Related Experiment Video
Updated: Dec 24, 2025
An In Vitro Bladder Model of Catheter-Associated Urinary Tract Infection
Published on: June 24, 2025
The Influence of an Electronic Medical Record Embedded Best Practice Alert on Rate of Hospital Acquired Catheter
Colette Gnade1, Chaorong Wu2, Patrick Ten Eyck2
1University of Iowa Hospitals and Clinics, Department of Obstetrics and Gynecology, Iowa City, IA.
Insights
A best practice alert (BPA) in electronic medical records did not reduce catheter-associated urinary tract infections (CAUTIs) or catheter utilization (CU). The BPA even increased CAUTIs in adult intensive care units, despite lowering catheter use.
Area of Science:
- Healthcare Quality Improvement
- Infectious Disease Prevention
- Health Informatics
Background:
- Catheter-associated urinary tract infections (CAUTIs) remain a significant healthcare-associated infection.
- Electronic medical record (EMR) systems offer potential for implementing best practice alerts (BPAs) to mitigate CAUTIs.
- Understanding the impact of BPAs on both CAUTI rates and catheter utilization (CU) is crucial for effective infection control.
Purpose of the Study:
- To evaluate the effectiveness of an EMR-embedded BPA in reducing hospital-wide CAUTI and CU rates.
- To analyze the impact of the BPA on CAUTI and CU rates across different patient subpopulations, including intensive care units (ICUs) and non-ICU adults.
Main Methods:
- A prospective CAUTI database spanning 2011-2016 was analyzed.
- The study compared pre-BPA (2011-2012) and post-BPA (2013-2016) periods.
- Generalized linear models were used to assess changes in CU and CAUTI rates.
Main Results:
- The BPA did not decrease overall CU or CAUTI rates.
- Adult ICU populations experienced a significant increase in CAUTI rates (0.2 to 1.8 per 1,000 catheter days) despite a decrease in CU.
- Non-ICU adult populations showed a decrease in CAUTI rates (2.8 to 1.7 per 1,000 catheter days) without a significant change in CU.
Conclusions:
- EMR-embedded BPAs may have limited success in reducing CAUTI and CU rates, particularly in populations with already low catheter use.
- The BPA intervention was associated with an increased CAUTI rate in the adult ICU population.
- Patient-specific factors or comorbidities may influence CAUTI development, irrespective of catheter utilization or BPA implementation.
Objective:
To understand if an electronic medical record embedded best practice alert decreased our hospital's Catheter-associated urinary tract infections (CAUTIs) and catheter utilization (CU) rates.
Methods:
Data from our inpatient prospective CAUTI database, spanning 2011 to 2016, were utilized for our analysis with the Best Practice Alert (BPA) starting in 2013. Using generalized linear models we compared the CU and CAUTI rates between pre- and post-BPA periods in different patient subpopulations.
Results:
We identified no decrease in the CU rate and no effect on the CAUTI rates as a result of the BPA. However, there was an increase in CAUTI rates in our adult intensive care unit (ICU) population from 0.2 to 1.8 CAUTIs per 1,000 catheter days (P <.01) despite a significant decrease in CU rate within this population after the BPA (pre-BPA odds ratio [OR] 0.93 vs post-BPA OR 0.89; P <0.01). In contrast, our non-ICU adult population had a decrease in CAUTI rate from 2.8 to 1.7 CAUTIs per 1,000 catheter days (P <.01) despite no significant decrease after the BPA (pre-BPA OR 0.90 vs post-BPA OR 0.95; P <.1).
Conclusion:
CAUTI rates are exceedingly low, with or without the use of a BPA. Such an alert appears to have limited success in lowering CU rates in populations where catheter use is already low and may not always lead to an improvement in CAUTI rates as there appears to be some populations that may be more prone to CAUTI development secondary to possible intrinsic or co-morbid conditions.
More Related Videos
Related Concept Videos
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:18Guidelines and Strategies for Safe Computer Charting
Maintain Confidentiality and Security:
01:26Urine Studies II: Urine Culture and Sensitivity Test
01:17Urinary Tract Infection IV: Nursing Management
01:26Healthcare Associated Infections I: Iatrogenic, Exogenic and Endogenic
HAIs significantly increase the cost of health care. Extended stays in healthcare institutions, increased disability, increased costs of medications, including specialized antibiotics, and prolonged recovery times add to the patient's expenses and the healthcare institution and funding bodies.
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care