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Catheter-associated urinary tract infection (CAUTI) is a large problem for most hospitals but one that can be prevented with the adoption of the right technical evidence and behavior-changing strategies, according to a patient safety expert.

"Preventing CAUTI is no different than preventing other patient safety problems, in that there are technical aspects ... and socioadaptive components – and these are critically important," Dr. Sanjay Saint said during a webinar sponsored by National Priorities Partnership and the Partnership for Patients.

It’s estimated that CAUTI costs approximately $400 million each year. More important, as many as 380,000 infections and 9,000 deaths related to CAUTI each year could be prevented, according to the Centers for Disease Control and Prevention.

In terms of the technical aspects, the No. 1 rule of UTI prevention is to make sure that the patient really needs the catheter. (See related video.) Appropriate indications include bladder outlet obstruction, incontinence/sacral wound, urine-output monitoring, patient’s request (end of life), and during or just after surgery, said Dr. Saint, who is a professor of medicine at the Veterans Affairs Medical Center and the University of Michigan, both in Ann Arbor.

One reason that catheters are used inappropriately is that physicians are unaware that a catheter is being used, he said. In one study, researchers found that 18%, 25%, and 38% of residents, house officers, and attending physicians, respectively, were unaware of the catheter (Am. J. Med. 2000;109:476-80).

There have been four recent guidelines on CAUTI prevention, said Dr. Saint. In general, these recommendations can be remembered by the mnemonic "ABCDE":

"Preventing CAUTI is absolutely a team sport."

• Adherence to infection control principles (aseptic insertion, proper maintenance, education) is vital.

• Bladder ultrasound may avoid catheterization.

• Condom or intermittent catheterization is appropriate in certain patients.

• Do not use the indwelling catheter unless you must.

• Early removal of the catheter using reminders or stop-orders appears warranted.

To understand the socioadaptive side of infection prevention, Dr. Saint and his colleagues conducted a national mixed-methods study – why some hospitals are better at preventing infection than are others. It included phone interviews and site visits to hospitals across the United States to identify barriers to and facilitators of the use of evidence-based practices to prevent infection (Infect. Control Hosp. Epidemiol. 2008;29:333-41).

They identified two key barriers: "active resisters" and "organization constipators."

Active resisters are people who prefer doing things the way they have always done them (Acad. Manag. Rev. 2008;33:362-77).

Organization constipators are passive-aggressives who undermine change without active resistance (Jt. Comm. J. Qual. Patient Saf. 2009;35:449-55).

The most important key facilitator is leadership at all levels – not just the director – but also infection-prevention personnel, patient-safety officers, hospitalists, ED physicians, chief medical officers, and nurse managers. "Engaging leadership is critically important, and we found that leadership at all levels is important," he said.

They also identified four key behaviors of effective infection prevention leaders (Infect. Control Hosp. Epidemiol. 2000;21:375-80):

• Cultivating a culture of clinical excellence with a clear vision that is successfully conveyed to the staff.

• Inspiring staff by motivating and energizing followers.

• Being solution oriented: focusing on overcoming barriers rather than complaining and dealing directly with resistant staff.

• Thinking strategically, while acting locally. Planning ahead and leaving little to chance; politicking before crucial issues come up for a vote in committees.

"Preventing CAUTI is absolutely a team sport," Dr. Saint concluded.

Dr. Saint has not reported any relevant financial relationships.

Catheter-associated urinary tract infection (CAUTI) is a large problem for most hospitals but one that can be prevented with the adoption of the right technical evidence and behavior-changing strategies, according to a patient safety expert.

"Preventing CAUTI is no different than preventing other patient safety problems, in that there are technical aspects ... and socioadaptive components – and these are critically important," Dr. Sanjay Saint said during a webinar sponsored by National Priorities Partnership and the Partnership for Patients.

It’s estimated that CAUTI costs approximately $400 million each year. More important, as many as 380,000 infections and 9,000 deaths related to CAUTI each year could be prevented, according to the Centers for Disease Control and Prevention.

In terms of the technical aspects, the No. 1 rule of UTI prevention is to make sure that the patient really needs the catheter. (See related video.) Appropriate indications include bladder outlet obstruction, incontinence/sacral wound, urine-output monitoring, patient’s request (end of life), and during or just after surgery, said Dr. Saint, who is a professor of medicine at the Veterans Affairs Medical Center and the University of Michigan, both in Ann Arbor.

One reason that catheters are used inappropriately is that physicians are unaware that a catheter is being used, he said. In one study, researchers found that 18%, 25%, and 38% of residents, house officers, and attending physicians, respectively, were unaware of the catheter (Am. J. Med. 2000;109:476-80).

There have been four recent guidelines on CAUTI prevention, said Dr. Saint. In general, these recommendations can be remembered by the mnemonic "ABCDE":

"Preventing CAUTI is absolutely a team sport."

• Adherence to infection control principles (aseptic insertion, proper maintenance, education) is vital.

• Bladder ultrasound may avoid catheterization.

• Condom or intermittent catheterization is appropriate in certain patients.

