January 6, 2011

Efforts help lower catheter-associated infection rates

Efforts help lower catheter-associated infection rates

Rates of catheter associated urinary tract infection in Vanderbilt critical care units have plummeted in recent months to less than half the expected rates established by the Centers for Disease Control and Prevention.

Prevention experts say the drop is due to staff and faculty education and increased prevention extending across all of Vanderbilt University Hospital.

Across Vanderbilt ICUs as a whole, infections have decreased from an average of 13 per month in the first quarter of this calendar year to 5.3 per month in the third quarter.

The CDC uses extensive surveillance data to calculate expected rates of catheter-associated urinary tract infection (CAUTI) per catheter-day in areas such as medical ICUs, surgical ICUs, burn units and general care units.

On a monthly basis, across Vanderbilt ICUs as a whole, CAUTI rates per catheter-day in the third quarter ran between 31 percent and 49 percent of the rates expected in ICUs of major teaching hospitals when using CDC surveillance standards. (The CAUTI rates for non-ICUs at Vanderbilt haven't been calculated.)

Urinary catheterization involves threading a plastic tube via the urethra into the bladder, usually for draining and collection of urine. Nationally, 15 percent to 25 percent of all hospital patients receive a temporary indwelling urinary catheter at some point during their stay.

“Catheters provide a superhighway for bacteria to get from the outside of the body to the inside,” said Roger Dmochowski, M.D., professor of Urology and executive physician for safety at VUH.

CAUTI is said to account for more than 40 percent of all hospital-acquired infections.

One estimate puts the cost of caring for CAUTI at $589 per case. Medicare recently stopped paying hospitals to treat these preventable infections, prompting hospitals across the country to step up prevention.

Most cases of CAUTI will be successfully treated with antibiotics. But these infections can sometimes evade notice, and according to Dmochowski about 10 percent to 20 percent develop into potentially far more dangerous and costly blood infections.

Consensus has been vital to the CAUTI effort at VUH.

“This wasn't a bunch of people issuing directives from a smoke-filled room. These new measures have been a partnership among nursing and physicians,” Dmochowski said.

Avoiding delays in catheter removal is apparently the quickest route to improved prevention.

“None of this would work if we didn't have staff at the bedside making sure we're doing the right thing for the patient,” said Barbara Martin, MBA, R.N., a quality consultant with the Center for Clinical Improvement.

When doctors in VUH issue electronic orders for a urinary catheter, they now have the option of clicking a box to free the nurse from waiting for a separate order to remove the catheter, allowing the nurse independently to initiate removal per protocol. In the course of electronically documenting care, nurses are automatically prompted to evaluate whether a catheter should be removed.

Vanderbilt efforts have focused on the adult hospital, as use of urinary catheters is far more routine in adults than in children.

Related infection control programs at Vanderbilt, such as the hand-washing campaign, may also have helped influence the recent drop in CAUTI.