Urinary tract infections can be prevented when hospitals emphasise proper catheter use

A collaborative study between the University of Michigan Health System, Michigan Health & Hospital Association (MHA) Keystone Center for Patient Safety & Quality, and St. John Hospital and Medical Center shows less is more in the effort to reduce urinary tract infections among hospitalized patients.

Researchers evaluated the use of urinary catheters at 71 Michigan hospitals that launched educational programs that emphasised using catheters only when needed.

Twenty weeks through the intervention, the average urinary catheter utilisation rate decreased from 18.1 per cent to 14.8 per cent, while the rate of appropriate catheter use increased from 44.3 per cent to 53.5 per cent, according to the study published online ahead of print in the Archives of Internal Medicine.

“Avoiding initial catheter use and reducing how long a patient is catheterised can mean fewer infection complications,” says senior study author Sanjay Saint, MD, MPH, director of the VA/UM Patient Safety Enhancement Program, and U-M professor of internal medicine.

“In addition to reducing infection risk, promoting proper catheter use can lead to fewer non-infection complications, such as urethral injury. Patients also might experience less discomfort and be free of the restraints brought by the catheter.”

Hospitals can reduce their overall catheter use – and potentially prevent urinary tract infections, according to the study in which Mohamad G Fakih, MD, MPH, at the St John Hospital and Medical Center and Wayne State University School of Medicine, collaborated as lead author.

In 2007, the MHA Keystone Center started statewide intervention programs in 163 inpatient units at 71 hospitals. The MHA Keystone Center initiative was based on the success of a pilot intervention at St. John Hospital and Medical Center in Detroit that saw a 45 per cent reduction in inappropriate catheter use.

Hospital staffs involved in the interventions participated in webinars that highlighted the risk of improper catheterization and emphasized daily evaluation of a patient’s urinary catheter need.

Appropriate indications for catheter use include urinary tract obstruction, neurogenic bladder dysfunction and urinary retention, and end-of-life care.

The results of the study show that educational interventions and increasing urinary catheter awareness can help reduce improper catheterization and such initiatives can have success on a broad scale.

“These findings continue to empower and guide hospitals across the country to use similar programs to reduce inappropriate catheter use,” says co-author Sam R Watson, MSA, MT, Senior Vice President for Patient Safety and Quality of the MHA and the Executive Director of the MHA Keystone Center.

Resources: For more information about how hospitals can prevent catheter-associated urinary tract infections as well as information for patients and families, visit www.catheterout.org.

Additional authors: From U-M: M. Todd Greene, Edward H. Kennedy, Sarah L. Krein; From Saint Joseph Mercy Health System: Russ N. Olmsted.

Citation: Archives of Internal Medicine, DOI:10.1001/archinternmed.2011.627; published online Jan. 9, 2012. “Reducing Inappropriate Urinary Catheter Use: A Statewide Effort”.

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