• Do not use the indwelling catheter unless you must.

• Early removal of the catheter using reminders or stop-orders appears warranted.

To understand the socioadaptive side of infection prevention, Dr. Saint and his colleagues conducted a national mixed-methods study – why some hospitals are better at preventing infection than are others. It included phone interviews and site visits to hospitals across the United States to identify barriers to and facilitators of the use of evidence-based practices to prevent infection (Infect. Control Hosp. Epidemiol. 2008;29:333-41).

They identified two key barriers: "active resisters" and "organization constipators."

Active resisters are people who prefer doing things the way they have always done them (Acad. Manag. Rev. 2008;33:362-77).

Organization constipators are passive-aggressives who undermine change without active resistance (Jt. Comm. J. Qual. Patient Saf. 2009;35:449-55).

The most important key facilitator is leadership at all levels – not just the director – but also infection-prevention personnel, patient-safety officers, hospitalists, ED physicians, chief medical officers, and nurse managers. "Engaging leadership is critically important, and we found that leadership at all levels is important," he said.

They also identified four key behaviors of effective infection prevention leaders (Infect. Control Hosp. Epidemiol. 2000;21:375-80):

• Cultivating a culture of clinical excellence with a clear vision that is successfully conveyed to the staff.

• Inspiring staff by motivating and energizing followers.

• Being solution oriented: focusing on overcoming barriers rather than complaining and dealing directly with resistant staff.

• Thinking strategically, while acting locally. Planning ahead and leaving little to chance; politicking before crucial issues come up for a vote in committees.

"Preventing CAUTI is absolutely a team sport," Dr. Saint concluded.

Dr. Saint has not reported any relevant financial relationships.

Catheter-associated urinary tract infection (CAUTI) is a large problem for most hospitals but one that can be prevented with the adoption of the right technical evidence and behavior-changing strategies, according to a patient safety expert.

"Preventing CAUTI is no different than preventing other patient safety problems, in that there are technical aspects ... and socioadaptive components – and these are critically important," Dr. Sanjay Saint said during a webinar sponsored by National Priorities Partnership and the Partnership for Patients.

It’s estimated that CAUTI costs approximately $400 million each year. More important, as many as 380,000 infections and 9,000 deaths related to CAUTI each year could be prevented, according to the Centers for Disease Control and Prevention.

In terms of the technical aspects, the No. 1 rule of UTI prevention is to make sure that the patient really needs the catheter. (See related video.) Appropriate indications include bladder outlet obstruction, incontinence/sacral wound, urine-output monitoring, patient’s request (end of life), and during or just after surgery, said Dr. Saint, who is a professor of medicine at the Veterans Affairs Medical Center and the University of Michigan, both in Ann Arbor.

One reason that catheters are used inappropriately is that physicians are unaware that a catheter is being used, he said. In one study, researchers found that 18%, 25%, and 38% of residents, house officers, and attending physicians, respectively, were unaware of the catheter (Am. J. Med. 2000;109:476-80).

There have been four recent guidelines on CAUTI prevention, said Dr. Saint. In general, these recommendations can be remembered by the mnemonic "ABCDE":

"Preventing CAUTI is absolutely a team sport."

• Adherence to infection control principles (aseptic insertion, proper maintenance, education) is vital.

• Bladder ultrasound may avoid catheterization.

• Condom or intermittent catheterization is appropriate in certain patients.

• Do not use the indwelling catheter unless you must.

• Early removal of the catheter using reminders or stop-orders appears warranted.

To understand the socioadaptive side of infection prevention, Dr. Saint and his colleagues conducted a national mixed-methods study – why some hospitals are better at preventing infection than are others. It included phone interviews and site visits to hospitals across the United States to identify barriers to and facilitators of the use of evidence-based practices to prevent infection (Infect. Control Hosp. Epidemiol. 2008;29:333-41).

They identified two key barriers: "active resisters" and "organization constipators."

Active resisters are people who prefer doing things the way they have always done them (Acad. Manag. Rev. 2008;33:362-77).

Organization constipators are passive-aggressives who undermine change without active resistance (Jt. Comm. J. Qual. Patient Saf. 2009;35:449-55).

The most important key facilitator is leadership at all levels – not just the director – but also infection-prevention personnel, patient-safety officers, hospitalists, ED physicians, chief medical officers, and nurse managers. "Engaging leadership is critically important, and we found that leadership at all levels is important," he said.

They also identified four key behaviors of effective infection prevention leaders (Infect. Control Hosp. Epidemiol. 2000;21:375-80):

• Cultivating a culture of clinical excellence with a clear vision that is successfully conveyed to the staff.

• Inspiring staff by motivating and energizing followers.

• Being solution oriented: focusing on overcoming barriers rather than complaining and dealing directly with resistant staff.

• Thinking strategically, while acting locally. Planning ahead and leaving little to chance; politicking before crucial issues come up for a vote in committees.

"Preventing CAUTI is absolutely a team sport," Dr. Saint concluded.

Dr. Saint has not reported any relevant financial relationships.