A Program to Prevent Catheter-Associated Urinary Tract Infection in Acute Care

Details

• Alternative Title:
  N Engl J Med
• Personal Author:
  Saint, Sanjay ; Greene, M. Todd ; Krein, Sarah L. ; Rogers, Mary A.M. ; Ratz, David ; Fowler, Karen E. ; Edson, Barbara S. ; Watson, Sam R. ; Meyer-Lucas, Barbara ; Masuga, Marie ; Faulkner, Kelly ; Gould, Carolyn V. ; Battles, James ; Fakih, Mohamad G.
• Description:
  BACKGROUND
  
  Catheter-associated urinary tract infection (UTI) is a common device-associated infection in hospitals. Both technical factors — appropriate catheter use, aseptic insertion, and proper maintenance — and socioadaptive factors, such as cultural and behavioral changes in hospital units, are important in preventing catheter-associated UTI.
  
  METHODS
  
  The national Comprehensive Unit-based Safety Program, funded by the Agency for Healthcare Research and Quality, aimed to reduce catheter-associated UTI in intensive care units (ICUs) and non-ICUs. The main program features were dissemination of information to sponsor organizations and hospitals, data collection, and guidance on key technical and socioadaptive factors in the prevention of catheter-associated UTI. Data on catheter use and catheter-associated UTI rates were collected during three phases: baseline (3 months), implementation (2 months), and sustainability (12 months). Multilevel negative binomial models were used to assess changes in catheter use and catheter-associated UTI rates.
  
  RESULTS
  
  Data were obtained from 926 units (59.7% were non-ICUs, and 40.3% were ICUs) in 603 hospitals in 32 states, the District of Columbia, and Puerto Rico. The unadjusted catheter-associated UTI rate decreased overall from 2.82 to 2.19 infections per 1000 catheter-days. In an adjusted analysis, catheter-associated UTI rates decreased from 2.40 to 2.05 infections per 1000 catheter-days (incidence rate ratio, 0.86; 95% confidence interval [CI], 0.76 to 0.96; P = 0.009). Among non-ICUs, catheter use decreased from 20.1% to 18.8% (incidence rate ratio, 0.93; 95% CI, 0.90 to 0.96; P<0.001) and catheter-associated UTI rates decreased from 2.28 to 1.54 infections per 1000 catheter-days (incidence rate ratio, 0.68; 95% CI, 0.56 to 0.82; P<0.001). Catheter use and catheter-associated UTI rates were largely unchanged in ICUs. Tests for heterogeneity (ICU vs. non-ICU) were significant for catheter use (P = 0.004) and catheter-associated UTI rates (P = 0.001).
  
  CONCLUSIONS
  
  A national prevention program appears to reduce catheter use and catheter-associated UTI rates in non-ICUs. (Funded by the Agency for Healthcare Research and Quality.)
  
  
• Subjects:
  Article Catheter-Related Infections Cross Infection Hospital Bed Capacity Hospital Units Humans Incidence Models, Statistical United States Urinary Catheterization Urinary Tract Infections

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• Source:
  N Engl J Med. 374(22):2111-2119
• Pubmed ID:
  27248619
• Pubmed Central ID:
  PMC9661888
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/ ; (HHSA290201000025I/HHSA29032001T/PHS HHSUnited States/
• Volume:
  374
• Issue:
  22
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:6c9388a1a079bb651aafff34f505c661ac0a51c6c5ece41beddce741a17c08de
• Download URL:
  https://stacks.cdc.gov/view/cdc/122202/cdc_122202_DS1.pdf
• File Type:
  [PDF - 216.51 KB ]