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04-04-2013 | Internal medicine | Article

Catheter infections prove to be a problem that cannot be ignored


Free abstract

medwireNews: Prompt identification of when to remove an indwelling urethral catheter can prevent catheter-associated urinary tract infection (CAUTI) in hospital patients, studies find.

The US study analyzed the experiences of 12 Michigan hospitals that participated in a statewide program to reduce unnecessary use of urinary catheters, known as the Bladder Bundle.

The qualitative assessment revealed a need to incorporate urinary management into other patient safety programs to better engage nurses and physicians in addressing CAUTI.

The authors also emphasized the need to explain infection risks to reduce patient and family requests for catheter insertion.

Lastly, the authors suggested mitigating routine catheter insertions in emergency departments by guiding relevant nurses and physicians about the appropriate indications for catheter use.

"The documented success of the Bladder Bundle initiative…provides the impetus for broader dissemination," conclude Sarah Krein (University of Michigan, Ann Arbor, USA) and colleagues in JAMA Internal Medicine. "If some barriers and potential opportunities are addressed, program success might be further enhanced."

Program success was quantitatively validated by a second JAMA Internal Medicine study, which found that preventive practices and timely removal of urinary catheters - a key focus of the Bladder Bundle initiative - led to a lower rate of CAUTI in Michigan hospitals compared with hospitals outside of the state.

The researchers surveyed 470 infection preventionists who represented Michigan hospitals (n=78) or non-Michigan hospitals (n=392).

Overall, Michigan hospitals participated more frequently in collaborative efforts to reduce healthcare-associated infection (94%) compared with hospitals in the rest of the USA (67%).

Bladder scanner use was also greater in Michigan (53 vs 39%), as was the use of catheter reminders or stop orders and/or nurse initiated discontinuation (44 vs 23%).

Michigan's greater use of preventive practices was associated with a 25% reduction in CAUTI rates, which was significantly higher than the 6% overall drop that occurred in the rest of the country.

"[C]ollaborative efforts to reduce CAUTI may positively influence the adoption of infection prevention measures, which may subsequently reduce both urinary catheters and CAUTI rates," conclude the University of Michigan's Sanjay Saint and colleagues.

In a related commentary, Paul Pottinger (University of Washington, Seattle, USA), notes that the above studies reflect how CAUTI is mistakenly viewed as innocuous. "But for those afflicted, and for health care delivery as a whole, the impact is profound," he warned. "Admitting we have a problem must surely be the first step toward a solution."

By Peter Sergo, medwireNews Reporter

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