Study found new training method led to fewer cases of painful, potentially dangerous infections
If you find yourself hospitalized, you’ve got a one in five chance of needing a urinary catheter — raising your risk for a urinary tract infection.
Now, researchers report that a new program shows it might be possible to reduce both catheter use and its associated infections.
“Catheter-associated urinary tract infections are common and costly patient safety problems,” said lead researcher Dr. Sanjay Saint. He is a professor of internal medicine at the University of Michigan in Ann Arbor.
Roughly 250,000 such infections occur in hospitals each year in the United States, costing about $250 million, the researchers pointed out.
Although about 20 percent of hospitalized patients get a urinary catheter, one-third of the time they aren’t needed, Saint said. He believes that patients can play a role in reducing catheter use.
“A lot of patients and families don’t realize that there are problems with a urinary catheter, so they may request them because they think it will allow patients to stay in bed,” Saint said.
“Unfortunately, there are side effects with a catheter. And I’ve seen patients who have gotten up in the middle of the night and they trip and fall on the tubing,” he explained.
“Patients and families should request that a catheter not be put in, and if there is one there, the patient should ask every day whether it is still needed,” Saint suggested.
For the study, Saint and his colleagues tried the new program in 600 hospitals.
After 18 months of using the program, infection rates among hospital patients in general wards dropped by one-third, while catheter use had dropped about 1 percent.
But there was no drop in infections or catheter use in intensive care units (ICUs), the study findings showed.
Hospital-acquired urinary tract infection rates rose nationwide during the same time period, Saint noted.
The program Saint helped develop — called the “bladder bundle” — includes protocols, checklists, training and information-sharing that help doctors and nurses reduce catheter use and prevent infections.
Included in the program are:
The researchers found that catheter infection rates in the new program dropped 14 percent overall in general wards (non-ICU).
The findings were published June 2 in the New England Journal of Medicine.
Dr. Susan Huang, a professor of infectious disease at the University of California, Irvine, wrote an editorial accompanying the study. She said, “While we’ve known the correct care processes for managing urinary catheters, we haven’t been able to reliably reduce catheter-related infections.”
An intervention that focuses on changing the culture in hospitals to make them more responsive to the problem of infection control — one that involves “rallying around a focused problem and ensuring team-based solutions — is integral to improving infection control in hospitals,” she said.
As for improving infection control in intensive care units, Huang said, “further analysis may help us understand why this intervention didn’t work.”
“This program can reduce urinary infections in hospitals if a team is assembled to ensure adoption of best practices and to rapidly correct reasons for failing to comply with these processes,” she added.
Visit the U.S. Centers for Disease Control and Prevention for more on urinary tract infections.
SOURCES: Sanjay Saint, M.D., M.P.H., professor, internal medicine, University of Michigan, Ann Arbor; Susan Huang, M.D., M.P.H., professor, infectious disease, University of California, Irvine; June 2, 2016, New England Journal of Medicine
Last Updated: Jun 1, 2016
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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.