National Program Reduces Catheter-Associated Urinary Tract Infections


Clinical question: Can a program of education, feedback, and proper training reduce catheter-associated urinary tract infections in hospitalized patients?

Bottom line: The Comprehensive Unit-based Safety Program, or CUSP, is a national program in the United States that aims to reduce catheter-associated urinary tract infections (CAUTIs) by focusing on proper technical skills, behavioral changes, education, and feedback. Implementation of the CUSP recommendations was effective in reducing catheter use and CAUTIs in patients in nonintensive care units (non-ICUs). The program was likely successful because it included both socioadaptive and technical changes and allowed the individual hospitals to customize interventions based on their own needs.

Reference: Saint S, Greene MT, Krein SL, et al. A program to prevent catheter-associated urinary tract infection in acute care. N Engl J Med 2016;374(22):2111-2119.

Design: Case series; LOE: 2b

Setting: Inpatient (any location)

Synopsis: This study reports the results of an 18-month program to reduce CAUTIs that was implemented in 926 inpatient units in 603 acute-care U.S. hospitals (which represents 10% of the acute care hospitals in the country). Overall, 40% of the units were ICUs while the remainder were non-ICUs.

Key recommendations of the program included the following: (1) assessing for the presence and need for a urinary catheter daily, (2) avoiding the use of a urinary catheter while emphasizing alternative urine-collection methods, and (3) promoting proper insertion and maintenance of catheters, when necessary. Hospitals were allowed to decide how best to implement these interventions in their individual units. Furthermore, participating unit teams received education on the prevention of CAUTIs as well as feedback on catheter use and the rate of CAUTIs on their individual units.

Data were collected over a 3-month baseline phase, a 2-month implementation phase, and a 12-month sustainability phase. After adjusting for hospital characteristics, the rate of CAUTIs decreased from 2.40 infections per 1000 catheter-days at the end of the baseline phase to 2.05 infections per 1000 catheter-days at the end of the sustainability phase. The reduction was statistically significant only in non-ICUs where CAUTIs decreased from 2.28 to 1.54 infections per 1000 catheter-days while catheter use decreased from 20.1% to 18.8%. This was not a randomized controlled trial, so confounding variables including secular trends may have affected the findings in this study.

Dr. Kulkarni is an assistant professor of hospital medicine at Northwestern University in Chicago.

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