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

Published online by Cambridge University Press:  10 May 2016

M. Todd Greene
Affiliation:
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor, Michigan
Mohamad G. Fakih
Affiliation:
St. John Hospital and Medical Center, Detroit, Michigan
Karen E. Fowler
Affiliation:
Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor, Michigan Hospital Outcomes Program of Excellence, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
Jennifer Meddings
Affiliation:
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor, Michigan
David Ratz
Affiliation:
Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor, Michigan Hospital Outcomes Program of Excellence, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
Nasia Safdar
Affiliation:
William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin; and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Russell N. Olmsted
Affiliation:
Saint Joseph Mercy Health System, Ann Arbor, Michigan
Sanjay Saint
Affiliation:
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor, Michigan Hospital Outcomes Program of Excellence, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
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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.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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