Preventing catheter-associated urinary tract infection in the United States: a national comparative study

JAMA Intern Med. 2013 May 27;173(10):874-9. doi: 10.1001/jamainternmed.2013.101.


Importance: Despite the national goal to reduce catheter-associated urinary tract infection (CAUTI) by 25% by 2013, limited data exist describing prevention practices for CAUTI in US hospitals and none associate national practice use to CAUTI-specific standardized infection ratios (SIRs).

Objectives: To identify practices currently used to prevent CAUTI and to compare use and SIRs for a national sample of US hospitals with hospitals in the state of Michigan, which launched a CAUTI prevention initiative in 2007 ("Keystone Bladder Bundle Initiative").

Design and setting: In 2009, we surveyed infection preventionists at a sample of US hospitals and all Michigan hospitals. CAUTI rate differences between Michigan and non-Michigan hospitals were assessed using SIRs.

Participants: A total of 470 infection preventionists.

Main outcome measures: Reported regular use of CAUTI prevention practices and CAUTI-specific SIR data.

Results: Michigan hospitals, compared with hospitals in the rest of the United States, more frequently participated in collaboratives to reduce health care-associated infection (94% vs 67%, P < .001) and used bladder scanners (53% vs 39%, P = .04), as well as catheter reminders or stop orders and/or nurse-initiated discontinuation (44% vs 23%, P < .001). More frequent use of preventive practices coincided with a 25% reduction in CAUTI rates in the state of Michigan, a significantly greater reduction than the 6% overall decrease observed in the rest of the United States.

Conclusions and relevance: We observed more frequent use of key prevention practices and a lower rate of CAUTI in Michigan hospitals relative to non-Michigan hospitals. This may be related to Michigan's significantly higher use of practices aimed at timely removal of urinary catheters, the key focus area of Michigan's Keystone Bladder Bundle Initiative.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Catheter-Related Infections / epidemiology
  • Catheter-Related Infections / prevention & control*
  • Catheters, Indwelling / adverse effects
  • Confounding Factors, Epidemiologic
  • Cross Infection / epidemiology
  • Cross Infection / prevention & control*
  • Health Care Surveys
  • Hospitals / statistics & numerical data*
  • Humans
  • Incidence
  • Infection Control* / methods
  • Infection Control* / organization & administration
  • Infection Control* / trends
  • Michigan / epidemiology
  • Multivariate Analysis
  • Odds Ratio
  • Surveys and Questionnaires
  • United States / epidemiology
  • Urinary Catheters / adverse effects*
  • Urinary Tract Infections / etiology
  • Urinary Tract Infections / prevention & control*