November 2009 – the Centers for Disease Control and Prevention (CDC) has released new guidelines on the prevention and control of catheter-associated urinary tract infections (CAUTI). These guidelines are particularly timely in that a new Surgical Care Improvement Project (SCIP) measure regarding urinary catheter removal goes into effect for patients being discharged from the hospital starting January 1, 2010. For more information on SCIP, visit www.qualitynet.org.
The new CDC document updates and expands the CDC’s original guideline published in 1981. Developed by the Healthcare Infection Control Practices Advisory Committee, the 67-page document has been updated to include new research and technological advancements for preventing CAUTI in part because of an increased need to address patients in nonacute care settings and patients requiring long-term urinary catheterization. The new guidelines also put more emphasis on prevention initiatives and offer better-defined goals and metrics for outcomes and process measures.
The revised guideline addresses the prevention of CAUTI for patients in need of either short-term or long-term (i.e., > 30 days) urinary catheterization in any type of healthcare facility and evaluates evidence for alternative methods of urinary drainage, including intermittent catheterization, external catheters, and suprapubic catheters. The guideline also includes specific recommendations for implementation, performance measurement, and surveillance. Recommendations for further research are also provided to address the knowledge gaps in CAUTI prevention identified during the literature review.
Urinary tract infections (UTI) are the most common type of healthcare-associated infection, accounting for more than 30% of infections reported by acute care hospitals. Virtually all healthcare-associated UTIs are caused by instrumentation of the urinary tract. CAUTI has been associated with increased morbidity, mortality, hospital cost, and length of stay. In addition, bacteriuria commonly leads to unnecessary antimicrobial use, and urinary drainage systems are often reservoirs for multidrug-resistant bacteria and a source of transmission to other patients.
The prevalence of urinary catheter use in residents in long-term care facilities in the United States is on the order of 5%, representing approximately 50,000 residents with catheters at any given time. This number appears to be declining over time, likely because of federally mandated nursing home quality measures. However, the high prevalence of urinary catheters in patients transferred to skilled nursing facilities suggests that acute care hospitals should focus more efforts on removing unnecessary catheters prior to transfer.