CME/CE: A Program to Prevent Catheter-Associated UTIs

CME/CE: A Program to Prevent Catheter-Associated UTIs
Author Information (click to view)

Sanjay Saint, MD, MPH

Chief of Medicine
VA Ann Arbor Healthcare System
George Dock Professor & Senior Associate Chair
Department of Internal Medicine
University of Michigan Health System

Sanjay Saint, MD, MPH, has indicated to Physician’s Weekly that he has no financial disclosures to report.

Figure 1 (click to view)
Target Audience (click to view)

This activity is designed to meet the needs of physicians and nurses.

Learning Objectives(click to view)

Upon completion of the educational activity, participants should be able to:

 

  • Discuss the results from the first four of nine cohorts of hospital units involved in a nationwide effort to implement the Comprehensive Unit-Based Safety Program to reduce catheter-associated urinary tract infections in intensive care units (ICUs) as well as non-ICUs.

Method of Participation(click to view)

Release Date: 03/13/2017
Expiration Date: 03/13/2018

Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation.  A statement of credit will be available upon completion of an online evaluation/claimed credit form at akhcme.com/akhcme/lessons/46.  You must participate in the entire activity to receive credit.  If you have questions about this CME/CE activity, please contact AKH Inc. at dcotterman@akhcme.com.

Credit Available(click to view)

AKH

CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare

Physicians
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s.  AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.

AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

 

Physician Assistants
NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME.

 

Nursing
AKH Inc., Advancing Knowledge in Healthcare is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

This activity is awarded 0.5 contact hours.

Commercial Support(click to view)

There is no commercial support for this activity.

Disclosures(click to view)

It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.

Disclosure of Unlabeled Use & Investigational Product(click to view)

This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer(click to view)

This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.

Faculty & Credentials(click to view)

Keith D’Oria – Editorial Director
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Sanjay Saint, MD, MPH
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
AKH and PHYSICIAN WEEKLY’S STAFF/REVIEWERS

Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

AKH planners and reviewers have no relevant financial relationships to disclose.

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Sanjay Saint, MD, MPH (click to view)

Sanjay Saint, MD, MPH

Chief of Medicine
VA Ann Arbor Healthcare System
George Dock Professor & Senior Associate Chair
Department of Internal Medicine
University of Michigan Health System

Sanjay Saint, MD, MPH, has indicated to Physician’s Weekly that he has no financial disclosures to report.

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A national prevention program appears to reduce urinary catheter use and catheter-associated urinary tract infection (UTI) rates in non-ICUs. The findings highlight the need to use both technical and cultural interventions to prevent catheter-associated UTIs.
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Research has shown that urinary catheter-associated urinary tract infections (UTIs) are among the most common healthcare–associated infections both in the United States and throughout the world. Studies indicate that up to 69% of urinary catheter-associated UTIs are avoidable if clinicians use recommended infection-prevention practices when managing patients. According to current guidelines, several strategies are recommended to prevent these infections. These include using the devices appropriately, aseptic insertion, proper maintenance, and timely removal of indwelling urinary catheters in addition to using established practices, such as hand hygiene.

In addition to the technical aspects of prevention, there has been a focus on instituting behavioral and cultural changes to further improve quality of care, according to Sanjay Saint, MD, MPH. “Preventing catheter-associated UTIs has emerged as a priority in the United States,” he says. Catheter-associated UTI was the first hospital-acquired complication chosen by CMS in 2008 as the basis for denial of additional payment to hospitals. Since that time, more initiatives have been launched to provide strategic guidance for preventing infections in acute care hospitals. Despite these efforts, national data indicate that the incidence of catheter-associated UTI increased by 6% from 2009 to 2013.

 

A Nationwide Initiative

Recently, the AHRQ and several other partners launched a nationwide effort to implement the Comprehensive Unit-Based Safety Program to reduce catheter-associated UTIs in ICUs as well as non-ICUs. “This effort involved an explicit focus on the technical and socioadaptive aspects of preventing catheter-associated UTIs,” says Dr. Saint. He and his colleagues recently published the results from the first four of nine cohorts of hospital units in the New England Journal of Medicine.

