Research Activities April 2013, No. 392
New measure helps evaluate interventions to reduce catheter-associated urinary tract infections
Patient Safety and Quality
More than a third of all healthcare-associated infections originates in the urinary tract, including catheter-associated urinary tract infections (CAUTIs). Measures of CAUTIs are now used to rate hospital safety performance and are publically reported in some places. The measure from the National Healthcare Safety Network (NHSN) calculates the CAUTI rate by dividing the number of CAUTI episodes during a specific period by the total number of indwelling urinary catheter-days during the same period and multiplying by 1,000. Although the NHSN CAUTI rate accounts for the risk of infection in patients with an indwelling urinary catheter, it does not account for the risk to the total hospitalized patient population. According to the authors of a new study, this approach may not be able to capture the effectiveness of all interventions to reduce catheter usage. They propose a new population-based outcome measure that may better reflect these hospital-wide efforts.
Their proposed population CAUTI rate involves dividing the number of CAUTI episodes taking place during a specific period by the total number of patient-days during the same time period, and multiplying by 10,000. The researchers used computer-based simulation to compare both measures on 100 simulated catheter interventions. A total of 93 of the 100 simulated interventions produced reductions in both the total number of CAUTI episodes and population CAUTI rate. However, the NHSN CAUTI rate increased in 25 of these 93 simulations. For the 68 simulated interventions where both the NHSN and the population-based rate decreased, the reductions were consistently greater in the population-based CAUTI rate compared to the NHSN rate. According to the researchers, hospitals should calculate both rates. Institutions may find the NHSN CAUTI rate helpful in comparing specific units with similar characteristics from different facilities. The population-based rate is ideal for evaluating improvement programs to reduce inappropriate urinary catheter placement in the same institution. The study was supported in part by AHRQ (HS19767).
See "Introducing a population-based outcome measure to evaluate the effect of interventions to reduce catheter-associated urinary tract infection," by Mohamad G. Fakih, M.D., M.P.H., M. Todd Greene, Ph.D., M.P.H., Edward H. Kennedy, M.S., and others, in the American Journal of Infection Control 40, pp. 359-364, 2012.