Assessing a National Collaborative Program To Prevent Catheter-Associated Urinary Tract Infection in a Veterans...

Area of Science:

• Infection Control and Hospital Epidemiology
• Healthcare Quality Improvement
• Long-Term Care Medicine

Background:

• Collaborative programs have historically reduced catheter-associated urinary tract infection (CAUTI) rates in community nursing homes.
• The Veterans Health Administration (VHA) operates an integrated system of nursing homes, necessitating an evaluation of collaborative program effectiveness within this context.

Purpose of the Study:

• To assess the impact of participation in the "AHRQ Safety Program for Long-Term Care" on CAUTI rates within VHA nursing homes.
• To determine if collaborative efforts yielded similar CAUTI reductions in VHA facilities as observed in community-based settings.

Main Methods:

• The study included 63 VHA nursing homes participating in a CAUTI reduction program.
• Data on CAUTI rates, catheter utilization, and urine culture orders were collected over 12 months (June 2015-May 2016).
• Multilevel mixed-effects negative binomial regression was employed to analyze changes over the program period.

Main Results:

• No statistically significant changes were observed in CAUTI rates (IRR, 0.99; 95% CI, 0.67-1.44).
• Catheter utilization rates also remained stable (IRR, 1.02; 95% CI, 0.95-1.09).
• The frequency of urine culture orders per 1,000 residents showed no significant change (IRR, 0.93; 95% CI, 0.82-1.05).

Conclusions:

• The collaborative program did not lead to significant reductions in CAUTI rates, catheter use, or urine culture orders in VHA nursing homes.
• A potential reason for the lack of change is the VHA's low baseline CAUTI rate, likely due to prior prevention initiatives.
• Future collaborative efforts may need to target higher-prevalence safety issues in settings with established infection prevention programs.