title: A Program to Prevent Catheter-Associated Urinary Tract Infection in Acute Care.
abstract: BACKGROUND
  Catheter-associated urinary tract infection (UTI) is a common device-associated infection in hospitals. Both technical factors--appropriate catheter use, aseptic insertion, and proper maintenance--and socioadaptive factors, such as cultural and behavioral changes in hospital units, are important in preventing catheter-associated UTI.
  
  
  METHODS
  The national Comprehensive Unit-based Safety Program, funded by the Agency for Healthcare Research and Quality, aimed to reduce catheter-associated UTI in intensive care units (ICUs) and non-ICUs. The main program features were dissemination of information to sponsor organizations and hospitals, data collection, and guidance on key technical and socioadaptive factors in the prevention of catheter-associated UTI. Data on catheter use and catheter-associated UTI rates were collected during three phases: baseline (3 months), implementation (2 months), and sustainability (12 months). Multilevel negative binomial models were used to assess changes in catheter use and catheter-associated UTI rates.
  
  
  RESULTS
  Data were obtained from 926 units (59.7% were non-ICUs, and 40.3% were ICUs) in 603 hospitals in 32 states, the District of Columbia, and Puerto Rico. The unadjusted catheter-associated UTI rate decreased overall from 2.82 to 2.19 infections per 1000 catheter-days. In an adjusted analysis, catheter-associated UTI rates decreased from 2.40 to 2.05 infections per 1000 catheter-days (incidence rate ratio, 0.86; 95% confidence interval [CI], 0.76 to 0.96; P=0.009). Among non-ICUs, catheter use decreased from 20.1% to 18.8% (incidence rate ratio, 0.93; 95% CI, 0.90 to 0.96; P<0.001) and catheter-associated UTI rates decreased from 2.28 to 1.54 infections per 1000 catheter-days (incidence rate ratio, 0.68; 95% CI, 0.56 to 0.82; P<0.001). Catheter use and catheter-associated UTI rates were largely unchanged in ICUs. Tests for heterogeneity (ICU vs. non-ICU) were significant for catheter use (P=0.004) and catheter-associated UTI rates (P=0.001).
  
  
  CONCLUSIONS
  A national prevention program appears to reduce catheter use and catheter-associated UTI rates in non-ICUs. (Funded by the Agency for Healthcare Research and Quality.).
authors.affiliation: From the Hospital Outcomes Program of Excellence, Veterans Affairs (VA) Ann Arbor Healthcare System (S.S., M.T.G., S.L.K., D.R., K.E.F.), the Department of Internal Medicine, University of Michigan (UM) Medical School (S.S., M.T.G., S.L.K., M.A.M.R.), and the VA/UM Patient Safety Enhancement Program (S.S., M.T.G., S.L.K., M.A.M.R., D.R., K.E.F.), Ann Arbor, the Michigan Health and Hospital Association, Okemos (S.R.W., B.M.-L., M.M.), and St. John Hospital and Medical Center, Detroit (M.G.F.) - all in Michigan; the Health Research and Educational Trust, Chicago (B.S.E., K.F.); the Centers for Disease Control and Prevention, Atlanta (C.V.G.); and the Agency for Healthcare Research and Quality, Rockville, MD ( J.B.).
authors.forename: Sanjay
authors.initials: S
authors.lastname: Saint
authors.affiliation: From the Hospital Outcomes Program of Excellence, Veterans Affairs (VA) Ann Arbor Healthcare System (S.S., M.T.G., S.L.K., D.R., K.E.F.), the Department of Internal Medicine, University of Michigan (UM) Medical School (S.S., M.T.G., S.L.K., M.A.M.R.), and the VA/UM Patient Safety Enhancement Program (S.S., M.T.G., S.L.K., M.A.M.R., D.R., K.E.F.), Ann Arbor, the Michigan Health and Hospital Association, Okemos (S.R.W., B.M.-L., M.M.), and St. John Hospital and Medical Center, Detroit (M.G.F.) - all in Michigan; the Health Research and Educational Trust, Chicago (B.S.E., K.F.); the Centers for Disease Control and Prevention, Atlanta (C.V.G.); and the Agency for Healthcare Research and Quality, Rockville, MD ( J.B.).
