title: Beyond Infection: Device Utilization Ratio as a Performance Measure for Urinary Catheter Harm.
abstract: Catheter-associated urinary tract infection (CAUTI) is considered a reasonably preventable event in the hospital setting, and it has been included in the US Department of Health and Human Services National Action Plan to Prevent Healthcare-Associated Infections. While multiple definitions for measuring CAUTI exist, each has important limitations, and understanding these limitations is important to both clinical practice and policy decisions. The National Healthcare Safety Network (NHSN) surveillance definition, the most frequently used outcome measure for CAUTI prevention efforts, has limited clinical correlation and does not necessarily reflect noninfectious harms related to the catheter. We advocate use of the device utilization ratio (DUR) as an additional performance measure for potential urinary catheter harm. The DUR is patient-centered and objective and is currently captured as part of NHSN reporting. Furthermore, these data are readily obtainable from electronic medical records. The DUR also provides a more direct reflection of improvement efforts focused on reducing inappropriate urinary catheter use.
authors.affiliation: 1St. John Hospital and Medical Center,Detroit,Michigan.
authors.forename: Mohamad G
authors.initials: MG
authors.lastname: Fakih
authors.affiliation: 3Division of Healthcare Quality Promotion,Centers for Disease Control and Prevention,Atlanta,Georgia.
authors.forename: Carolyn V
authors.initials: CV
authors.lastname: Gould
authors.affiliation: 4Houston VA Center for Innovations in Quality,Effectiveness and Safety (IQuESt),Michael E. DeBakey Veterans Affairs Medical Center,Houston,Texas.
authors.forename: Barbara W
authors.initials: BW
authors.lastname: Trautner
authors.affiliation: 6Department of Internal Medicine,Division of General Medicine,University of Michigan Medical School,Ann Arbor,Michigan.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Meddings
authors.affiliation: 7Infection Prevention and Control,Unified Clinical Organization,Trinity Health,Livonia,Michigan.
authors.forename: Russell N
authors.initials: RN
authors.lastname: Olmsted
authors.affiliation: 8VA Ann Arbor Healthcare System,Ann Arbor,Michigan.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Krein
authors.affiliation: 8VA Ann Arbor Healthcare System,Ann Arbor,Michigan.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Saint
mesh_terms: D055499:Catheter-Related Infections / Q000517:prevention & control*; D003428:Cross Infection / Q000517:prevention & control*; D057286:Electronic Health Records; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000592:standards*; D017063:Outcome Assessment, Health Care; D014481:United States; D062885:Urinary Catheters / Q000009:adverse effects* / Q000706:statistics & numerical data*; D014552:Urinary Tract Infections / Q000517:prevention & control*