There are estimated to be over 500,000 hospital-acquired urinary tract infections in the United States each year. As 80% are associated with indwelling urinary catheters, evidence-based use of catheters is paramount. Despite this well known association, surveillance of catheter-associated urinary tract infections (CAUTIs) is limited, and documentation of catheters is poor. However, new regulatory initiatives have provided incentives to address CAUTIs and rationalize urinary catheter use. This project will refine at one hospital and implement at multiple member hospitals of a national geriatric nursing program (NICHE or Nurses Improving the Care of Hospitalized Elders) a methodology for healthcare information technology (HIT)-enhanced surveillance of urinary catheter duration and CAUTIs. We will use the methodology to conduct a multi-site, cluster randomized trial of the impact of audit and feedback of catheter duration on both catheter duration and CAUTI rates. We hypothesize 1) that the HIT-enhanced methodology will perform favorably compared with manual surveillance, 2) that collection of patient-level urinary catheter duration is both feasible and can be automated at diverse hospitals, and 3) that the audit and feedback of catheter use and CAUTI's using this methodology will reduce catheter duration by 15% and CAUTIs by 10% in participating hospitals. After refinement and validation of the surveillance methodology at the University of Colorado Hospital, 16 member-hospitals of NICHE will participate in its dissemination. Each institution will implement urinary catheter duration and CAUTI surveillance on selected medical/surgical units. Electronic medical records will be utilized to automate surveillance using the methodology defined above whenever possible. Each hospital will be assigned to either a continued or delayed intervention group as part of a cluster randomized trial of audit and feedback of catheter duration on catheter duration and CAUTI rates. The proposed project addresses an important root cause of the CAUTI, a high burden healthcare-associated infection. The PI is a geriatrician and hospitalist who has studied catheter use extensively and has piloted the automated surveillance of catheter duration. The co-investigators are a health services researcher who has led several national multi-site studies and explored the deployment of HIT;and the director of NICHE, a nursing educator and investigator expert in inpatient geriatric care. This study extends surveillance from the ICU to medical/surgical units. It tracks device use using a novel methodology that will be automated where possible. Finally, it creates a framework to study other evidence-based interventions to reduce CAUTIs.

Public Health Relevance

Reducing Catheter-Associated Urinary Tract Infections in NICHE Hospitals The patient safety movement has resulted in unprecedented scrutiny of preventable adverse events in hospitals. One example is Medicare's recent policy of non-payment for hospital-acquired harms. Also known as hazards of hospitalization, these events were once largely ignored outside of the geriatrics community. The broad goal of this proposal is to create a framework for the study of evidence-based interventions for the hazards of hospitalization for older adults at hospitals participating in a geriatric nursing program. We will use the catheter-associated urinary tract infection as a prototype and disseminate a strategy to collect data regarding urinary catheter use.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Demonstration and Dissemination Projects (R18)
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Health Care Technology and Decision Science (HTDS)
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Gray, Darryl T
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University of Colorado Denver
Internal Medicine/Medicine
Schools of Medicine
United States
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