authors.forename: M Todd
authors.initials: MT
authors.lastname: Greene
authors.affiliation: From the Hospital Outcomes Program of Excellence, Veterans Affairs (VA) Ann Arbor Healthcare System (S.S., M.T.G., S.L.K., D.R., K.E.F.), the Department of Internal Medicine, University of Michigan (UM) Medical School (S.S., M.T.G., S.L.K., M.A.M.R.), and the VA/UM Patient Safety Enhancement Program (S.S., M.T.G., S.L.K., M.A.M.R., D.R., K.E.F.), Ann Arbor, the Michigan Health and Hospital Association, Okemos (S.R.W., B.M.-L., M.M.), and St. John Hospital and Medical Center, Detroit (M.G.F.) - all in Michigan; the Health Research and Educational Trust, Chicago (B.S.E., K.F.); the Centers for Disease Control and Prevention, Atlanta (C.V.G.); and the Agency for Healthcare Research and Quality, Rockville, MD ( J.B.).
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Krein
authors.affiliation: From the Hospital Outcomes Program of Excellence, Veterans Affairs (VA) Ann Arbor Healthcare System (S.S., M.T.G., S.L.K., D.R., K.E.F.), the Department of Internal Medicine, University of Michigan (UM) Medical School (S.S., M.T.G., S.L.K., M.A.M.R.), and the VA/UM Patient Safety Enhancement Program (S.S., M.T.G., S.L.K., M.A.M.R., D.R., K.E.F.), Ann Arbor, the Michigan Health and Hospital Association, Okemos (S.R.W., B.M.-L., M.M.), and St. John Hospital and Medical Center, Detroit (M.G.F.) - all in Michigan; the Health Research and Educational Trust, Chicago (B.S.E., K.F.); the Centers for Disease Control and Prevention, Atlanta (C.V.G.); and the Agency for Healthcare Research and Quality, Rockville, MD ( J.B.).
authors.forename: Mary A M
authors.initials: MA
authors.lastname: Rogers
authors.affiliation: From the Hospital Outcomes Program of Excellence, Veterans Affairs (VA) Ann Arbor Healthcare System (S.S., M.T.G., S.L.K., D.R., K.E.F.), the Department of Internal Medicine, University of Michigan (UM) Medical School (S.S., M.T.G., S.L.K., M.A.M.R.), and the VA/UM Patient Safety Enhancement Program (S.S., M.T.G., S.L.K., M.A.M.R., D.R., K.E.F.), Ann Arbor, the Michigan Health and Hospital Association, Okemos (S.R.W., B.M.-L., M.M.), and St. John Hospital and Medical Center, Detroit (M.G.F.) - all in Michigan; the Health Research and Educational Trust, Chicago (B.S.E., K.F.); the Centers for Disease Control and Prevention, Atlanta (C.V.G.); and the Agency for Healthcare Research and Quality, Rockville, MD ( J.B.).
authors.forename: David
authors.initials: D
authors.lastname: Ratz
authors.affiliation: From the Hospital Outcomes Program of Excellence, Veterans Affairs (VA) Ann Arbor Healthcare System (S.S., M.T.G., S.L.K., D.R., K.E.F.), the Department of Internal Medicine, University of Michigan (UM) Medical School (S.S., M.T.G., S.L.K., M.A.M.R.), and the VA/UM Patient Safety Enhancement Program (S.S., M.T.G., S.L.K., M.A.M.R., D.R., K.E.F.), Ann Arbor, the Michigan Health and Hospital Association, Okemos (S.R.W., B.M.-L., M.M.), and St. John Hospital and Medical Center, Detroit (M.G.F.) - all in Michigan; the Health Research and Educational Trust, Chicago (B.S.E., K.F.); the Centers for Disease Control and Prevention, Atlanta (C.V.G.); and the Agency for Healthcare Research and Quality, Rockville, MD ( J.B.).
