UTI reduction initiative has little effect at VHA nursing homes

by U.S. Medicine

July 14, 2018

ANN ARBOR, MI — In community-based, long-term care facilities, collaborative programs have been successful in reducing catheter-associated urinary tract infection (CAUTI) rates. A study published in Infection Control and Hospital Epidemiology sought to determine whether the programs could produce similar benefits in VHA nursing homes, which are part of an integrated system.1

A study team led by researchers from the Center for Clinical Management Research at the Ann Arbor, MI, VA Healthcare System focused on 63 VHA nursing homes enrolled in the “AHRQ Safety Program for Long-Term Care,” which encourages practices to reduce CAUTI.

Researchers tracked changes in CAUTI rates, catheter utilization and urine culture orders from June 2015 through May 2016. Results indicated no significant change in CAUTI among VHA sites, with a CAUTI rate of 2.26 per 1,000 catheter days at Month One and a rate of 3.19 at Month 12 (incidence rate ratio [IRR], 0.99; 95% confidence interval [CI], 0.67-1.44).

Similar results were documented for catheter utilization rates—11.02% at Month One and 11.30% at Month 12 (IRR, 1.02; 95% CI, 0.95-1.09). In addition, the numbers of urine cultures per 1,000 residents were 5.27 in Month One and 5.31 in Month 12 (IRR, 0.93; 95% CI, 0.82-1.05), the study team noted.

The bottom line, according to the study, was that no changes in CAUTI rates, catheter use or urine culture orders were found during the program period.

“One potential reason was the relatively low baseline CAUTI rate, as compared with a cohort of community-based nursing homes,” study authors explained. “This low baseline rate is likely related to the VHA’s prior CAUTI prevention efforts. While broad-scale collaborative approaches may be effective in some settings, targeting higher-prevalence safety issues may be warranted at sites already engaged in extensive infection prevention efforts.”

1Krein SL, Greene MT, King B, Welsh D, Fowler KE, Trautner BW, Ratz D, Saint S, Roselle G, Clifton M, Kralovic SM, Martin T, Mody L. Assessing a National Collaborative Program To Prevent Catheter-Associated Urinary Tract Infection in a Veterans Health Administration Nursing Home Cohort. Infect Control Hosp Epidemiol. 2018 May 10:1-6. doi: 10.1017/ice.2018.99. [Epub ahead of print] PubMed PMID: 29745358.

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