Reduction of Healthcare-Acquired Urinary Tract Infections—A Patient Safety Analysis

BACKGROUND: Leape and colleagues (JAMA 2002; 288:501–507) reported that use of a silver alloy–coated urinary catheter (SACC) is a high strength of evidence practice for the patient safety target of catheter-associated urinary tract infections (CA-UTIs). At our facility, data related to CA-UTIs was only available for the ICUs and certain surgical procedures. The total rate of symptomatic and asymptomatic CA-UTIs was unknown, as was whether the asymptomatic infections were treated. The decision was made to evaluate the effectiveness of a SACC at reducing the incidence of CA-UTIs. METHODS: Six months of retrospective data was collected for both the control (July 2002–December 2002) and evaluation (May 2003–October 2003) periods. Only CA-UTIs related to indwelling urinary catheters were recorded. RESULTS: There were 2.2 CA-UTIs per 1000 patient days (61 infections/27,788 patient days) in the control period. Of these, 45 (74%) of the CA-UTIs were symptomatic, and 16 (26%) were asymptomatic. During the evaluation period, 1.1 CA-UTIs occurred per 1000 patient days (28 infections/26,142 patient days); 15 (54%) were symptomatic, and 13 (46%) were asymptomatic. The relative risk of CA-UTI with use of the SACC was 0.50 (p=0.001). Further analysis revealed that 81% and 77% of the asymptomatic CA-UTIs resulted in treatment during the control and evaluation periods, respectively. CONCLUSIONS: This study confirmed that the use of a SACC is a significant patient safety intervention reducing the incidence of CA-UTIs by 50%. The study also found that asymptomatic CA-UTIs are frequently treated, adding to the cost of this common healthcare-acquired infection.