National Program Reduces Urinary Tract Infections in Hospitalized Patients

Sanjay Saint, MD, MPH Chief of Medicine, VA Ann Arbor Healthcare System George Dock Professor of Internal Medicine & Senior Associate Chair - Department of Internal Medicine University of Michigan Medical School

Dr. Sanjay Saint Interview with:
Sanjay Saint, MD, MPH
Chief of Medicine
VA Ann Arbor Healthcare System
George Dock Professor of Internal Medicine & Senior Associate Chair –
Department of Internal Medicine
University of Michigan Medical School What is the background for this study? What are the main findings?

Dr. Saint: Catheter-associated urinary tract infection (CAUTI) is a common, costly, and morbid complication of hospitalization. Urinary tract infection (UTI) is one of the most common device-related infections in the United States. CAUTI rates rose nationally between 2009 and 2013.

We put in place a national program to reduce CAUTI. Specifically, we enrolled 926 intensive care unit (ICU) and non-ICU hospital units in 603 hospitals spread over 32 states, the District of Columbia and Puerto Rico between March 2011 and November 2013.

By the end of the 18-month program, UTI rates among hospital patients in general wards had dropped by a third. Specifically:
• The rate of CAUTIs dropped from 2.40 per 1000 days of catheter use to 2.05 (a ~14 percent overall drop).
• Nearly all of the decrease in CAUTI rates was due to changes in infection rates in non-ICUs, which went from 2.28 to 1.54 infections per 1,000 catheter-days – a drop of 32 percent. In non-ICUs, the overall use of catheters decreased by 7%.
• ICUs didn’t see a substantial change in either CAUTI or catheter use, likely because the nature of patients treated in ICUs means more frequent urine output monitoring and culturing of urine, so UTIs are more likely to be spotted. What should readers take away from your report?

Dr. Saint: To help decrease CAUTIs, both technical and behavioral interventions are needed. Factors likely important to the success of this program included a focus on appropriate catheter use and alternatives to the use of an indwelling catheter, emphasis on aseptic insertion when the indwelling catheter is needed, and proper maintenance and removal of the urinary catheter. General infection prevention principles such as proper hand hygiene is also important. What recommendations do you have for future research as a result of this study?

Dr. Saint: We need to focus on how to reduce CAUTI in ICUs and how to extend our findings to hospitals that have persistently elevated CAUTI rates. Is there anything else you would like to add?

Dr. Saint: Approximately one in five hospital patients has a catheter collecting their urine – and putting them at risk of a painful and potentially dangerous UTI. Many of them may not actually need a catheter. But both catheter use and UTI rates have stayed high despite years of national attention on the issue. Our program shows we can make a difference in CAUTI rates and the use of catheters in the non-ICU setting.

This was a terrific team effort that included governmental agencies, state hospital associations, professional societies, academic partners, and individual hospitals and health systems. I am thankful for being part of this important collaboration.

Check out my TEDx Talk on improving healthcare: Thank you for your contribution to the community.


A Program to Prevent Catheter-Associated Urinary Tract Infection in Acute Care

Sanjay Saint, M.D., M.P.H., M. Todd Greene, Ph.D., M.P.H., Sarah L. Krein, Ph.D., R.N., Mary A.M. Rogers, Ph.D., David Ratz, M.S., Karen E. Fowler, M.P.H., Barbara S. Edson, R.N., M.B.A., M.H.A., Sam R. Watson, M.S.A., C.P.P.S., Barbara Meyer-Lucas, M.D., M.H.S.A., Marie Masuga, R.N., M.S.N., Kelly Faulkner, M.S.P.A., Carolyn V. Gould, M.D., M.S.C.R., James Battles, Ph.D., and Mohamad G. Fakih, M.D., M.P.H.

N Engl J Med 2016; 374:2111-2119
June 2, 2016 DOI: 10.1056/NEJMoa1504906

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

More Medical Research Interviews on

[wysija_form id=”5″]