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Indwelling urinary catheters are the most common source of infections in intensive care units (ICUs). The aim of this study was to evaluate the efficacy of nurse-generated daily reminders to physicians to remove unnecessary urinary catheters 5 days after insertion.
A time-sequence nonrandomized intervention study.
Adult ICUs (medical, surgical, cardiovascular surgical, neurosurgical, and coronary care) of a tertiary-care university medical center.
All patients admitted to the adult ICUs during a 2-year period. The study consisted of a 12-month observational phase (15,960 patient-days) followed by a 12-month intervention phase (15,525 patient-days).
Daily reminders to physicians from the nursing staff to remove unnecessary urinary catheters 5 days after insertion.
The duration of urinary catheterization was significantly reduced during the intervention phase (from 7.0 ± 1.1 days to 4.6 ± 0.7 days; P < .001). The rate of catheter-associated urinary tract infection (CAUTI) was also significantly reduced (from 11.5 ± 3.1 to 8.3 ± 2.5 patients with CAUTI per 1,000 catheter-days; P = .009). There was a linear relationship between the monthly average duration of catheterization and the rate of CAUTI (r = 0.50; P = .01). The excess monthly cost of antibiotics for CAUTI was reduced by 69% (from $4,021 ± $1,800 to $1,220 ± $941; P = .004).
This study demonstrated that a simple measure instituted as part of a continuous quality improvement program significantly reduced the duration of urinary catheterization, rate of CAUTI, and additional costs of antibiotics to manage CAUTI.
It is not difficult to predict the future of hospital epidemiology. It will become increasingly important. The need to prevent and control hospital-acquired infections and to protect the staff from communicable diseases will grow. Hospitals will continue to be filled with patients, life-prolonging technical advances will continue to be introduced, resistance will emerge to the new antimicrobial agents, the number of patients with acquired immunodeficiency syndrome (AIDS) will increase and the population will continue to age. Concomitant increases in costs and demands for accountability and for quality assurance will occur (Table 1).
The future for practitioners of hospital epidemiology is less assured. We will have to continue to convince hospital administrators that we are more than “bean counters” engaged mainly in surveillance. We must assure them that the benefits of our work justify the costs of maintaining effective infection control units and that we are dedicated to prevention and control.