Beyond Infection: Device Utilization Ratio as a Performance Measure for Urinary Catheter Harm

Area of Science:

• Healthcare quality improvement
• Infection prevention
• Medical device utilization

Background:

• Catheter-associated urinary tract infection (CAUTI) is a preventable healthcare-associated infection.
• Existing CAUTI definitions have limitations in clinical correlation and capturing noninfectious harms.
• The National Healthcare Safety Network (NHSN) definition is widely used but imperfect.

Purpose of the Study:

• To advocate for the device utilization ratio (DUR) as an additional performance measure for urinary catheter harm.
• To highlight the limitations of current CAUTI surveillance definitions.
• To propose a more patient-centered and objective metric for evaluating catheter use.

Main Methods:

• Analysis of existing CAUTI surveillance definitions and their limitations.
• Proposal of the device utilization ratio (DUR) as a supplementary performance metric.
• Discussion of data availability from electronic medical records and NHSN reporting.

Main Results:

• The NHSN surveillance definition for CAUTI has limited clinical correlation.
• The DUR is patient-centered, objective, and readily obtainable.
• The DUR directly reflects efforts to reduce inappropriate urinary catheter use.

Conclusions:

• The device utilization ratio (DUR) should be adopted as an additional performance measure for urinary catheter harm.
• DUR provides a more direct reflection of improvements in reducing unnecessary catheter use.
• Understanding limitations of current CAUTI metrics is crucial for clinical practice and policy.