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ORIGINAL ARTICLE

A Program to Prevent Catheter-Associated Urinary Tract Infection in Acute Care

Sanjay Saint, M.D., M.P.H.1,2,3, M. Todd Greene, Ph.D., M.P.H.2,3 , Sarah L. Krein, Ph.D., R.N.1,2,3, Mary A.M. Rogers, Ph.D.2,3, David Ratz, M.S.1,3, Karen E. Fowler, M.P.H.1,3, Barbara S. Edson, R.N., M.B.A., M.H.A.4, Sam R. Watson, M.S.A., C.P.P.S.5, Barbara Meyer Lucas, M.D., M.H.S.A.5, Marie Masuga, R.N., M.S.N.5, Kelly Faulkner, M.S.P.A.4, Carolyn V. Gould, M.D., M.S.C.R.6, James Battles, Ph.D.7, Mohamad G. Fakih, M.D., M.P.H. M.D., Alan Decherney, M.D., and Jeffrey P. Kahn, Ph.D., M.P.H.


N Engl J Med 2016; 374:22 | June 2, 2016 | DOI: 10.1056/NEJMoa1504906

BACKGROUND
Catheter-associated urinary tract infection (CAUTI) is a common device-associated infection in hospitals. Both technical aspects – appropriate catheter use, aseptic insertion, proper maintenance – and socio-adaptive components, such as unit culture and behavior change, are important in preventing CAUTI.

METHODS
The National Implementation of Comprehensive Unit-based Program to reduce CAUTI, funded by the Agency for Healthcare Research and Quality, aimed to reduce CAUTI in intensive care units (ICUs) and non-ICUs. The main features were: 1) information dissemination to sponsor organizations and hospitals; 2) data collection; and 3) guidance on key CAUTI prevention practices and socio-adaptive aspects. Catheter utilization and CAUTI rate data were collected during three phases: baseline (3 months), implementation (2 months) and sustainability (12 months). Multilevel negative binomial models were used to assess changes in CAUTI rates and catheter utilization. 

RESULTS
Data were obtained from 926 units (59.7% non-ICUs, 40.3% ICUs) from 603 hospitals in 30 states that participated in the first four cohorts. The unadjusted CAUTI rate decreased overall from 2.82 to 2.19 per 1,000 urinary catheter-days. In adjusted analysis, CAUTI rates decreased from 2.40 to 2.05 (IRR: 0.86 (0.76-0.96), P=0.009). Among non-ICUs, CAUTI rates decreased from 2.28 to 1.54 (IRR: 0.68 (0.56-0.82), P<0.001) and catheter utilization decreased from 20.1% to 18.8% (IRR: 0.93 (0.90-0.96), P<0.001). CAUTI rates and catheter utilization were largely unchanged in ICUs. Tests for heterogeneity (ICU versus non-ICU) were significant for CAUTI rates (p=0.001) and catheter utilization (p=0.004). 

CONCLUSIONS
A national CAUTI prevention program appears to reduce CAUTI rates and catheter use in non-ICUs.

 Originally Appeared in The New England Journal of Medicine on June 2, 2016.

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