The program disseminated primary and secondary recommendations to sponsor organizations and hospitals (Table), collected data, and offered guidance on key technical and socioadaptive factors in the prevention of catheter-associated UTI. Data on catheter use and catheter-associated UTI rates were collected during three phases: at baseline (3 months), during implementation (2 months), and through long-term sustainability (12 months). “This was a large study in that data were obtained from 926 units in 603 hospitals in 32 states, the District of Columbia, and Puerto Rico,” says Dr. Saint. Nearly 60% of the units were non-ICUs while about 40% were ICUs.

 

Important Results

According to the findings, the unadjusted catheter-associated UTI rate decreased overall from 2.82 to 2.19 infections per 1,000 catheter-days after initiating the intervention. In an adjusted analysis, the rates of catheter-associated UTIs decreased from 2.40 to 2.05 infections per 1,000 catheter-days. Among non-ICUs, catheter use decreased significantly and catheter-associated UTI rates dropped from 2.28 to 1.54 infections per 1,000 catheter-days. “Overall, we saw a reduction in catheter-associated UTI rates of about 32% in non-ICUs,” Dr. Saint says. He adds, however, that catheter use and catheter-associated UTI rates were largely unchanged in ICUs.

“Our data show that a collaborative effort focusing on both technical and socioadaptive interventions can reduce catheter-associated UTI rates in non-ICU settings,” says Dr. Saint. “When we add this data to what has been learned from that of local and regional level investigations, we have better guidance on how to scale up the intervention to benefit the nation.” Dr. Saint adds that his study group also used the results of previous qualitative studies to guide their implementation efforts.

Non-ICUs benefited from participating in the program but ICUs did not experience the same benefits. This dichotomy between ICUs and non-ICUs has also been seen in studies using CDC surveillance data. Dr. Saint says the reasons are unclear as to why ICUs have been less successful than non-ICUs in preventing catheter-associated UTIs.

“It’s possible that clinicians believe patients who are sick enough to warrant being admitted to the ICU require close monitoring of urine output, which is an appropriate criterion for indwelling urinary catheters,” Dr. Saint says. The higher catheter-associated UTI rate in ICUs could also be related to the fact that fevers occur frequently in critically ill patients. This could lead clinicians to couple routine culturing of various body fluids, including urine, to identify possible sources of infection. Given the findings observed in the study and the CDC criteria for catheter-associated UTI, patients in ICUs may meet the surveillance definition of catheter-associated UTIs more frequently than patients in non-ICUs.

 

Significant Implications

According to Dr. Saint, a key take home message for all clinicians is that the national prevention program used in the study appears to reduce catheter use and catheter-associated UTI rates in non-ICUs. “Our national collaborative program used both technical and cultural interventions that led to a decrease in rates of catheter-associated UTIs in non-ICUs,” he says. “There is no ‘silver bullet’ approach that will work for all hospitals, but developing and maintaining a culture of excellence is critical to further reducing the burden of these infections.” He notes that the next step, which is currently underway, is to conduct a similar collaborative effort in long-term care settings, for which preventive data are more limited.

Readings & Resources (click to view)

Saint S, Green MT, Krein SL, et al. A program to prevent catheter-associated urinary tract infection in acute care. N Engl J Med. 2016;374-2111-2119. Available at: http://www.nejm.org/doi/full/10.1056/NEJMoa1504906?query=featured_home#t=article.

Saint S, Greene MT, Kowalski CP, Watson SR, Hofer TP, Krein SL. Preventing catheter-associated urinary tract infection in the United States: a national comparative study. JAMA Intern Med. 2013;173:874-879.

Saint S, Olmsted RN, Fakih MG, et al. Translating health care-associated urinary tract infection prevention research into practice via the bladder bundle. Jt Comm J Qual Patient Saf. 2009;35:449-455.

Hooton TM, Bradley SF, Cardenas DD, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010;50:625-663.

Saint S. Hand washing stops infections, so why do health care workers skip it? The Conversation.
May 17, 2016. Available at: http://theconversation.com/hand-washing-stops-infections-so-why-do-health-care-workers-skip-it-58763. For more on this, go to https://www.youtube.com/watch?v=U3MtvvNjUR4.

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