×

Copyright

References

Hide All
1. Klevens, RM, Edwards, JR, Richards, CL Jr, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep 2007;122:160166.
2. Foxman, B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med 2002;113(suppl 1A): 5S13S.
3. Saint, S. Clinical and economic consequences of nosocomial catheter-related bacteriuria. Am J Infect Control 2000;28:6875.
4. Hollingsworth, JM, Rogers, MA, Krein, SL, et al. Determining the noninfectious complications of indwelling urethral catheters: a systematic review and meta-analysis. Ann Intern Med 2013;159: 401410.
5. Saint, S, Lipsky, BA, Baker, PD, McDonald, LL, Ossenkop, K. Urinary catheters: what type do men and their nurses prefer? J Am Geriatr Soc 1999;47:14531457.
6. Saint, S, Lipsky, BA, Goold, SD. Indwelling urinary catheters: a one-point restraint? Ann Intern Med 2002;137:125127.
7. Centers for Medicare and Medicaid Services. Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 2008 rates. Fed Regist 2007;72:4712948175.
8. Gould, CV, Umscheid, CA, Agarwal, RK, Kuntz, G, Pegues, DA; Healthcare Infection Control Practices Advisory Committee. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol 2010;31:319326.
9. Meddings, J, Rogers, MA, Krein, SL, Fakih, MG, Olmsted, RN, Saint, S. Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review. BMJ Qual Saf 2014;23:277289.
10. Dudeck, MA, Horan, TC, Peterson, KD, et al. National Healthcare Safety Network report, data summary for 2011, device-associated module. Am J Infect Control 2013;41:286300.
11. Huang, WC, Wann, SR, Lin, SL, et al. Catheter-associated urinary tract infections in intensive care units can be reduced by prompting physicians to remove unnecessary catheters. Infect Control Hosp Epidemiol 2004;25:974978.
12. Topal, J, Conklin, S, Camp, K, Morris, V, Balcezak, T, Herbert, P. Prevention of nosocomial catheter-associated urinary tract infections through computerized feedback to physicians and a nurse-directed protocol. Am J Med Qual 2005;20:121126.
13. Saint, S, Kaufman, SR, Thompson, M, Rogers, MA, Chenoweth, CE. A reminder reduces urinary catheterization in hospitalized patients. Jt Comm J Qual Patient Saf 2005;31:455462.
14. Crouzet, J, Bertrand, X, Venier, AG, Badoz, M, Husson, C, Talon, D. Control of the duration of urinary catheterization: impact on catheter-associated urinary tract infection, J Hosp Infect 2007; 67:253257.
15. Loeb, M, Hunt, D, O'Halloran, K, Carusone, SC, Dafoe, N, Walter, SD. Stop orders to reduce inappropriate urinary catheterization in hospitalized patients: a randomized controlled trial. J Gen Intern Med 2008;23:816820.
16. Goetz, AM, Kedzuf, S, Wagener, M, Muder, RR. Feedback to nursing staff as an intervention to reduce catheter-associated urinary tract infections. Am J Infect Control 1999;27:402404.
17. Fakih, MG, Dueweke, C, Meisner, S, et al. Effect of nurse-led multidisciplinary rounds on reducing the unnecessary use of urinary catheterization in hospitalized patients. Infect Control Hosp Epidemiol 2008;29:815819.
18. Saint, S, Kowalski, CP, Kaufman, SR, et al. Preventing hospital-acquired urinary tract infection in the United States: a national study. Clin Infect Dis 2008;46:243250.
19. Krein, SL, Kowalski, CP, Hofer, TP, Saint, S. Preventing hospital-acquired infections: a national survey of practices reported by U.S. Hospitals in 2005 and 2009. J Gen Intern Med 2012;27: 773779.
20. Saint, S, Greene, M, Kowalski, S, Watson, S, Hofer, T, Krein, S. Preventing catheter-associated urinary tract infection in the United States: a national comparative study. JAMA Intern Med 2013;173:874879.
21. Weber, DJ, Sickbert-Bennett, EE, Gould, CV, Brown, VM, Huslage, K, Rutala, WA. Incidence of catheter-associated and non-catheter-associated urinary tract infections in a healthcare system. Infect Control Hosp Epidemiol 2011;32:822823.
22. Lewis, SS, Knelson, LP, Moehring, RW, Chen, LF, Sexton, DJ, Anderson, DJ. Comparison of non-intensive care unit (ICU) versus ICU rates of catheter-associated urinary tract infection in community hospitals. Infect Control Hosp Epidemiol 2013;34:744747.
23. Wald, H, Epstein, A, Kramer, A. Extended use of indwelling urinary catheters in postoperative hip fracture patients. Med Care 2005;43:10091017.
24. Wald, HL, Epstein, AM, Radcliff, TA, Kramer, AM. Extended use of urinary catheters in older surgical patients: a patient safety problem? Infect Control Hosp Epidemiol 2008;29:116124.
25. Wald, HL, Ma, A, Bratzier, DW, Kramer, AM. Indwelling urinary catheter use in the postoperative period: analysis of the national surgical infection prevention project data. Arch Surg 2008;143: 551557.
26. Rogers, MA, Mody, L, Kaufman, SR, Fries, BE, McMahon, LF Jr, Saint, S. Use of urinary collection devices in skilled nursing facilities in five states. J Am Geriatr Soc 2008;56:854861.
27. Fakih, MG, George, C, Edson, BS, Goeschel, CA, Saint, S. Implementing a national program to reduce catheter-associated urinary tract infection: a quality improvement collaboration of state hospital associations, academic medical centers, professional societies, and governmental agencies. Infect Control Hosp Epidemiol 2013;34:10481054.
28. Fakih, MG, Greene, MT, Kennedy, EH, et al. Introducing a population-based outcome measure to evaluate the effect of interventions to reduce catheter-associated urinary tract infection. Am J Infect Control 2012;40:359364.
29. US Census Bureau. Statistical Abstract of the United States. Washington, DC: US Census Bureau, 2012. http://www.census.gov/compendia/statab/. Accessed November 27, 2013.
30. Centers for Disease Control and Prevention (CDC), National Center for Health Statistics. National Hospital Discharge Survey, 2010. Atlanta: CDC, 2010. http://www.cdc.gov/nchs/data/nhds/lgeneral/2010genl_agesexalos.pdf. Accessed November 28, 2013.
31. Daniels, KR, Lee, GC, Frei, CR. Trends in catheter-associated urinary tract infections among a national cohort of hospitalized adults, 2001-2010. Am J Infect Control 2014;42:1722.
32. Conway, LJ, Pogorzelska, M, Larson, E, Stone, PW. Adoption of policies to prevent catheter-associated urinary tract infections in United States intensive care units. Am J Infect Control 2012; 40:705710.
33. Centers for Medicare and Medicaid Services. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and FY 2012 rates; hospitals' FTE resident caps for graduate medical education payment. Final rules. Fed Regist 2011; 76:5147651846.
34. Centers for Medicare and Medicaid Services. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and Fiscal Year 2014 rates; quality reporting requirements for specific providers; hospital conditions of participation; payment policies related to patient status. Final rules. Fed Regist 2013;78:5049551040.

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed