AHRQ Program Reduces Urinary Tract Infections in Hospitals
Press Release Date: June 1, 2016
A national project called the Comprehensive Unit-based Safety Program (CUSP), funded by the Agency for Healthcare Research and Quality (AHRQ) has significantly helped reduce catheter-associated urinary tract infections (CAUTIs) in hospitals, according to a study published in the June 2 New England Journal of Medicine.
Approximately 250,000 CAUTIs occur in hospitals each year, costing about $250 million. CAUTIs, which are among the most common health care-associated infections (HAIs), are largely preventable. Stopping HAIs spares patients an infection that can have serious complications, such as bloodstream infection. It also reduces the need for antibiotics, which decreases the chance that bacteria will develop resistance to these life-saving medications.
“AHRQ’s research shows that we can make significant progress in advancing patient safety and reducing costs in health care,” said AHRQ Director Andy Bindman, M.D. “Tools such as CUSP are an important part of our efforts to improve the way we deliver care, helping frontline clinicians make care safer, less expensive and better for public health.”
CUSP is a customizable safety program in which clinicians use a checklist of clinical best practices and combine it with improvement in safety culture, teamwork, and communications. The study, “A Program to Prevent Catheter-Associated Urinary Tract Infection in Acute Care,” was led by Sanjay Saint, M.D., M.P.H., Chief of Medicine at the VA Ann Arbor (MI) Healthcare System, and George Dock Professor at the University of Michigan. The study authors examined data from 926 hospital units (including intensive care units [ICUs] and non- ICUs) in 32 states, the District of Columbia, and Puerto Rico that participated in the early stages of the 4-year CUSP project.
Researchers found that CAUTI rates decreased by 32 percent in non-ICUs, from 2.28 to 1.54 infections per 1,000 days of catheter use. These units were also able to reduce the overall use of catheters from 20.1 percent to 18.8 percent by avoiding unnecessary or unnecessarily prolonged catheterizations and using alternative urinary collection methods.
Although CAUTI rates and catheter use decreased in non-ICUs, the study showed that rates of CAUTIs and catheter use in participating ICUs were unchanged. Reducing the use of catheters is one of the main ways to prevent CAUTI. The authors suggest that differences in routine care processes between ICUs and other hospital units could be a reason why CAUTIs did not decrease in ICUs. For example, ICU patients are sicker than other hospital patients and may require closer monitoring. ICU clinicians must balance the need to monitor urine output closely by means of a catheter with the increased risk of CAUTI that comes with catheter use.
“These results demonstrate that a collaborative effort focusing on both technical and socio-adaptive interventions can reduce CAUTI rates in non-ICU settings,” Dr. Saint said. “Importantly, we learned how to scale up the intervention when going from a single hospital and region to a broader group encompassing about 10 percent of all U.S. hospitals. The overall experience in this project should help us implement methods to reduce CAUTI in other settings such as long-term care.”
The project was conducted under a contract from AHRQ to the Health Research & Educational Trust, an affiliate of the American Hospital Association, and its partners, the Michigan Health and Hospital Association Keystone Center for Patient Safety & Quality, St. John Hospital and Medical Center, the University of Michigan Health System, and the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, collectively referred to as the National Project Team. The National Project Team collaborated with a number of organizations, including the Association for Professionals in Infection Control and Epidemiology, the Emergency Nurses Association, the Society for Healthcare Epidemiology of America, the Society of Hospital Medicine, and the Society of Critical Care Medicine.
AHRQ, part of the U.S. Department of Health and Human Services (HHS), works with other Federal agencies, researchers and providers on numerous projects that prevent and reduce HAIs. The efforts of AHRQ’s HAI Program, including CUSP, align with HHS’s National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination and the White House’s National Action Plan for Combating Antibiotic-Resistant Bacteria. Many of AHRQ’s resources, including its HAI toolkits, have been used by hospitals across the country to reduce hospital-acquired conditions and implement best practices, such as guidelines from the Centers for Disease Control and Prevention. AHRQ’s activities are essential elements of HHS’ commitment to make our health care system provide better care with smarter spending, leading to healthier patients.