authors.forename: Karen E
authors.initials: KE
authors.lastname: Fowler
authors.affiliation: From the Hospital Outcomes Program of Excellence, Veterans Affairs (VA) Ann Arbor Healthcare System (S.S., M.T.G., S.L.K., D.R., K.E.F.), the Department of Internal Medicine, University of Michigan (UM) Medical School (S.S., M.T.G., S.L.K., M.A.M.R.), and the VA/UM Patient Safety Enhancement Program (S.S., M.T.G., S.L.K., M.A.M.R., D.R., K.E.F.), Ann Arbor, the Michigan Health and Hospital Association, Okemos (S.R.W., B.M.-L., M.M.), and St. John Hospital and Medical Center, Detroit (M.G.F.) - all in Michigan; the Health Research and Educational Trust, Chicago (B.S.E., K.F.); the Centers for Disease Control and Prevention, Atlanta (C.V.G.); and the Agency for Healthcare Research and Quality, Rockville, MD ( J.B.).
authors.forename: Barbara S
authors.initials: BS
authors.lastname: Edson
authors.affiliation: From the Hospital Outcomes Program of Excellence, Veterans Affairs (VA) Ann Arbor Healthcare System (S.S., M.T.G., S.L.K., D.R., K.E.F.), the Department of Internal Medicine, University of Michigan (UM) Medical School (S.S., M.T.G., S.L.K., M.A.M.R.), and the VA/UM Patient Safety Enhancement Program (S.S., M.T.G., S.L.K., M.A.M.R., D.R., K.E.F.), Ann Arbor, the Michigan Health and Hospital Association, Okemos (S.R.W., B.M.-L., M.M.), and St. John Hospital and Medical Center, Detroit (M.G.F.) - all in Michigan; the Health Research and Educational Trust, Chicago (B.S.E., K.F.); the Centers for Disease Control and Prevention, Atlanta (C.V.G.); and the Agency for Healthcare Research and Quality, Rockville, MD ( J.B.).
authors.forename: Sam R
authors.initials: SR
authors.lastname: Watson
authors.affiliation: From the Hospital Outcomes Program of Excellence, Veterans Affairs (VA) Ann Arbor Healthcare System (S.S., M.T.G., S.L.K., D.R., K.E.F.), the Department of Internal Medicine, University of Michigan (UM) Medical School (S.S., M.T.G., S.L.K., M.A.M.R.), and the VA/UM Patient Safety Enhancement Program (S.S., M.T.G., S.L.K., M.A.M.R., D.R., K.E.F.), Ann Arbor, the Michigan Health and Hospital Association, Okemos (S.R.W., B.M.-L., M.M.), and St. John Hospital and Medical Center, Detroit (M.G.F.) - all in Michigan; the Health Research and Educational Trust, Chicago (B.S.E., K.F.); the Centers for Disease Control and Prevention, Atlanta (C.V.G.); and the Agency for Healthcare Research and Quality, Rockville, MD ( J.B.).
authors.forename: Barbara
authors.initials: B
authors.lastname: Meyer-Lucas
authors.affiliation: From the Hospital Outcomes Program of Excellence, Veterans Affairs (VA) Ann Arbor Healthcare System (S.S., M.T.G., S.L.K., D.R., K.E.F.), the Department of Internal Medicine, University of Michigan (UM) Medical School (S.S., M.T.G., S.L.K., M.A.M.R.), and the VA/UM Patient Safety Enhancement Program (S.S., M.T.G., S.L.K., M.A.M.R., D.R., K.E.F.), Ann Arbor, the Michigan Health and Hospital Association, Okemos (S.R.W., B.M.-L., M.M.), and St. John Hospital and Medical Center, Detroit (M.G.F.) - all in Michigan; the Health Research and Educational Trust, Chicago (B.S.E., K.F.); the Centers for Disease Control and Prevention, Atlanta (C.V.G.); and the Agency for Healthcare Research and Quality, Rockville, MD ( J.B.).
