Reducing Nosocomial Urinary Tract Infections

The Agency for Healthcare Research and Quality issued in April its annual quality report including data on rates of healthcare-associated infections (HAI) in adult hospital patients tracked in the report. Five specific HAIs are tracked because of their high incidence and therefore high costs, one of which is postoperative catheter-associated urinary tract infections (UTIs). The five are also targeted because they stem from categories considered "never events" because they never should happen in the course of a normal hospital stay when care meets established standards and protocols.

The National Quality Forum (NQF), in reference to particularly shocking errors (such as wrong-site surgery) that should never occur, first introduced the term "never event" in 2001. The NQF initially defined 28 such events in 2002. Four years later it revised and expanded the list. Over time, the list has been expanded to signify adverse events that are unambiguous (clear identifiable and measurable), serious (resulting in death or significant disability), and usually preventable. The list is grouped into six categorical events: surgical, product or device, patient protection, care management, environmental, and criminal¹. In August 2007, the Centers for Medicare and Medicaid announced that beginning in 2008 it would no longer reimburse hospitals for costs associated with certain infections and complications occurring during hospitalization, including catheter-associated UTIs.² These are also referred to as nosocomial UTIs.

Catheters are associated with colonization of bacteria and increased risks of clinical infection. While single-use, sterile catheters reduce the risks they do not prevent UTIs. While catheters coated with antimicrobial agents such as nitrofurazone have received considerable attention, they come at a six-fold increase in cost and raise questions about how to best select the most appropriate patients for their use.

Despite all the attention and focus on this an other "never events," the latest quality report reveals postoperative catheter-associated UTIs increased by 3.6 percent in 2009. Such a fact begs the question of whether the attention and focus are where they need to be. Nearly a decade ago, Kunin declared there is no need to wait for a mechanical or chemical answer to the problem of nosocomial UTIs because the culprits are "unnecessary and prolonged use of indwelling urinary catheters when they are no longer needed."³ This echoed a similar declaration published six years earlier.⁴

In the end, as with the practice of intermittent catheterization for emptying the bladder of urine, there is no substitute for maintaining proper care, while remaining alert to symptoms of UTI. There's help for that from NAFC and other online sources.

¹Agency for Healthcare Research and Quality, accessed on May 25, 2010 at http://www.psnet.ahrq.gov/primer.aspx?primerID=3

²Pear, R. Medicare says it won't cover hospital errors, The New York Times, August 19, 2007, accessed on May 25, 2010 at http://www.nytimes.com/2007/08/19/washington/19hospital.html?_r=1

³Kunin, C.M. (2001). Nosocomial urinary tract infections and the indwelling catheter: what is new and what is true? Chest, 120 (1): 10-12

⁴Jain, P., Parada, J.P., David, A. et al. (1995). Overuse of the indwelling urinary catheter in hospitalized medical patients. Archives of Internal Medicine, 155: 1425-1429.