Hospital Strategies to Prevent UTI Found Wanting

By Michael Smith
Sanjay Saint, M.D., MPH, Department of Internal MedicineVA Ann Arbor Healthcare SystemSource: University of Michigan Health System
ANN ARBOR, Mich., Jan. 3 -- Fewer than half of U.S. hospitals track which patients have an indwelling urinary catheter and only about a quarter have a system that monitors how long a catheter has been in place, a new survey shows. And fewer than one hospital in 10 employs a system that has been shown to reduce infections -- a daily reminder that asks physicians if a patient's catheter is still needed, Sanjay Saint, M.D., of the University of Michigan here, and colleagues, reported in the January issue of Clinical Infectious Diseases.
Infections related to urinary catheters are a "common and costly patient-safety problem," Dr. Saint said, and until this survey of 719 hospitals there was little information on how hospitals were dealing with the issue.
"Now that we have these data," Dr. Saint said, "it's clear that there's no one dominant practice that's being used, including physician reminders, which have proven benefit and make a lot of common sense."
Dr. Saint and colleagues surveyed all 119 Veterans Affairs hospitals that have an acute care department, as well as 600 non-VA hospitals across the country. The response rate was 72%.
The survey found that:
30% of hospitals regularly use antimicrobial urinary catheters and portable bladder scanners.
14% regularly use condom catheters in men.
9% regularly use catheter reminders and suprapubic catheters.
3% regularly use antimicrobial agents in the drainage bag.
Interestingly, there were significant differences between VA and non-VA hospitals. The VA hospitals were more likely to use portable bladder scanners (49% versus 29%), condom catheters in men (46% versus 12%), and suprapubic catheters (22% versus 9%), all significant at P<0.001.
On the other hand, non-VA hospitals were significantly more likely to use antimicrobial urinary catheters -- at 30% versus 14%, which was significant at P<0.002.
The VA hospitals were included in the survey to see if there were any effects of a centralized, top-down structure, Dr. Saint and colleagues said.
"Centralization does seem to be relevant in terms of the use of infection prevention practices, but not in a straightforward manner," they concluded, because four of five infection control practices were more common in VA hospitals.
On the other hand, there was little difference between VA and other hospitals when it came to one of the most effective practices -- physician reminders and/or a default stop order.
Only 11.5% of VA hospitals routinely remind doctors to re-think the need for a catheter or use a stop order as the default practice, compared with 9.2% of non-VA institutions, the survey found.
In the absence of such a routine, Dr. Saint offered this advice: "The bottom line for hospitalized patients and their families is, if you have a catheter, ask the doctor or nurse every day if you really still need it."
Nosocomial urinary tract infections are surprisingly neglected, considering their status as "the single most common hospital-acquired infection," according to Lindsay Nicolle, M.D., of the University of Manitoba in Winnipeg.
In an accompanying editorial, Dr. Nicolle said that about 40% of all hospital-acquired infections are in the urinary tract, and 80% of those result from indwelling catheters.
Yet, Dr. Nicolle said, the results obtained by Dr. Saint and colleagues suggests that hospitals "are not paying attention" to the issue, or were not in 2005, when the survey was conducted.
Dr. Nicolle noted that implementation of recent patient safety initiatives is making changes, but concluded that "clearly, much progress is needed."
The study was supported by the Department of Veterans Affairs and the Ann Arbor VA Medical Center/University of Michigan Patient Safety Enhancement Program.
Dr. Saint reported honoraria for speaking at a nosocomial infection conference sponsored by VHA, a group-purchasing organization. Dr. Nicolle reported no conflicts.
Primary source: Clinical Infectious DiseasesSource reference:Saint S, et al "Preventing hospital-acquired urinary tract infection in the United States: a national study" Clinical Infectious Diseases 2008; 46: 243-50. Additional source: Clinical Infectious DiseasesSource reference: Nicolle L, "The prevention of hospital-acquired urinary tract infection" Clinical Infectious Diseases 2008; 46: 251-3.