Hospitals Score Poorly on Preventing Urinary Tract Infection
WEDNESDAY Jan. 9, 2008 -- Urinary catheters may be one of the least pleasant parts of a hospital stay, but doctors, families and patients need to pay more attention to the risk of infection.
According to a new national study, fewer than one in three hospitals are using either bladder scanners or antimicrobial catheters to prevent urinary tract infection and less than one in 10 are using daily, automated reminders that prompt doctors to review the need for a catheter.
Researchers at the University of Michigan noted that one in four hospital patients has a urinary catheter, a tube inserted into the urinary tract to allow urine to flow out of the bladder and into a bag. One percent of these patients are at risk for a urinary tract infection, the most common kind of infection acquired while hospitalized.
To study policies and practices surrounding the prevention of urinary tract infections, the Michigan team sent a detailed survey to all 119 Veterans Administration hospitals in the United States, as well as 600 randomly selected non-federal hospitals with an intensive care unit over 50 hospital beds.
They inquired about a variety of techniques that can prevent urinary tract infections, including the use of infection-reducing catheters (antimicrobial, condom-style or suprapubic). They also asked about the use of bladder scanners, which are used to find out if bladders are completely emptied, or the use of antimicrobial agents in the bags themselves.
The research team also asked about other infection-control methods, such as automated reminders, stop orders, monitoring systems, evaluation of infections and urinary catheter teams.
When they analyzed the results, the group found no consistently applied strategy for preventing catheter-related infections. Furthermore, most hospitals were not using even basic, proven tactics that can prevent these infections.
The study, published in the January issue of Clinical Infectious Disease, is the first national survey of catheter-related urinary tract infection prevention, the researchers said.
"Until now, we haven't had national data to tell us what hospitals are doing to prevent this common and costly patient-safety problem," lead author Dr. Sanjay Saint, director of the U-M/VA Patient Safety Enhancement Program, said in a prepared statement. "Now that we have these data, it's clear that there's no one dominant practice that's being used, including physician reminders, which have proven benefit and make a lot of common sense. The bottom line for hospitalized patients and their families is, if you have a catheter, ask the doctor or nurse every day if you really still need it."
The researchers added that infection control is of particular interest to hospitals now that Medicare no longer covers the cost of treating infections acquired during hospitalization.
According to the researchers, previous studies have shown that one third of patients have a catheter longer than needed, and one third of doctors do not know whether any particular patient still has a catheter in place.
VA hospitals were no more likely than other hospitals to have an automated catheter-reminder system, despite the hospitals' use of electronic medical records and information, said the researchers.
To learn more about preventing hospital-acquired infections, visit the World Health Organization.
Posted: January 2008