HealthDay highlights a national effort to help reduce an uncomfortable and costly problem: hospital-acquired urinary tract infections (UTIs), and specifically those caused by indwelling catheters. These devices are tubes that snake up the urethra into a person’s bladder, are anchored there with an inflatable balloon, and continuously drain a patient’s urine.
HealthDay nicely captures the scope of the problem, noting that one in five hospital patients are catheterized, and that, of these, 20% are bound to get a UTI. Looking at a typical year, this adds up to about 250,000 hospital-acquired UTIs and roughly $250 million in healthcare costs.
The story included quotes from Dr. Sanjay Saint, the lead author of the new study, which was published in the New England Journal of Medicine (NEJM). The story breaks down his team’s effort to attack catheter-caused UTIs with a program called “Stop CAUTI,” which is a government-sponsored training toolkit to not only reduce indwelling catheterization rates, but also help caretakers use better technique when they have to insert the devices.
The results, as HealthDay explains them? It’s not clear; we’re not given many quantified benefits or study details, and the results that are included happen to conflict with each other. Also missing was a discussion around limitations of the research.
Indwelling catheters are very common sights at hospitals, since nurses can insert them once and they rarely slip out (a balloon at the end holds them in place). However, about 75% of UTIs are caused by such catheters, according to the CDC, and more than two-thirds of those infections are thought to be avoidable — both through better caretaker training and by avoiding the use of indwelling catheters.
Given the suffering and cost, any program that could decrease the rate of such infections, especially one without any new medical devices — just training sessions and use of alternative, short-term catheterization — would be welcomed by patients, hospitals, insurance companies, and taxpayers alike.
We’re told that, each year, catheters in hospitals cause 250,000 infections and cost $250 million to treat. That’s important to note and we’re glad it was included. However, the story didn’t tell us how much the intervention costs to implement. But, because this is an intervention that doesn’t have direct consumer costs (unlike, say, a new cancer drug or surgery), we’ll rate this is as N/A.
The story attempted to quantify the benefits but missed the mark.
What was missing: The chief way to quantify the benefits of such an intervention is to explain, in absolute numbers, how much the infection rate dropped. This can be expressed in terms of “1,000 catheter-days.” In this case, the rate was reduced from 2.28 to 1.54 infections per 1,000 catheter-days in the non-ICU patients. This is a 32% reduction. Use of the catheters themselves was also reduced by the program (which was one of the goals), from 20.1% to 18.8% (1.3% total reduction).
Harms aren’t discussed in this story, but improved caretaker education on when and when not to use a catheter, and how to insert one while reducing the risk of infection, doesn’t seem to warrant it. Although there may be some harms from this “bundle,” the study itself was not set up to look for them.
We’re not convinced the reader gets a clear enough picture of the study’s strengths and weaknesses. For example, the story didn’t let readers know how many people were enrolled in the study, nor did it point out the lack of a control group, an important limitation in research on quality improvement.
We didn’t find any frightening language or graphic depictions of UTIs that would unnecessarily alarm a reader.
The writer included comments from Dr. Huang, an editorial writer in NEJM, which suffices as an independent source.
But, we’re not told that Dr. Saint — the lead author — is a paid advisory board member for the health services companies Doximity and Jvion. This was probably worth mentioning, since Jvion sells a data product to hospitals “that looks at the patient population and predicts the risk of an illness or condition before symptoms occur” so that “providers are better able to stop hospital acquired conditions, prevent patient suffering and deterioration, target population health activities, and save resources.”
The alternative is the status quo, which is discussed in terms of its problems.
We’re told the procedure is in use at 600 hospitals, though it would have helped to note they’re spread across 32 states, plus Washington D.C. and Puerto Rico. It could have been made clearer that any hospital can use this safety bundle now that the methods are published widely.
The “Stop CAUTI” program has been around for years, but it’s implied that hundreds of hospitals have never implemented it before in a systematic way. The scale and duration of the study makes this novel and worth covering.
The story included original quotes, presumably from an interview with Dr. Sanjay Saint. While it does extensively quote a NEJM editorial, those views help put the study and its limitations — e.g. no effect on ICUs, where reducing UTIs could do the most to save lives and reduce suffering — into plain view.