A Multimodal Intervention to Reduce Urinary Catheter Use and Associated Infection at a Veterans Affairs Medical Center

Abstract

We assessed the impact of a quality improvement intervention to reduce urinary catheter use and associated urinary tract infections (UTIs) at a single hospital. After implementation, UTIs were reduced by 39% ([Formula: see text]). Additionally, we observed a slight decrease in catheter use and the number of catheters without an appropriate indication.

Sustainability of a program to reduce unnecessary urethral catheter use at a Veterans Affairs hospital

“…Initial results, evaluated through June 2012, showed a 3.1% absolute reduction in indwelling urethral catheter prevalence hospital-wide, including a significant reduction in internal medicine units (4.6% absolute reduction; P = .01). 1 We also detected an 11.0% absolute reduction in inappropriate urethral catheter use. 1 The infection prevention literature is full of examples of interventions with initial success.…”

“…1 We also detected an 11.0% absolute reduction in inappropriate urethral catheter use. 1 The infection prevention literature is full of examples of interventions with initial success. 2 Unfortunately, assessing sustainability, the extent to which program benefits (ie, effectiveness) persist, 3,4 is much less common; only a few studies have shown the long-term success of programs to reduce urethral catheter utilization or CAUTI.…”

“…Using the same methods as the initial study, 1 we used pointprevalence surveillance to assess urethral catheter use and appropriateness between March 2011 and July 2019. Every ~1-2 years during this period, study staff evaluated every patient in the hospital every day during a work week to determine the percentage of inpatients with an indwelling urethral catheter (ie, catheter prevalence).…”

“…In February 2011, the Veterans Affairs (VA) Ann Arbor Healthcare System implemented a program to reduce catheter-associated urinary tract infection (CAUTI). 1 The intervention comprised the following measures: standardized indwelling urethral catheter insertion kits with a closed system; a urinary management nursing note template in the electronic medical record to facilitate daily review of catheter presence and need; and a urinary management policy encouraging prompt removal of nonindicated catheters. Initial results, evaluated through June 2012, showed a 3.1% absolute reduction in indwelling urethral catheter prevalence hospital-wide, including a significant reduction in internal medicine units (4.6% absolute reduction; P = .01).…”

Beyond Infection: Device Utilization Ratio as a Performance Measure for Urinary Catheter Harm

“…Furthermore, the device utilization ratio does not predict the proportion of appropriately used catheters, although a reduction over time is likely correlated with improvement. 39 Prior to implementation, evaluation of a proposed risk-adjusted device utilization metric with regard to usability as a quality metric and association with appropriateness is needed.…”