National Initiative to Reduce Catheter-Associated Urinary Tract Infection Leads to 32 Percent Improvement in non-ICU setting

ST. LOUIS, June 3, 2016 /PRNewswire/ -- The results of a national initiative to reduce catheter-associated urinary tract infections (CAUTI) in the hospital setting were just published in the New England Journal of Medicine. The study was funded by the Agency for Healthcare Research and Quality (AHRQ) and coordinated by the Health Research and Educational Trust (HRET), with the support of faculty from the University of Michigan, St. John Hospital and Medical Center, the MHA Keystone Center, and Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality. It aimed at reducing CAUTI in intensive care units (ICUs) and non-ICUs. St. John Hospital and Medical Center, part of Ascension Michigan, participated in the national project called On the CUSP: Stop CAUTI.

St. John Hospital and Medical Center faculty, Mohamad Fakih, MD, MPH, and Karen Jones, RN, MPH, served on the national project team providing project implementation advice, expertise in infection prevention, leadership in content development, and educational support over the project's span of 4 years.

Dr. Fakih, Senior Medical Director, Ascension Center of Excellence for Antimicrobial Stewardship and Infection Prevention, co-authored findings of the first 4 (of 9) cohorts that participated in the initiative, which encompassed 926 units in 603 hospitals across 32 states, the District of Columbia, and Puerto Rico. "We are proud to see some of the work that was piloted at St. John Hospital and Medical Center replicated and adopted in many other hospitals, leading to less patient harm," Dr. Fakih said. In 2006, St. John Hospital and Medical Center, supported by an Ascension grant, piloted a nurse-led multidisciplinary approach to evaluate the urinary catheter need, and was associated with a reduction of unnecessary use.

CAUTIs are common healthcare-associated infections. Preventing CAUTI and unnecessary urinary catheter use not only spares patients the infection, but also reduces the risk of more serious complications such as bloodstream infection. It also decreases the need for antibiotics, often misused for treating asymptomatic bacteriuria. The judicious use of antibiotics reduces the chance that bacteria will develop resistance to these life-saving medications. By the end of the first four cohorts, researchers found no significant reduction in use of catheters or rate of CAUTI in the ICU setting, whereas CAUTI rates decreased by 32 percent and catheter use by 7 percent in non-ICUs.

Based upon previous research, leaders of The National Project Team developed a combination of protocols, checklists, training modules and data sharing practices to address catheterization use. Researchers found that a collaborative approach effort focused on both technical and socioadaptive interventions (behavior and culture change) can reduce catheter-associated UTI rates in the non-ICU setting. The study also allowed researchers to scale interventions intended for a single hospital to a broader group.

"Patient safety has always been a primary objective for St. John Hospital and Medical Center. Participation in this study exemplifies our commitment to Ascension's Quadruple Aim of improving patient outcomes, provider and patient experience all at the lower overall cost of care," said Kevin Grady, MD, Chief Medical Officer and Director of Pulmonary-Critical Care Services at St. John Hospital and Medical Center. "We are honored to play a part in this national study, which has led to a significant reduction in CAUTIs."

St. John Hospital and Medical Center's participation with the On the CUSP: Stop CAUTI initiative parallels Ascension's system-wide efforts to reduce the utilization of catheters and rate of CAUTI.  A study published in 2014 in the Annals of Emergency Medicine highlights the collaborative work of 18 Ascension emergency departments to reduce unnecessary urinary catheter use. The Ascension Health study was led by Dr. Fakih and initiated under the Partnership for Patients program, an initiative of the Centers for Medicare and Medicaid Services (CMS). Through standardizing the process, the program resulted in a 30 percent reduction in use of newly placed catheters, which was sustained during a six-month period.

"Ascension continues to demonstrate its longstanding commitment to patient safety through efforts such as our ongoing participation with Partnership for Patients and AHRQ," said Ann Hendrich RN, PhD, FAAN, Senior Vice President, Chief Quality/Safety and Nursing Officer for Ascension Health. "Our hospitals are leading the transformation of healthcare through implementing strategies that protect patients from avoidable harm and improve outcomes."

About Ascension
Ascension (www.ascension.org) is a faith-based healthcare organization dedicated to transformation through innovation across the continuum of care. As the largest non-profit health system in the U.S. and the world's largest Catholic health system, Ascension is committed to delivering compassionate, personalized care to all, with special attention to persons living in poverty and those most vulnerable. In FY2015, Ascension provided nearly $2 billion in care of persons living in poverty and other community benefit programs. Approximately 160,000 associates and 36,000 aligned providers serve in 2,500 sites of care – including 142 hospitals and more than 30 senior living facilities – in 24 states and the District of Columbia. In addition to healthcare delivery, Ascension subsidiaries provide a variety of services and solutions including physician practice management, venture capital investing, investment management, biomedical engineering, clinical care management, information services, risk management, and contracting through Ascension's own group purchasing organization.

About St. John Hospital and Medical Center
St. John Hospital & Medical Center is a regional destination hospital for leading-edge medical care and technology. It is a member of St. John Providence, the largest provider of inpatient care in southeast Michigan. SJP is also a ministry of Ascension, (www.ascension.org) a faith-based healthcare organization dedicated to transformation through innovation across the continuum of care. As the largest non-profit health system in the U.S. and the world's largest Catholic health system, Ascension is committed to delivering compassionate, personalized care to all, with special attention to persons living in poverty and those most vulnerable. In FY2015, Ascension provided nearly $2 billion in care of persons living in poverty and other community benefit programs. Approximately 160,000 associates and 36,000 aligned providers serve in 2,000 sites of care – including 137 hospitals and more than 30 senior living facilities – in 24 states and the District of Columbia. In addition to healthcare delivery, Ascension subsidiaries provide a variety of services and solutions including physician practice management, venture capital investing, investment management, biomedical engineering, clinical care management, information services, risk management, and contracting through Ascension's own group purchasing organization.

About the Agency for Healthcare Research and Quality
AHRQ, part of the U.S. Department of Health and Human Services (HHS), works with other Federal agencies, researchers and providers on numerous projects that prevent and reduce HAIs. The efforts of AHRQ's HAI Program, including CUSP, align with HHS's National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination and the White House's National Action Plan for Combating Antibiotic-Resistant Bacteria. Many of AHRQ's resources, including its HAI toolkits, have been used by hospitals across the country to reduce hospital-acquired conditions and implement best practices, such as guidelines from the Centers for Disease Control and Prevention. AHRQ's activities are essential elements of HHS' commitment to make our health care system provide better care with smarter spending, leading to healthier patients.

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