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Beyond Infection: Device Utilization Ratio as a Performance Measure for Urinary Catheter Harm

Published online by Cambridge University Press:  27 November 2015

Mohamad G. Fakih ,
Carolyn V. Gould ,
Barbara W. Trautner ,
Jennifer Meddings ,
Russell N. Olmsted ,
Sarah L. Krein  and
Sanjay Saint
Mohamad G. Fakih*
Affiliation:
St. John Hospital and Medical Center, Detroit, Michigan Wayne State University School of Medicine, Detroit, Michigan
Carolyn V. Gould
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Barbara W. Trautner
Affiliation:
Houston VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Section of Infectious Diseases, Department of Medicine and Department of Surgery, Baylor College of Medicine, Houston, Texas
Jennifer Meddings
Affiliation:
Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, Michigan
Russell N. Olmsted
Affiliation:
Infection Prevention and Control, Unified Clinical Organization, Trinity Health, Livonia, Michigan
Sarah L. Krein
Affiliation:
VA Ann Arbor Healthcare System, Ann Arbor, Michigan
Sanjay Saint
Affiliation:
VA Ann Arbor Healthcare System, Ann Arbor, Michigan Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
*
Address correspondence to Mohamad G. Fakih, MD, MPH, Medical Director, Infection Prevention and Control, St. John Hospital and Medical Center, 19251 Mack Ave, Suite 190, Grosse Pointe Woods, MI 48236 (Mohamad.Fakih@stjohn.org).
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Abstract

Catheter-associated urinary tract infection (CAUTI) is considered a reasonably preventable event in the hospital setting, and it has been included in the US Department of Health and Human Services National Action Plan to Prevent Healthcare-Associated Infections. While multiple definitions for measuring CAUTI exist, each has important limitations, and understanding these limitations is important to both clinical practice and policy decisions. The National Healthcare Safety Network (NHSN) surveillance definition, the most frequently used outcome measure for CAUTI prevention efforts, has limited clinical correlation and does not necessarily reflect noninfectious harms related to the catheter. We advocate use of the device utilization ratio (DUR) as an additional performance measure for potential urinary catheter harm. The DUR is patient-centered and objective and is currently captured as part of NHSN reporting. Furthermore, these data are readily obtainable from electronic medical records. The DUR also provides a more direct reflection of improvement efforts focused on reducing inappropriate urinary catheter use.

