Adoption of policies to prevent catheter-associated urinary tract infections in United States intensive care units

Abstract

Background Little is known about whether recommended strategies to prevent catheter-associated urinary tract infection (CAUTI) are being implemented in intensive care units (ICU) in the United States. Objectives Our objectives were to describe the presence of and adherence to CAUTI prevention policies in ICUs, to identify variations in policies based on organizational characteristics, and to determine whether a relationship exists between prevention policies and CAUTI incidence rates. Methods Four hundred forty-one hospitals that participate in the National Healthcare Safety Network were surveyed in spring 2008. Results Two hundred fifty hospitals provided information for 415 ICUs (response rate, 57%). A small proportion of ICUs surveyed had policies supporting bladder ultrasound (26%, n = 106), condom catheters (20%, n = 82), catheter removal reminders (12%, n = 51), or nurse-initiated catheter discontinuation (10%, n = 39). ICUs in hospitals with ≥ 500 beds were half as likely as those in smaller hospitals to have adopted at least 1 CAUTI prevention policy (odds ratio, 0.52; 95% confidence interval: 0.33-0.86), and ICUs in hospitals where the infection control director reported always having access to key decision makers for planning were more than twice as likely as those with less access to have adopted a policy (odds ratio, 2.41; 95% confidence interval: 1.56-3.72). Conclusion Little attention is currently placed on CAUTI prevention in ICUs in the United States. Further research is needed to elucidate relationships between adherence to CAUTI prevention recommendations and CAUTI incidence rates.

Regional Variation in Urinary Catheter Use and Catheter-Associated Urinary Tract Infection: Results from a National Collaborative

“…Prior work has suggested that larger teaching hospitals, which typically care for more medically complex patients, have a higher incidence of CAUTI and may be less likely to adopt CAUTI prevention policies. 32 Compared with recent data submitted by NHSN participating hospitals, we found greater differences in catheter utilization and CAUTI within non-ICU settings. Although the reporting of CAUTI in adult and pediatric ICUs to the NHSN has been mandated by the CMS since January 1, 2012, 33 reporting in non-ICU locations is not yet required.…”

Preventing Catheter-Associated Urinary Tract Infection in the United States

“…12 A recent study by Conway and colleagues also revealed that adoption of policies to prevent CAUTI in intensive care units (ICUs) is lacking, with only 42% of ICUs reporting having written policies in place for at least 1 of 4 prevention practices: use of portable bladder ultrasound scanners, condom catheters for men, urinary catheter reminders or stop-orders, or nurse-initiated urinary catheter discontinuation. 13 …”

A nurse–family partnership intervention to increase the self‐efficacy of family caregivers and reduce catheter‐associated urinary tract infection in catheterized patients

“…Studies have shown that hospitals with more than 500 beds, as well as teaching hospitals and medical–surgical intensive care units (ICUs), report more cases of CAUTI compared with smaller hospitals . Patients who are older, female, bedridden or hospitalized for more than 7 days, and patients with malignant tumours, diabetes, renal failure and long‐term catheterization are at the highest risk of CAUTI …”