A national project called the Comprehensive Unit-based Safety Program (CUSP), funded by the Agency for Healthcare Research and Quality (AHRQ) has significantly helped reduce catheter-associated urinary tract infections in hospitals, according to a study published in the June 2 New England Journal of Medicine.
Approximately 250,000 catheter-associated urinary tract infections (CAUTIs) occur in hospitals each year, costing about $250 million. CAUTIs, which are among the most common healthcare-associated infections (HAIs), are largely preventable. Stopping HAIs spares patients an infection that can have serious complications, such as bloodstream infection. It also reduces the need for antibiotics, which decreases the chance that bacteria will develop resistance to these life-saving medications.
CUSP is a customizable safety program in which clinicians use a checklist of clinical best practices and combine it with improvement in safety culture, teamwork, and communications. The study, “A Program to Prevent Catheter-Associated Urinary Tract Infection in Acute Care,” was led by Sanjay Saint, M.D., M.P.H., Chief of Medicine at the VA Ann Arbor (MI) Healthcare System and George Dock Professor at the University of Michigan. The study authors examined data from 926 hospital units (including intensive care units [ICUs] and non- ICUs) in 32 states, the District of Columbia, and Puerto Rico that participated in the early stages of the 4-year CUSP project.
Researchers found that CAUTI rates decreased by 32 percent in non-ICUs, from 2.28 to 1.54 infections per 1,000 days of catheter use. These units were also able to reduce the overall use of catheters from 20.1 percent to 18.8 percent by avoiding unnecessary or unnecessarily prolonged catheterizations and using alternative urinary collection methods.
Although CAUTI rates and catheter use decreased in non-ICUs, the study showed that rates of CAUTIs and catheter use in participating ICUs were unchanged. Reducing the use of catheters is one of the main ways to prevent CAUTI. The authors suggest that differences in routine care processes between ICUs and other hospital units could be a reason why CAUTIs did not decrease in ICUs. For example, ICU patients are sicker than other hospital patients and may require closer monitoring. ICU clinicians must balance the need to monitor urine output closely by means of a catheter with the increased risk of CAUTI that comes with catheter use. Check out our press releaseand the toolkit for more information.