Infect. Control Hosp. Epidemiol. 2016;37(3):327–333

Type
Review Article
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 3 , March 2016 , pp. 327 - 333
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination. U.S. Department of Health & Human Services website. http://www.health.gov/hcq/prevent_hai.asp. Accessed on July 4, 2015.Google Scholar
2. Department of Health and Human Services, Centers for Medicare & Medicaid Services. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and Fiscal Year 2014 rates; quality reporting requirements for specific providers; hospital conditions of participation; payment policies related to patient status. Final rules. Fed Regist 2013;78:50495–51040.Google Scholar
3. Fakih, MG, George, CM, Edson, BS, Goeschel, CA, Saint, S. Implementing a national program to reduce catheter-associated urinary tract infection: a quality improvement collaboration of state hospital associations, academic medical centers, professional societies, and governmental agencies. Infect Control Hosp Epidemiol 2013;34:1048–1054.CrossRefGoogle ScholarPubMed
4. Chenoweth, CE, Saint, S. Urinary tract infections. Infect Dis Clin N Am 2011;25:103–115.CrossRefGoogle ScholarPubMed
5. Meddings, J, Saint, S. Disrupting the life cycle of the urinary catheter. Clin Infect Dis 2011;52:1291–1293.CrossRefGoogle ScholarPubMed
6. Cope, M, Cevallos, ME, Cadle, RM, Darouiche, RO, Musher, DM, Trautner, BW. Inappropriate treatment of catheter-associated asymptomatic bacteriuria in a tertiary care hospital. Clin Infect Dis 2009;48:1182–1188.CrossRefGoogle ScholarPubMed
7. Jacob, JT, Klein, E, Laxminarayan, R, et al. Vital signs: carbapenem-resistant Enterobacteriaceae. MMWR 2013;62:165–170.Google Scholar
8. Sievert, DM, Ricks, P, Edwards, JR, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009–2010. Infect Control Hosp Epidemiol 2013;34:1–14.CrossRefGoogle Scholar
9. Drekonja, DM, Rector, TS, Cutting, A, Johnson, JR. Urinary tract infection in male veterans: treatment patterns and outcomes. Arch Intern Med 2013;173:62–68.Google ScholarPubMed
10. Hollingsworth, JM, Rogers, MAM, Krein, SL, et al. Determining the noninfectious complications of indwelling urethral catheters: a systematic review and meta-analysis. Ann Intern Med 2013;159:401–410.CrossRefGoogle ScholarPubMed
11. Saint, S, Lipsky, BA, Goold, SD. Indwelling urinary catheters: a one-point restraint? Ann Intern Med 2002;137:125–127.CrossRefGoogle ScholarPubMed
12. National Healthcare Safety Network. Surveillance for Urinary Tract infections. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/acute-care-hospital/CAUTI/index.html. Accessed on July 4, 2015.Google Scholar
13. 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.CrossRefGoogle Scholar
14. Hospital-Acquired Conditions. Centers for Medicare & Medicaid Services website. http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/Hospital-Acquired_Conditions.html. Accessed on July 4, 2015.Google Scholar
15. Department of Health and Human Services, Centers for Medicare & Medicaid Services. Medicare program: changes to the hospital inpatient prospective payment systems and fiscal year 2009 rates; payments for graduate medical education in certain emergency situations; changes to disclosure of physician ownership in hospitals and physician self-referral rules; updates to the long-term care prospective payment system; updates to certain IPPS-excluded hospitals; and collection of information regarding financial relationships between hospitals. Final rules. Fed Regist 2008;73:48433–49084.Google Scholar
16. Meddings, JA, Reichert, H, Rogers, MA, Saint, S, Stephansky, J, McMahon, LF. Effect of nonpayment for hospital-acquired, catheter-associated urinary tract infection: a statewide analysis. Ann Intern Med 2012;157:305–312.CrossRefGoogle ScholarPubMed
17. Meddings, J, Saint, S, McMahon, LF Jr. Hospital-acquired catheter-associated urinary tract infection: documentation and coding issues may reduce financial impact of Medicare’s new payment policy. Infect Control Hosp Epidemiol 2010;31:627–633.CrossRefGoogle ScholarPubMed
18. Goto, M, Ohl, ME, Schweizer, ML, Perencevich, EN. Accuracy of administrative code data for the surveillance of healthcare-associated infections: a systematic review and meta-analysis. Clin Infect Dis 2014;58:688–696.CrossRefGoogle ScholarPubMed
19. Meddings, J, Reichert, H, Dueweke, E, Rhyner, J. Issues regarding identification of urinary catheter use from medical records. In Battles JB, Cleeman JI, Kahn KK, Weinberg DA, ed. Advances in the Prevention and Control of Healthcare-Associated Infections. Rockville, MD: Agency for Healthcare Research and Quality, 2014.Google Scholar
