title: Introducing a population-based outcome measure to evaluate the effect of interventions to reduce catheter-associated urinary tract infection.
abstract: BACKGROUND
  The catheter-associated urinary tract infection (CAUTI) measure recommended by the National Healthcare Safety Network (NHSN) accounts for the risk of infection in patients with an indwelling urinary catheter, but might not adequately reflect all efforts aimed to enhance patient safety by reducing urinary catheter use.
  
  
  METHODS
  We used computer-based Monte Carlo simulation to compare the NHSN-recommended CAUTI rate (CAUTIs per 1,000 catheter-days) with the proposed "population CAUTI rate" (CAUTIs per 10,000 patient-days). We simulated 100 interventions with a wide range of effects on catheter utilization and CAUTI risk in patients with catheters, and then compared the 2 measures before and after intervention across the simulated interventions.
  
  
  RESULTS
  Out of our 100 simulated interventions, 93 yielded reductions in CAUTI; however, in 25 (27%) of these 93 simulations, the NHSN CAUTI rate increased after the intervention. In addition, among the 68 simulations in which both the NHSN and the population CAUTI rates decreased, the percent decreases in the population CAUTI rate were consistently greater than those in the NHSN rate.
  
  
  CONCLUSIONS
  The population CAUTI rate-CAUTIs per 10,000 patient-days-should be calculated along with the NHSN rate, particularly in settings where interventions lead to substantial reductions in catheter placement. We suspect that this population CAUTI rate may eventually emerge as a primary outcome for hospital-based quality improvement interventions for reducing urinary catheter utilization, especially those focusing on avoiding urinary catheter placement.
authors.affiliation: St John Hospital and Medical Center, Detroit, MI, USA. mohamad.fakih@stjohn.org
authors.forename: Mohamad G
authors.initials: MG
authors.lastname: Fakih
authors.forename: M Todd
authors.initials: MT
authors.lastname: Greene
authors.forename: Edward H
authors.initials: EH
authors.lastname: Kennedy
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Meddings
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Krein
authors.forename: Russell N
authors.initials: RN
authors.lastname: Olmsted
authors.forename: Sanjay
authors.initials: S
authors.lastname: Saint
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000517:prevention & control*