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

Abstract

OBJECTIVE. To examine regional variation in the use and appropriateness of indwelling urinary catheters and catheter-associated urinary tract infection (CAUTI). DESIGN AND SETTING. Cross-sectional study.PARTICIPANTS. US acute care hospitals.METHODS. Hospitals were divided into 4 regions according to the US Census Bureau. Baseline data on urinary catheter use, catheter appropriateness, and CAUTI were collected from participating units. The catheter utilization ratio was calculated by dividing the number of catheter-days by the number of patient-days. We used the National Healthcare Safety Network (NHSN) definition (number of CAUTIs per 1,000 catheter-days) and a population-based definition (number of CAUTIs per 10,000 patient-days) to calculate CAUTI rates. Logistic and Poisson regression models were used to assess regional differences.RESULTS. Data on 434,207 catheter-days over 1,400,770 patient-days were collected from 1,101 units within 726 hospitals across 34 states. Overall catheter utilization was 31%. Catheter utilization was significantly higher in non-intensive care units (ICUs) in the West compared with non-ICUs in all other regions. Approximately 30%-40% of catheters in non-ICUs were placed without an appropriate indication. Catheter appropriateness was the lowest in the West. A total of 1,099 CAUTIs were observed (NHSN rate of 2.5 per 1,000 catheter-days and a population-based rate of 7.8 per 10,000 patient-days). The population-based CAUTI rate was highest in the West (8.9 CAUTIs per 10,000 patient-days) and was significantly higher compared with the Midwest, even after adjusting for hospital characteristics (P = .02).CONCLUSIONS. Regional differences in catheter use, appropriateness, and CAUTI rates were detected across US hospitals.

Microbiological profile, comorbidity, incidence and rate analysis of catheter associated urinary tract infections in adult intensive care

“…This comparison clearly explains that catheter utilization is always high in ICU setup and thus the risk of CAUTI in ICU could be proportionately higher. In this study, the incidence of CAUTI was found to be 16 per 100 catheterization which was lesser than the study report of Mahim Koshariya et al , Mangukiya JD et al, Gupta V, et al, Wazait HD et al, Chanda R et al, and Mulhall et al [12][13][14][15][16][17][18][19][20] who reported CAUTI incidence of 27,30.71,36.3,38.75,41,44 per 100 catheterization respectively. Even though its incidence appears lesser, it is not up to the standard of NHSN.…”

“…18,23,24 In the present study, when compared to above-mentioned studies, tuberculosis (25%) was also found to be the other important comorbid condition associated with CAUTI (Fig. 1).…”

“…17 In this study, device utilization ratio was 0.72 which was comparable to the study report of Choudhuri JA et al 14 in ICUs (0.77). In contrary to this, M. Todd Greene et al 18 reported the low device utilization ratio (0.5) in non ICU setup. This comparison clearly explains that catheter utilization is always high in ICU setup and thus the risk of CAUTI in ICU could be proportionately higher.…”

“…Even though no statistical significance was found between the incidence of CAUTI and gender, CAUTI was slightly common (2.5% higher incidence) among the female patients, which is also comparable with other studies. 9,18 This increased risk in women is likely to be due to the shorter female urethra, urethra being in close proximity to the anus and hormonal influences.…”

The effect of a short educational intervention on the use of urinary catheters: a prospective cohort study

“…Using electronic alerts, which can assist in reducing CAUTIs [6,12,13] and allow easily accessible audits, was not an option because the hospital's electronic documentation system did not offer such features. Despite the decrease in the proportion of inpatient days with a catheter, the ratio was still quite high (41%) at T2 compared to some other studies [27], where it has been reported to be as low as 10% [28]. Failure to reduce the use of catheters can be explained by two factors.…”