title: Regional variation in urinary catheter use and catheter-associated urinary tract infection: results from a national collaborative.
abstract: OBJECTIVE
  To examine regional variation in the use and appropriateness of indwelling urinary catheters and catheter-associated urinary tract infection (CAUTI).
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  US acute care hospitals.
  
  
  METHODS
  Hospitals were divided into 4 regions according to the US Census Bureau. Baseline data on urinary catheter use, catheter appropriateness, and CAUTI were collected from participating units. The catheter utilization ratio was calculated by dividing the number of catheter-days by the number of patient-days. We used the National Healthcare Safety Network (NHSN) definition (number of CAUTIs per 1,000 catheter-days) and a population-based definition (number of CAUTIs per 10,000 patient-days) to calculate CAUTI rates. Logistic and Poisson regression models were used to assess regional differences.
  
  
  RESULTS
  Data on 434,207 catheter-days over 1,400,770 patient-days were collected from 1,101 units within 726 hospitals across 34 states. Overall catheter utilization was 31%. Catheter utilization was significantly higher in non-intensive care units (ICUs) in the West compared with non-ICUs in all other regions. Approximately 30%-40% of catheters in non-ICUs were placed without an appropriate indication. Catheter appropriateness was the lowest in the West. A total of 1,099 CAUTIs were observed (NHSN rate of 2.5 per 1,000 catheter-days and a population-based rate of 7.8 per 10,000 patient-days). The population-based CAUTI rate was highest in the West (8.9 CAUTIs per 10,000 patient-days) and was significantly higher compared with the Midwest, even after adjusting for hospital characteristics (P = .02).
  
  
  CONCLUSIONS
  Regional differences in catheter use, appropriateness, and CAUTI rates were detected across US hospitals.
authors.affiliation: Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: M Todd
authors.initials: MT
authors.lastname: Greene
authors.forename: Mohamad G
authors.initials: MG
authors.lastname: Fakih
authors.forename: Karen E
authors.initials: KE
authors.lastname: Fowler
authors.forename: Jennifer
authors.initials: J
authors.lastname: Meddings
authors.forename: David
authors.initials: D
authors.lastname: Ratz
authors.forename: Nasia
authors.initials: N
authors.lastname: Safdar
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*; D003428:Cross Infection / Q000453:epidemiology; D003430:Cross-Sectional Studies; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D014481:United States / Q000453:epidemiology; D019564:Unnecessary Procedures / Q000009:adverse effects / Q000706:statistics & numerical data; D014546:Urinary Catheterization / Q000009:adverse effects / Q000706:statistics & numerical data*