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ONLINE EXCLUSIVE: The Case Against a Common Denominator for Urinary Tract Infections


 

The recent surge in attention to catheter-associated urinary tract infections (CAUTIs) has increased the focus on both preventing and removing inappropriate catheterizations. Ironically, one outcome rate currently reported by hospitals—the number of infections per 1,000 catheter days—could unfairly punish those facilities that are doing the most to address the problem.

You may end up having a paradoxical increased rate of CAUTI after your successful initiative has reduced catheter use.


—Sanjay Saint, MD, MPH, FHM, professor of internal medicine, University of Michigan, Ann Arbor VA Medical Center

“If your focus is on not putting in the catheter or removing a catheter as soon as possible, you now reduce that denominator of catheter days,” explains Sanjay Saint, MD, MPH, FHM, professor of internal medicine at the University of Michigan and the Ann Arbor VA Medical Center. “The only people who now get a catheter in your hospital are those who are pretty sick; therefore, they need a catheter. These people, because of their underlying sickness, are more likely to have an infection, so you may end up having a paradoxical increased rate of CAUTI after your successful initiative has reduced catheter use.”

Using the wrong denominator, in other words, could defeat the whole point: reducing infections by reducing catheter use.

“If we’re going to publicly report data, we have to make sure that the data we’re reporting and the metrics that we’re using are actually the best metrics for the intended purpose,” Dr. Saint says.

For quality-improvement (QI) efforts, his recommendation is to use 10,000 patient days as a more appropriate denominator.

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