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N Engl J Med. 2016 Jun 2;374(22):2111-9. doi: 10.1056/NEJMoa1504906.

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

Author information

1
From the Hospital Outcomes Program of Excellence, Veterans Affairs (VA) Ann Arbor Healthcare System (S.S., M.T.G., S.L.K., D.R., K.E.F.), the Department of Internal Medicine, University of Michigan (UM) Medical School (S.S., M.T.G., S.L.K., M.A.M.R.), and the VA/UM Patient Safety Enhancement Program (S.S., M.T.G., S.L.K., M.A.M.R., D.R., K.E.F.), Ann Arbor, the Michigan Health and Hospital Association, Okemos (S.R.W., B.M.-L., M.M.), and St. John Hospital and Medical Center, Detroit (M.G.F.) - all in Michigan; the Health Research and Educational Trust, Chicago (B.S.E., K.F.); the Centers for Disease Control and Prevention, Atlanta (C.V.G.); and the Agency for Healthcare Research and Quality, Rockville, MD ( J.B.).

Abstract

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.).

PMID:
27248619
DOI:
10.1056/NEJMoa1504906
[Indexed for MEDLINE]
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