20. Lin, E, Bhusal, Y, Horwitz, D, Shelburne, SA 3rd, Trautner, BW. Overtreatment of enterococcal bacteriuria. Arch Intern Med 2012;172:33–38.CrossRefGoogle ScholarPubMed
21. Trautner, BW, Petersen, NJ, Hysong, SJ, Horwitz, D, Kelly, PA, Naik, AD. Overtreatment of asymptomatic bacteriuria: identifying provider barriers to evidence-based care. Am J Infect Control 2014;42:653–658.CrossRefGoogle ScholarPubMed
22. Shaughnessy, MK, Amundson, WH, Kuskowski, MA, DeCarolis, DD, Johnson, JR, Drekonja, DM. Unnecessary antimicrobial use in patients with current or recent Clostridium difficile infection. Infect Control Hosp Epidemiol 2013;34:109–116.CrossRefGoogle ScholarPubMed
23. Wang, Y, Eldridge, N, Metersky, ML, et al. National Trends in Patient Safety for Four Common Conditions, 2005–2011. N Engl J Med 2014;370:341–351.CrossRefGoogle ScholarPubMed
24. Dudeck, MA, Horan, TC, Peterson, KD, et al. National Healthcare Safety Network report, data summary for 2011, device-associated module. Am J Infect Control 2013;41:286–300.CrossRefGoogle ScholarPubMed
25. Leis, JA, Rebick, GW, Daneman, N, et al. Reducing antimicrobial therapy for asymptomatic bacteriuria among noncatheterized inpatients: a proof-of-concept study. Clin Infect Dis 2014;58:980–983.CrossRefGoogle ScholarPubMed
26. Al-Qas Hanna, F, Sambirska, O, Iyer, S, Szpunar, S, Fakih, MG. Clinician practice and the National Healthcare Safety Network definition for the diagnosis of catheter-associated urinary tract infection. Am J Infect Control 2013;41:1173–1177.CrossRefGoogle ScholarPubMed
27. Fortuna, JA, Brenneman, WA, Storli, S, Birnbaum, D, Brown, KL. The current state of validating the accuracy of clinical data reporting: lessons to be learned from quality and process improvement scientists. Infect Control Hosp Epidemiol 2013;34:611–614.CrossRefGoogle ScholarPubMed
28. Talbot, TR, Bratzler, DW, Carrico, RM, et al. Public reporting of health care-associated surveillance data: recommendations from the Healthcare Infection Control Practices Advisory Committee. Ann Intern Med 2013;159:631–635.CrossRefGoogle ScholarPubMed
29. Trautner, BW, Patterson, JE, Petersen, NJ, et al. Quality gaps in documenting urinary catheter use and infectious outcomes. Infect Control Hosp Epidemiol 2013;34:793–799.CrossRefGoogle ScholarPubMed
30. Dudeck, MA, Edwards, JR, Allen-Bridson, K, et al. National Healthcare Safety Network report, data summary for 2013, Device-Associated Module. Am J Infect Control 2015;43:206–221.CrossRefGoogle ScholarPubMed
31. Golob, JF Jr, Claridge, JA, Sando, MJ, et al. Fever and leukocytosis in critically ill trauma patients: it’s not the urine. Surg Infect (Larchmt) 2008;9:49–56.CrossRefGoogle Scholar
32. Hartley, S, Valley, S, Kuhn, L, et al. Inappropriate testing for urinary tract infection in hospitalized patients: an opportunity for improvement. Infect Control Hosp Epidemiol 2013;34:1204–1207.CrossRefGoogle ScholarPubMed
33. Fakih, MG, Heavens, M, Grotemeyer, J, Szpunar, SM, Groves, C, Hendrich, A. Avoiding potential harm by improving appropriateness of urinary catheter use in 18 emergency departments. Ann Emerg Med 2014;63:761–768.e761.CrossRefGoogle ScholarPubMed
34. Wright, M-O, Kharasch, M, Beaumont, JL, Peterson, LR, Robicsek, A. Reporting catheter-associated urinary tract infections: denominator matters. Infect Control Hosp Epidemiol 2011;32:635–640.CrossRefGoogle ScholarPubMed
35. Fakih, MG, Greene, MT, Kennedy, EH, et al. Introducing a population-based outcome measure to evaluate the effect of interventions to reduce catheter-associated urinary tract infection. Am J Infect Control 2012;40:359–364.CrossRefGoogle ScholarPubMed
36. Meddings, J, Rogers, MA, Krein, SL, Fakih, MG, Olmsted, RN, Saint, S. Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review. BMJ Qual Saf 2014;23:277–289.CrossRefGoogle ScholarPubMed
37. Woeltje, KF, Lin, MY, Klompas, M, Wright, MO, Zuccotti, G, Trick, WE. Data requirements for electronic surveillance of healthcare-associated infections. Infect Control Hosp Epidemiol 2014;35:1083–1091.CrossRefGoogle ScholarPubMed
38. Garibaldi, RA, Mooney, BR, Epstein, BJ, Britt, MR. An evaluation of daily bacteriologic monitoring to identify preventable episodes of catheter-associated urinary tract infection. Infect Control 1982;3:466–470.CrossRefGoogle ScholarPubMed
39. Miller, BL, Krein, SL, Fowler, KE, et al. A multimodal intervention to reduce urinary catheter use and associated infection at a Veterans Affairs Medical Center. Infect Control Hosp Epidemiol 2013;34:631–633.CrossRefGoogle Scholar
40. Fridkin, SK, Olmsted, RN. Meaningful measure of performance: a foundation built on valid, reproducible findings from surveillance of health care-associated infections. Am J Infect Control 2011;39:87–90.CrossRefGoogle ScholarPubMed