Hospitals fail to prevent urinary tract infections

NEW YORK (Reuters Health) - United States hospitals have few strategies in place for preventing catheter-related urinary tract infections, the results of a national survey suggest.

Urinary tract infection is the most common hospital-acquired infection in the U.S., and more than 80 percent of patients who develop a urinary tract infection during hospitalization have an indwelling urinary catheter, authors note in the medical journal Clinical infectious Diseases. Furthermore, Medicare no longer reimburses for the cost of treating preventable complications during hospitalization.

To examine how hospitals are addressing the risk of urinary tract infections, Dr. Sanjay Saint at the Veterans Affairs Ann Arbor Healthcare System in Michigan and colleagues mailed surveys to infection control coordinators at 719 hospitals across the U.S. The response rate was 72 percent.

The results show that most hospitals do not monitor which patients have a catheter, how long it's been in place, or when it is removed. Nearly one third don't track urinary tract infection rates in their patient populations.

Only 30 percent of hospitals reported regular use of antimicrobial urinary catheters and portable ultrasound bladder scanners to measure urinary retention. Less than 15 percent regularly used alternative devices, such as condom catheters in men.

Urinary catheter reminders were used in less 10 percent of hospitals, despite evidence that they are effective, Saint and his associates note.

Hospitals participating in collaborative efforts to reduce hospital-acquired infections were no more likely to have measures in place to prevent urinary tract infections.

"This neglect seems exceptional," Dr. Lindsay E. Nicolle writes in an accompanying editorial, but there are plausible explanations. Hospital-acquired urinary tract infections are at the bottom of the list for infection control specialists because they cause fewer cases of severe illness and deaths than do surgical site infections, pneumonia or systemic infections, and because treatment is straightforward and inexpensive.

Nicolle, at the University of Manitoba in Canada, maintains that decreasing the extent and duration of indwelling catheter use can prevent urinary tract infections. Data monitoring systems, physician reminders, and stop orders are the most obvious means to achieve this goal.

SOURCE: Clinical infectious Diseases, January 15, 2008.