Monday, June 06, 2016

We need to cut down catheter use in hospitals

My late mother used to suffer from urinary tract infections--to the point of being hospitalized. There, they immediately gave her a catheter to collect her urine--we suspected because it made it easier than taking her to the toilet over and over.

Of course, catheters can also CAUSE infections--which a person with an infection does not need.

Now, though, there is a large national effort to show it's possible to reduce catheter use and UTIs at the same time.

More than 600 hospitals are working on this (NEJM).

The program, in more than 10% of US hospitals, shows the system can be changed. Overuse of catheters is partly medical and partly cultural--in the latter case, because "we have always done it."

The program is dubbed (weirdly) ON THE CUSP: Stop CAUTI (don't ask, I don't have room to type why).

It's a bundle of protocols, checklists, training modules, and data sharing practices to encourage:

--Daily checks on patients with a catheter to see if they need it

--Less idwelling catheter use and more use of other means

--Training on urinary management

--Regular use of infection-prevention techniques for those who need a catheter

--Feedback on how it's working

--Coaching calls from regional leaders on how the program is going

Results of the first four cohorts (60% in non-ICU medical and surgical wards):

--A 14% drop in use of catheters

--Infection rate dropped 32%

--ICUs did not see a big effect because patients there are monitored more closely for everything, incl UTIs

Any hospital can now access the toolkit via the Agency for Healthcare Research and Quality (AHRQ. gov).

This could be a boon to older sick people and surgical patients. Yay! Often, we found with Mom, the catheter was put in wrong anyway and the patients felt like they had to "go" the whole time--even though the urine was being collected. Very uncomfortable--even without an infection.

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