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Multifaceted Approach Best to Ward off CAUTIs

Following best practices for the “placement, maintenance, and removal” of catheters is just as important as appropriate testing in order to reduce catheter-associated urinary tract infections (CAUTIs).

New research from the Society for Healthcare Epidemiology of America is suggesting that focusing equally on properly using and maintaining catheters, as well as testing for infections is best to reduce the number of catheter-associated urinary tract infections (CAUTIs).

The Centers for Disease Control and Prevention (CDC) notes that, “UTIs are the most common type of healthcare-associated infection reported to the National Healthcare Safety Network (NHSN),” and approximately 75% of those infections are associated with the use of a urinary catheter. While the latest data on healthcare-associated infections and statistics showed “no change in overall CAUTIs between 2009 and 2014,” some progress was noted, “in non-ICU settings between 2009 and 2014, progress in all settings between 2013 and 2014, and even more progress in all settings towards the end of 2014.”

In this latest study, researchers (representing all critical care disciplines) set out to reduce the incidence of CAUTIs at the Cleveland Clinic. Over the course of two years, the researchers ensured that their catheter “placement, maintenance, and removal” techniques followed CDC recommended protocols, and their culturing practices aligned with the American College of Critical Care Medicine. In addition, they followed Infectious Disease Society of America “guidelines for evaluating a fever in a critically ill patient.” Furthermore, “surveillance data for CAUTI and hospital-acquired bloodstream infection (HABSI) were recorded prospectively according to National Healthcare Safety Network (NHSN) protocols. Device utilization ratios (DURs), rates of CAUTI, HABSI, and urine cultures were calculated and compared.”

According to the press release, “through a multifaceted intervention emphasizing best practices for insertion, maintenance and removal of indwelling catheters, as well as following strict criteria for testing patients for infection,” the researchers were able to reduce rates of CAUTI in the hospital patients from “3.0 per 1,000 catheter days in 2013 to 1.9 in 2014.”

Lead author of the study, Katherine Mullin, MD, an Infectious Disease Physician at Cleveland Clinic is quoted in the press release as stating, “Most efforts to reduce infections, such as CAUTIs, take an approach solely from an infection prevention standpoint, as opposed to evaluating and individualizing appropriate testing in the clinical care setting," said Mullin. "Our research suggests that combining both approaches is the most effective way to reduce these infections."