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CAUTI prevention requires improved practices and policies
Leslie Knudson
Managing Editor
To improve national health care-associated infection (HAI) rates, targeted infection prevention eorts have focused on evidence-
based strategies to help control and prevent specic HAIs, including catheter-associated urinary tract infections (CAUTI), central line-associated bloodstream infections, methicillin-resistant Staphylococcus aureus, and Clostridium difficile. National and state HAI reports show varied progress in each of these infection areas, with the exception of CAUTI.1 An estimated 54,500 CAUTIs occurred in U.S. acute care hospitals in 2012, representing a 3 percent increase from 2009.1
One of the most common HAIs, CAUTI is considered to be a reasonably preventable complication of hospitalization.2 The widespread use of catheters is largely to blame for CAUTI prevalenceone in 333 indwelling urinary catheters will cause infection and an estimated 1.5 infections occur per 1,000 catheter days in medical/ surgical wards.3 In addition, a large portion of patients have a urinary catheter placed without an appropriate clinical indication.2 National infection prevention eorts are aimed at reducing CAUTI by 25 percent by 2020 (based on 2015 data), with a focus on specic opportunities for improvement: reduction of catheter use, implementationof catheter insertion best practices, catheter maintenance, and appropriate diagnostic testing.4
CAUTI prevention strategies
The CDC Guideline for prevention of catheter-associated urinary tract infections emphasizes
using urinary catheters only as necessary, rather than routinely.5 The guideline provides key recommendations related to appropriate catheter use, proper techniques for urinary catheter insertion, proper techniques for catheter maintenance, quality improvement programs, administrative infrastructure, and surveillance.5
Recent evidence shows that hospitals are still in various stages of implementing the guideline, which was released in 2009. A report that analyzed data from 1,653 ICUs found that the presence of CAUTI prevention policies ranged from 27 to 68 percent and adherence to the policies ranged from 6 to 27 percent.6 The study highlights the need for implementation of and adherence to evidence-based practices related to CAUTI prevention.
Assessing catheter need
Although up to 23 percent of admitted emergency department...