Study finds catheter infections stoppable
January 3, 2008
BY PATRICIA ANSTETT
FREE PRESS MEDICAL WRITER
Urinary catheter infections account for 40% of all hospital infections, but U.S. hospitals do not have strategies in place to minimize them, according to a University of Michigan study to be released today.
Catheters are used on one in four patients, often after surgery, but as many as one third of the days in which patients have the devices are medically unnecessary, the study said. Infections from the devices, the most common type of infections acquired in hospitals, can be difficult to treat and can be life-threatening.
The issue takes on additional significance because in July Medicare stopped paying for care of urinary tract infections acquired while hospitalized. The average Medicare payment for a catheter-associated urinary tract infection was $40,347 in fiscal 2006.
Dr. Sanjay Saint, lead author and director of the patient safety enhancement program, advises hospitalized patients who have a catheter to ask their doctor every day: "Do I still need it?"
The study provides the first national examination of hospital prevention strategies at 119 Veterans Affairs and 600 nonfederal hospitals, conducted in 2005. It was published in the January issue of the journal Clinical Infectious Diseases, representing work by patient safety specialists at both U-M and the VA Ann Arbor Healthcare System.
One third of hospitals in the study did not track catheter use in their patients. Three-fourths had no system to know how long patients had one. Less than 10% used physician reminders, a proven strategy, to check catheter use daily, the study found............
Knowledge and attitudes of nursing home staff and surveyors about the revised federal guidance for incontinence care.
Section of Geriatrics, University of Chicago, Chicago, IL 60637, USA. cdubeau@medicine.bsd.uchicago.edu
PURPOSE: We assessed nursing home staff and state nursing home surveyors regarding their knowledge and attitudes about urinary incontinence, its management, and the revised federal Tag F315 guidance for urinary incontinence. DESIGN AND METHODS: We conducted a questionnaire survey of a convenience sample of nursing home staff and state nursing home surveyors from a midwestern state attending two statewide workshops on the revised guidance.
RESULTS: Of 558 attendees, 500 (85%) responded, including 39% of the state's directors of nursing and 57% of state nursing home surveyors. There were striking deficiencies in knowledge regarding urinary incontinence and catheter care, with significant discrepancies by type of respondent, particularly between state surveyors and nursing home staff. Staff cited documentation and staffing levels as the most frequent concerns about implementation. Open-ended responses reflected the divergence of concerns and antagonism among the stakeholders, and staff nurses' feeling that F315 violated residents' rights.
IMPLICATIONS: The revised Tag F315 guidance will be unlikely to improve the quality of urinary incontinence care in nursing homes because of significant knowledge and attitudinal discrepancies between nursing home staff and state surveyors, facility staff's focus on documentation and staffing, and reliance on implementation strategies known to be ineffective. Federal, state, and other urinary incontinence guideline efforts should focus on managerial structures and methods to improve quality nursing home care. Research is needed to address how nursing home residents and families define and value "quality" urinary incontinence management and to incorporate these in quality-improvement strategies and measures.
PMID: 17766668 [PubMed - indexed for MEDLINE]