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An In Vitro Bladder Model of Catheter-Associated Urinary Tract Infection

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Reducing inappropriate urinary catheter use: a statewide effort.

Mohamad G Fakih¹, Sam R Watson, M Todd Greene

¹University of Michigan Patient Safety Enhancement Program, Ann Arbor, MI 48109-0429, USA.

Archives of Internal Medicine

|January 11, 2012

Summary

A statewide quality improvement initiative significantly reduced inappropriate indwelling urinary catheter use in hospitals. This effort improved adherence to appropriate indications, with sustained positive results for at least two years.

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Area of Science:

Healthcare Quality Improvement
Infectious Disease Prevention
Patient Safety

Background:

Indwelling urinary catheters are associated with infectious and noninfectious complications.
Inappropriate catheter use is common in hospital settings.
A statewide initiative aimed to reduce unnecessary urinary catheter utilization.

Purpose of the Study:

To evaluate the effectiveness of a quality improvement program targeting urinary catheter use.
To assess changes in catheter utilization rates and adherence to appropriate indications.

Main Methods:

Retrospective analysis of data from 163 inpatient units across 71 Michigan hospitals (2007-2010).
Implementation of an educational intervention promoting appropriate indications and daily reassessment of catheter necessity.
Utilized generalized estimating equation (GEE) and multilevel methods to analyze changes over time.

Main Results:

Urinary catheter use decreased from 18.1% to 13.8% by year 2 (P < .001).
Appropriate catheter use indications increased from 44.3% to 57.6% by year 2 (P = .005).

Conclusions:

A statewide quality improvement effort effectively reduced inappropriate urinary catheter use.
The intervention led to improved compliance with appropriate catheter indications.
The positive impact of the intervention was sustained for at least two years.