CAUTI: The Rodney Dangerfield of HAIs

For several reasons (lower attributable mortality and cost, mostly), catheter-associated urinary tract infections (CAUTI) get far less respect or attention than VAP or CLABSI. However, the sheer number of CAUTIs provides a good reason to pay attention to their prevention. Fortunately, it’s not that complicated (here’s the SHEA compendium and HICPAC guidance).

The big message, of course, is “get the catheters out!” Which brings me to a recent study in Archives of Internal Medicine, reporting results from the statewide Keystone initiative to reduce urinary catheter use in Michigan hospitals. The good news is that the interventions (clinician education and daily assessment of catheter necessity during nursing rounds) were effective, resulting in an almost 30% reduction in catheter use in participating hospitals. The bad news is that even after the intervention, less than 60% of catheter use was for indications defined as “appropriate” based upon HICPAC guidelines. These guidelines aren’t all-inclusive as regards appropriate catheter use, but it seems clear that every hospital still has a lot of room for improvement here.