Hospitals with 500 or more beds had a 1.5-times higher average rate of catheter-associated urinary tract infections than hospitals with fewer beds, according to a study by nurse researchers.
The finding was not unanticipated since larger hospitals, particularly teaching hospitals, treat patients who often are sicker. More puzzling, the researchers said, was the finding that ICUs in larger hospitals also were less likely to have implemented a CAUTI prevention policy.
“What we find so baffling is that the very hospitals that have the highest rates of CAUTI are not following the CAUTI preventive guidelines in their intensive care units,” Laurie J. Conway, RN, MS, CIC, the studys lead author and a pre-doctoral trainee at the Columbia University School of Nursing, said in a news release.
Over the past 30 years, panels of experts in infection control and hospital epidemiology have unanimously recommended taking precautions to minimize unnecessary urinary catheter use. Among the recommendations are substituting condom catheters for indwelling catheters, using bladder ultrasound scanners to identify or rule out urinary retention, and using automated reminders, stop orders or nurse-driven protocols to ensure catheters are discontinued as soon as they are no longer needed.
Of 415 ICUs in 250 hospitals surveyed, 26% had policies supporting bladder ultrasound, 20% had policies supporting condom catheters, 12% had policies supporting catheter removal reminders and 10% had policies supporting nurse-initiated catheter discontinuation.
ICUs in hospitals with 500 or more beds were half as likely as those in smaller hospitals to have adopted at least one CAUTI prevention policy. ICUs in hospitals where the infection control director reported always having access to key decision makers for planning were more than twice as likely as those with less access to have adopted a policy.
The researchers concluded that recent federal regulations requiring public reporting of CAUTI rates may serve to refocus attention on CAUTI prevention in ICUs in the United States.
The study appears in the October issue of the American Journal of Infection Control. The study abstract is available at www.ajicjournal.org/article/S0196-6553%2811%2901256-9/abstract.