Catheters cause urinary tract infections (UTIs) and the longer one is in place, the more likely it is to cause an infection. These infections aren’t just painful to patients, either: They account for 40% of hospital-acquired conditions, for which CMS now penalizes hospitals. Avoiding them is high on the priority list of just about every hospital.
Now, researchers at Northwestern Memorial Hospital in Chicago have developed a protocol that aims to get catheters out of surgical patients as soon as possible — indeed, to keep them out of as many patients as possible to begin with. In its first five months, preliminary results are showing great success.”
As a result of the protocol, the hospital has reduced the incidence of UTIs among surgical patients. The study authors presented their findings in July at the meeting of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Conference.
Using data from NSQIP, the group found that Northwestern initially had higher UTI rates than similar hospitals in the program — as high as two per month. After the program started at the beginning of this year, rates fell to an average of 0.4 per month, with two months where there were zero infections.
Data also showed that prior to the program, two-thirds of all surgical patients who had catheters may not have needed them since their surgeries took less than three hours, and only 22% of the catheters were removed right after the surgery was finished. In the months since the protocol was instituted, there has been a 12% decline in the use of catheterization of patients with short duration surgeries, and a 6% increase in the number of patients who had their catheters removed right after surgery ended.
The objective was to change clinical culture, says Anthony Yang, MD, FACS, author of the study and an assistant professor of surgical oncology in the Surgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of Medicine in Chicago. “Physicians tend to err on the conservative side and order catheters routinely,” he says. “We wanted them to think more critically about when to use catheters and weigh the need against the risk of infection.”
The new protocol called for catheters in short cases only when there was an indication, for removal of catheters in theater or in the recovery room if at all possible, and for a two-person team to ensure that catheter placement adhered to all sterile techniques and guidelines, and the second person — the watcher — is to report any breaks in sterile procedure. If there is a break, a new catheter set is retrieved and they start again. Patients are instructed to void their bladders before surgery, as well.
Yang doesn’t believe there will ever be zero UTIs, because there will never be zero catheters. However, the number can be reduced significantly. “If you don’t have to put it in, don’t; if you do, get it out.”
He says that almost half the time, physicians forget that the patients even have a catheter in, which is why it’s so important for that call to remove it to happen in the operating theater or recovery room. “If we don’t do it there, then someone may forget.”
The results have been gratifying, and much larger than Yang says he expected to see. “You put in an intervention, and you don’t necessarily expect to see an immediate effect.”
For more information on this topic, contact Anthony D. Yang, MD, FACS, Assistant professor of Surgical Oncology, Surgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of Medicine. Telephone: (312) 695-1419.