Introducing a population-based outcome measure to evaluate the effect of interventions to reduce catheter-associated urinary tract infection - 28/04/12
, M. Todd Greene, PhD, MPH b, Edward H. Kennedy, MS b, c, Jennifer A. Meddings, MD, MSc b, Sarah L. Krein, PhD, RN b, c, Russell N. Olmsted, MPH d, Sanjay Saint, MD, MPH b, c
Address correspondence to Mohamad G. Fakih, MD, MPH, Infection Control and Prevention Department, St John Hospital and Medical Center, 19251 Mack Ave, Suite 190, Grosse Pointe Woods, MI 48236.Abstract |
Background |
The catheter-associated urinary tract infection (CAUTI) measure recommended by the National Healthcare Safety Network (NHSN) accounts for the risk of infection in patients with an indwelling urinary catheter, but might not adequately reflect all efforts aimed to enhance patient safety by reducing urinary catheter use.
Methods |
We used computer-based Monte Carlo simulation to compare the NHSN-recommended CAUTI rate (CAUTIs per 1,000 catheter-days) with the proposed “population CAUTI rate” (CAUTIs per 10,000 patient-days). We simulated 100 interventions with a wide range of effects on catheter utilization and CAUTI risk in patients with catheters, and then compared the 2 measures before and after intervention across the simulated interventions.
Results |
Out of our 100 simulated interventions, 93 yielded reductions in CAUTI; however, in 25 (27%) of these 93 simulations, the NHSN CAUTI rate increased after the intervention. In addition, among the 68 simulations in which both the NHSN and the population CAUTI rates decreased, the percent decreases in the population CAUTI rate were consistently greater than those in the NHSN rate.
Conclusion |
The population CAUTI rate—CAUTIs per 10,000 patient-days—should be calculated along with the NHSN rate, particularly in settings where interventions lead to substantial reductions in catheter placement. We suspect that this population CAUTI rate may eventually emerge as a primary outcome for hospital-based quality improvement interventions for reducing urinary catheter utilization, especially those focusing on avoiding urinary catheter placement.
Le texte complet de cet article est disponible en PDF.Key Words : Infection rate, Urinary tract infection, Health care–associated infection, Urinary catheter, Device
Plan
| Versions of the study were presented in part at the 50th Annual Meeting of the Interscience Conference for Antimicrobial Agents and Chemotherapy, Boston, MA, September, 2010 (Abstract k-2201), and at the 21st Annual Scientific Meeting of the Society of Healthcare Epidemiology of America, Dallas, TX, April, 2011 (Abstract LB11). |
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| Some of the authors have received support from the National Institute of Diabetes and Digestive and Kidney Diseases (Award R21-DK078717, to S.S.), National Institute of Nursing Research (Award R01-NR010700, to S.S. and S.K.), Agency for Healthcare Research and Quality (Award 1K08-HS019767-01, to J.M.), and a grant from the Blue Cross Blue Shield of Michigan Foundation (to J.M.). J.M. is the recipient of assistance from the National Institutes of Health Clinical Loan Repayment Program for 2009-2011. |
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| Conflict of interest: S.S. has received numerous honoraria and speaking fees from academic medical centers, hospitals, specialty societies, state-based hospital associations, and nonprofit foundations (eg, Institute for Healthcare Improvement) for lectures on catheter-associated urinary tract infection. None of the other authors reports any potential conflict of interest. |
Vol 40 - N° 4
P. 359-364 - mai 2012 Retour au numéro
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