Catheter-associated Urinary Tract Infections More Preventable Than Previously Thought

Main Category: Urology / Nephrology
Also Included In: Infectious Diseases / Bacteria / Viruses;  Medicare / Medicaid / SCHIP;  Medical Devices / Diagnostics
Article Date: 18 Nov 2008 - 3:00 PDT

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Catheter-associated urinary-tract infections (UTIs) are not fully preventable, according to a national survey of physicians on QuantiaMD, an online clinician community. This finding is contrary to expert opinion that these costly infections are indeed largely preventable.

On October 1, the Centers for Medicare and Medicaid Services (CMS) began withholding additional payments to hospitals for the care delivered to patients who suffer one of 11 identified serious and preventable adverse events, catheter-associated UTIs being one of them. The national QuantiaMD survey was designed to assess physician awareness of the new Medicare reimbursement policy, understand physician perspectives on preventability, and learn how ready physicians feel their institutions are for a "zero tolerance" payment environment.

The survey found that only 4.3% of physicians believe these infections are 100% preventable. The study also found that 38% of responding physicians were experienced in dealing with such infections, having had at least one patient who suffered a catheter-associated UTI in the last two years.

"Very few physicians felt that (catheter-associated UTIs) are completely or even largely preventable," says Robert M. Wachter, MD, professor of medicine at University of California at San Francisco, Investigator of the QuantiaMD Survey, and Moderator for the Safety and Reimbursement education series. "This I think led to the skepticism physicians have about the CMS policy, feeling a demand for complete preventability is unfair."

More preventable than presumed

"Catheter-associated UTIs are indeed a largely, although not totally, preventable risk to patient safety," says Daniel J. Sexton, MD, Professor of Medicine at Duke University School of Medicine and Director of QuantiaMD's Infectious Disease and HIV Community.

According to Sexton, more than 30% of the 100 billion catheters sold worldwide are used in the US, and 12-16% of American inpatients receive a urinary catheter during their hospital stay. One major key to prevention, he says, are the 20% of patients who receive urinary catheters but don't need them.

"About 50% of all urinary catheter days are unnecessary if you use reasonable criteria to assess whether a catheter is necessary," he adds. "And the risk of bacteuria in a catheterized patient is about 5% per patient per day, and that risk is cumulative. The longer the stay, the more likely the infection."

As of early 2007, Sexton says most hospitals had not developed good systems for preventing catheter-associated UTIs, which is consistent with QuantiaMD's survey findings. The survey found that only 40% of physicians felt their organizations were mostly or fully prepared to prevent catheter-associated UTIs.

"Physicians have to appreciate that relatively simple systems strategies can make a significant impact on these infections," says Sexton. Hospitals that want to systematically address catheter-associated UTIs need to employ three basic strategies, he says:

1. Nurse-driven, hospital-wide protocols to deal with urinary retention
2. Use of reminder systems to assess the need for continued catheterization
3. Criteria for using urinary catheters in surgical patients

Sexton believes a great many UTIs can be prevented through such measures. But he is careful to point out , in the context of CMS' policy, that hospitals will be greatly challenged to document and demonstrate that an infection did not exist prior to the patient's admission to the hospital.

Physician misperceptions abound

"Whatever feelings came across in this survey and from the many comments by physicians, it is clear there is a great deal of interest in this topic among doctors," says UCSF's Wachter. "Nearly 80% of participating physicians knew of this initiative by Medicare, which, in the physician community, is a remarkably high level of awareness."

Wachter points out that other data from QuantiaMD's national survey suggests that physicians displeasure with this policy shift may have more to do with misperceptions than an informed opinion. For example, 60% of participating physicians didn't understand the narrow scope of the policy, and 58% believe that the economic impact of the policy will exceed $1 billion in its first year. Medicare itself estimates that the first year impact will be just $22 million.

"Clearly there is a great opportunity to educate physicians with this series from QuantiaMD," concludes Wachter.

A total of 1,792 physicians participated in this survey.

The QuantiaMD Series in Series in Safety and Reimbursement

Dr. Sexton provides solutions to physician and organizational challenges with preventing catheter-associated UTIs in an exclusive education series on QuantiaMD (click here to view): http://my.quantiamd.com/player/kmzfqut

Dr. Wachter describes the CMS "never events" program on QuantiaMD (click here to view): http://www.quantiamd.com/player/kvgrxdm

QuantiaMD is an online clinician community improving the quality and safety of healthcare by clinicians participating in world-class education, interactive cases, field research and patient discussions using breakthrough mobile and web technology.

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