title: Risk factors for catheter-associated urinary tract infections in critically ill patients with subarachnoid hemorrhage.
abstract: BACKGROUND
  Catheter-associated urinary tract infections (CAUTIs) are preventable adverse outcomes that cause increased morbidity, mortality, and financial burdens to hospitals. These are particularly prevalent in intensive care units (ICUs). Patients with subarachnoid hemorrhage (SAH) in neurological ICUs have extended lengths of stay and may be at higher risk for CAUTIs.
  
  
  OBJECTIVE
  The purpose of this study was to assess the prevalence of and risk factors for CAUTIs among patients with SAH in the neurological ICU of a large urban teaching hospital in the eastern United States.
  
  
  METHODS
  This is a retrospective analysis using the Columbia University SAH Outcomes Project data set collected between 2005 and 2012. Logistic regression is used to identify predictors of CAUTI.
  
  
  RESULTS
  Catheterized adult patients (n = 242) with SAH over the 8-year period were included. The rate of CAUTIs was 20.7 per 1,000 catheter days, six times higher than the reported national average. Variables significantly associated with CAUTI were older age (odds ratio [OR] = 1.06, 95% confidence interval [CI] [1.01, 1.11]), blood sugar > 200 mg/dl (OR = 13.0, 95% CI [1.28, 107.4]), and anemia requiring transfusion (OR = 3.78, 95% CI [0.977, 14.67]).
  
  
  CONCLUSIONS
  Higher CAUTI rates in this study were likely associated with prolonged catheterization. On the basis of these findings, careful assessment of the need for catheterization and increased vigilance regarding urinary catheter care in patients with SAH is indicated, particularly among those who are older, with anemia requiring transfusion and elevated blood glucose levels.
authors.affiliation: Thomas Hagerty, RN MSN MSc CCRN, is a Registered Nurse at New York Presbyterian Hospital, New York, NY. Louise Kertesz, RN MSN ANP-BC CNOR, is a Clinical Nurse Educator at New York Presbyterian Hospital, New York, NY. J. Michael Schmidt, PhD, is an Assistant Professor of Clinical Neuropsychology in Neurology at Columbia University College of Physicians and Surgeons, New York, NY. Sachin Agarwal, MD MPH, is an Assistant Professor of Neurology at Columbia University College of Physicians and Surgeons, New York, NY. Jan Claassen, MD PhD, is an Assistant Professor of Neurology at Columbia University College of Physicians and Surgeons, New York, NY. Stephan A. Mayer, MD, is Director of the Institute for Critical Care Medicine at the Icahn School of Medicine at Mount Sinai Hospital, New York, NY. Questions or comments about this article may be directed to Elaine L. Larson, PhD RN, at ell23@columbia.edu. She is an Associate Dean for Nursing Research at Columbia University School of Nursing, New York, NY. Jingjing Shang, PhD RN OCN, is an Assistant Professor of Nursing at Columbia University School of Nursing, New York, NY.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hagerty
authors.forename: Louise
authors.initials: L
authors.lastname: Kertesz
authors.forename: J Michael
authors.initials: JM
authors.lastname: Schmidt
authors.forename: Sachin
authors.initials: S
authors.lastname: Agarwal
authors.forename: Jan
authors.initials: J
authors.lastname: Claassen
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Mayer
authors.forename: Elaine L
authors.initials: EL
authors.lastname: Larson
authors.forename: Jingjing
authors.initials: J
authors.lastname: Shang
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000451:nursing*; D015400:Clinical Nursing Research; D015331:Cohort Studies; D064648:Critical Care Nursing; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York; D012189:Retrospective Studies; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology / Q000451:nursing*; D014546:Urinary Catheterization / Q000451:nursing*; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000451:nursing*