Study: ICUs less successful at cutting CAUTI rates than non-intensive units

Despite the efforts of CMS and the Department of Health and Human Services, the rate of catheter-associated urinary tract infections (CAUTI) is on the rise. Between 2009 and 2013, infections linked to catheters increased by 6%, which has spurred The Joint Commission to create a new National Patient Safety Goal on CAUTI reduction.

Over the course of 18 months, 603 hospitals nationwide took part in a study done by the Comprehensive Unit-based Safety Program (CUSP) aimed at reducing CAUTIs. Participating facilities had to assemble CAUTI prevention teams, who would follow CUSP recommendations on catheter-use. The teams were also tasked with reducing catheter use in all units. Overall the program was a success, slashing CAUTI rates by 14% and reducing catheter usage by 1.6% in non-intensive units such as general medicine and 3.5% in ICUs.

However, there was a drastic difference as to where the changes were most effective. By themselves non-intensive care units saw a 32% reduction in CAUTIs. Meanwhile, the program had almost no effect on ICUs, with a less than 1% improvement in infection rates.

“Most ICU patients, approximately 60%, will have a urinary catheter placed. This is compared to 10%-15% of general medicine and surgical patients on average,” lead author Sanjay Saint, MD said to Modern Healthcare. “The culture in most ICUs is that if the patient is sick enough for an ICU bed, they are sick enough for a catheter.”  

 This fits into a larger trend, researchers wrote in their conclusion, noting that CAUTI rates in non-ICUs decreased by 14% between 2009 and 2012, but that the rates in ICUs increased by 9%.

 “The reason ICUs have been less successful than non-ICUs in preventing [CAUTI] is unclear,” researchers wrote. “One possible explanation is the belief that patients who are ill enough to warrant admission to the ICU require close monitoring of urine output, which is an appropriate criterion for indwelling urinary catheters. The higher [CAUTI rate] in ICUs could also be related to the frequent occurrence of fever in critically ill patients, coupled with routine culturing of various body fluids, including urine, to identify possible sources of infection.”