authors.forename: Marie
authors.initials: M
authors.lastname: Masuga
authors.affiliation: From the Hospital Outcomes Program of Excellence, Veterans Affairs (VA) Ann Arbor Healthcare System (S.S., M.T.G., S.L.K., D.R., K.E.F.), the Department of Internal Medicine, University of Michigan (UM) Medical School (S.S., M.T.G., S.L.K., M.A.M.R.), and the VA/UM Patient Safety Enhancement Program (S.S., M.T.G., S.L.K., M.A.M.R., D.R., K.E.F.), Ann Arbor, the Michigan Health and Hospital Association, Okemos (S.R.W., B.M.-L., M.M.), and St. John Hospital and Medical Center, Detroit (M.G.F.) - all in Michigan; the Health Research and Educational Trust, Chicago (B.S.E., K.F.); the Centers for Disease Control and Prevention, Atlanta (C.V.G.); and the Agency for Healthcare Research and Quality, Rockville, MD ( J.B.).
authors.forename: Kelly
authors.initials: K
authors.lastname: Faulkner
authors.affiliation: From the Hospital Outcomes Program of Excellence, Veterans Affairs (VA) Ann Arbor Healthcare System (S.S., M.T.G., S.L.K., D.R., K.E.F.), the Department of Internal Medicine, University of Michigan (UM) Medical School (S.S., M.T.G., S.L.K., M.A.M.R.), and the VA/UM Patient Safety Enhancement Program (S.S., M.T.G., S.L.K., M.A.M.R., D.R., K.E.F.), Ann Arbor, the Michigan Health and Hospital Association, Okemos (S.R.W., B.M.-L., M.M.), and St. John Hospital and Medical Center, Detroit (M.G.F.) - all in Michigan; the Health Research and Educational Trust, Chicago (B.S.E., K.F.); the Centers for Disease Control and Prevention, Atlanta (C.V.G.); and the Agency for Healthcare Research and Quality, Rockville, MD ( J.B.).
authors.forename: Carolyn V
authors.initials: CV
authors.lastname: Gould
authors.affiliation: From the Hospital Outcomes Program of Excellence, Veterans Affairs (VA) Ann Arbor Healthcare System (S.S., M.T.G., S.L.K., D.R., K.E.F.), the Department of Internal Medicine, University of Michigan (UM) Medical School (S.S., M.T.G., S.L.K., M.A.M.R.), and the VA/UM Patient Safety Enhancement Program (S.S., M.T.G., S.L.K., M.A.M.R., D.R., K.E.F.), Ann Arbor, the Michigan Health and Hospital Association, Okemos (S.R.W., B.M.-L., M.M.), and St. John Hospital and Medical Center, Detroit (M.G.F.) - all in Michigan; the Health Research and Educational Trust, Chicago (B.S.E., K.F.); the Centers for Disease Control and Prevention, Atlanta (C.V.G.); and the Agency for Healthcare Research and Quality, Rockville, MD ( J.B.).
authors.forename: James
authors.initials: J
authors.lastname: Battles
authors.affiliation: From the Hospital Outcomes Program of Excellence, Veterans Affairs (VA) Ann Arbor Healthcare System (S.S., M.T.G., S.L.K., D.R., K.E.F.), the Department of Internal Medicine, University of Michigan (UM) Medical School (S.S., M.T.G., S.L.K., M.A.M.R.), and the VA/UM Patient Safety Enhancement Program (S.S., M.T.G., S.L.K., M.A.M.R., D.R., K.E.F.), Ann Arbor, the Michigan Health and Hospital Association, Okemos (S.R.W., B.M.-L., M.M.), and St. John Hospital and Medical Center, Detroit (M.G.F.) - all in Michigan; the Health Research and Educational Trust, Chicago (B.S.E., K.F.); the Centers for Disease Control and Prevention, Atlanta (C.V.G.); and the Agency for Healthcare Research and Quality, Rockville, MD ( J.B.).
authors.forename: Mohamad G
authors.initials: MG
authors.lastname: Fakih
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology / Q000517:prevention & control*; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D006742:Hospital Bed Capacity; D006757:Hospital Units; D006801:Humans; D015994:Incidence; D015233:Models, Statistical; D014481:United States; D014546:Urinary Catheterization / Q000009:adverse effects / Q000706:statistics & numerical data*; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000517:prevention & control*