Major article
Effectiveness of a simple intervention for prevention of catheter-associated urinary tract infections in a community teaching hospital

https://doi.org/10.1016/j.ajic.2010.05.028Get rights and content

Background

Catheter-associated urinary tract infection (CA-UTI) is the most common health care–associated infection. Instrumentation of the urinary tract, mainly urinary catheterization, is the most important risk factor for CA-UTI. It is believed that proper catheter management can reduce the incidence of CA-UTI.

Methods

This was a prospective preintervention and postintervention study conducted to assess the effect of an intervention aimed at preventing CA-UTI. A reminder sticker was placed on each patient’s medical record binder to remind the physicians to consider discontinuing any unnecessary urinary catheters.

Results

There was a statistically significant increase in the number of appropriately retained urinary catheters at 3 months (57% vs 73%; P = .007) and 6 months postintervention (57% vs 86%; P < .001). There was also a statistically significant reduction in the rate of CA-UTI after 3 months (7.02 vs 2.08; P < .001) and 6 months postintervention (7.02 vs 2.72; P < .001).

Conclusion

A simple intervention using a sticker placed on patients’ medical record binder to remind physicians to remove unnecessary urinary catheters can significantly increase the appropriate utilization of urinary catheters and decrease the rate of CA-UTI in community teaching hospitals.

Section snippets

Study design

This prospective preintervention and postintervention study was conducted at St Vincent’s Medical Center, a 473-bed community teaching and referral hospital in southwestern Connecticut. We included patients from medical wards, surgical wards, cancer unit, cardiovascular units, and intensive care units. The study population comprised patients admitted to the in-patient service for at least 48 hours in September 2008, December 2008, and March 2009. Only patients with urethral catheters were

Results

A total of 400 patients were enrolled during the 3 study periods. The patients’ demographic and clinical characteristics are summarized in Table 2. No significant differences in demographic data were found between the preintervention period and the postintervention periods except for a higher rate of cardiovascular disease in the 6-month postintervention group compared with the preintervention group (P = .008).

Discussion

This infection control quality improvement initiative in our hospital demonstrates the positive impact of an intervention on the use of indwelling catheters, the most important risk factor for CA-UTI. A reminder sticker is practical, relatively inexpensive, and an effective intervention as part of a continuous quality improvement initiative to significantly increase the rate of appropriate use of urinary catheters (by 28.1% at 3 months postintervention and 50.9% at 6 months postintervention).

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Conflicts of interest: None to report.

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