We have blogged before how CAUTI is rather ‘unloved’ as an HCAI prevention target. CLABSI reduction, on the other hand, is all the rage. Now, there is a key reason why this makes sense: outcome! A CLABSI is much worse news for a patient than a CAUTI. However, this doesn’t mean we should turn a blind eye to CAUTI, especially since CAUTI is a common root cause for CLABSI! In the US there is an addiional driver for preventing CAUTI: the costs associated with CAUTI are no longer reimbursed by insurers (since 2008). With this in mind, it was great to see a CAUTI reduction study published in NEJM recently (and see some interesting analysis on the Controversies blog).
This is a vast study, including data from 926 units in 603 US hospitals from 32 states, representing more than 10% of US acute hospitals. It also icnludes a broad mix of facilities (not just well-funded large academic hopsitals). The interventions are super simple, and basic strategies that we all should be doing:
- Performing a daily check on whether a urinary catheter is still required (for the medical care of the patient, and not for the convenience of staff…);
- Considering alternative urine-collection methods; and
- Ensuring aseptic technique during catheter insertion.
There was also some feedback of catheter usage rates, and CAUTI rates to participating units, and education where gaps were identified. The programme website is still live, and contains some useful resources.
Data was collected for a 3 month baseline period, 2 months of implementation, and a 12 month sustainability period. There was an overall significant reduction in adjusted CAUTI rate from 2.4 to 2.0 per 1000 catheter-days; this was driven mainly by a significant reduction in non-ICU units (from 2.3 to 1.5 CAUTIs per 1000 catheter-days). The CAUTI rate in ICUs did not reduce significantly. Similarly, catheter use decreased significantly in non-ICUs from 20% to 19%, but not in ICUs.
Some points to consider:
- The study report does not specify exactly how data on catheter use was collected and recorded. Since a requirement of the study was to perform a daily review of the continuing need for the catheter, I suspect this was the mechanism used to record catheter usage. Although perhaps some units were able to extract catheter usage from electronic hospital records?
- The effort put into this CAUTI reduction programme was huge: multi-institutional, and seemingly well-funded. I would be interested to see how much the programme cost, and whether it proved cost-effective, given the relatively benign outcomes associated with most CAUTIs.
- It is interesting to ponder why there was no impact in the ICUs. Could this be because they have already got their catheter care down, and there isn’t much room for further reduction? I’d like to think this was the case, although would be interested to hear if anybody has other suggestions.
Many hospitals don’t even measure CAUTI, let alone demonstrate CAUTI reductions, so congratulations to the authors (and the 10% of US hospitals!) that participated in this programme.