FORT LAUDERDALE, FL USA (UroToday.com) - Presented by Jaime Ritter, MPH, CIC;a Lendon Thomas, BS, CIC;b James Lederer, MD;c and William R. Jarvis, MDd at the Association for Professionals in Infection Control and Epidemiology (APIC) 40th Annual Conference - June 8 - 10, 2013 - Fort Lauderdale, FL USA
Background/Objectives: Catheter-associated urinary tract infections (CAUTIs) remain one of the most common healthcare associated infections in acute care hospitals. While many strategies and/or technologies exist to reduce/prevent CAUTIs, most evidence supporting their effectiveness is based on a combination of symptomatic CAUTI and asymptomatic bacteriuria definitions. The objective of this study was to assess the impact of a silver-alloy and hydrogel coated urinary catheter (SAH) on symptomatic catheter-associated urinary tract infections (CAUTIs).
Methods: This before-after cohort study was conducted in seven acute care hospitals (6 community, 1 teaching) ranging in size from 124 to 921 beds. Patients between 18 and 89 years of age, with a significant positive urine culture ≥ 2 calendar days after hospital admission, and who underwent Foley catheterization during their admission were considered to be CAUTI candidates. CAUTI surveillance was conducted at each hospital for ≥ 3 months using a standard, non-silver Foley catheter (STD). An equal number of months of surveillance were performed after the SAH catheter was introduced. Both the 2009 Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network (NHSN) surveillance and a clinical CAUTI definition of infection were used to calculate infection rates.
Results: A total of 64 months of data were collected. Eight-hundred fifty three (853) patients met all inclusion and exclusion criteria (453 STD period; 400 SAH period). A total of 174 CAUTIs occurred in 170 patients in the STD period; 90 CAUTIs occurred in 88 patients in the SAH time period. A 47% relative reduction in the CAUTI rate was observed with the use of the SAH catheter compared to the STD catheter (0.94 per 1,000 patient days vs. 0.50 per 1,000 patient days) (odds ratio 0.537; p < 0.0001; 95% C.I. 0.44-0.62). Of all CAUTIs identified, 111 (64%) in the STD period and 46 (51%) in the SAH period met the CDC NHSN CAUTI definition. This resulted in a 58% relative reduction in the NHSN CAUTI rate in the SAH period compared to the STD period (0.60 per 1,000 patient days vs. 0.25 per 1,000 patient days) (odds ratio 0.42; p < 0.0001; 95% C.I. 0.34-0.53). Antimicrobial therapy days for the treatment of CAUTIs decreased from 1,165 in the STD time period to 406 in the SAH time period.
Conclusions: Use of the silver-alloy and hydrogel coated Foley catheter resulted in a 47% relative reduction in the total (NHSN + clinical) CAUTI rate and a 58% reduction in the NHSN-defined CAUTI rate.
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aSenior Manager, Clinical Affairs, C. R. Bard, Inc., Bard Medical Division; bInfection Preventionist, C. R. Bard, Inc., Bard Medical Division; cInfectious Diseases/Epidemiology, Novant Health; dInfectious Disease Consultant, Jason and Jarvis Associates, L.L.C
The APIC Annual Conference: Each year more than 2,500 clinical professionals from around the world gather for three days to advance their network and learn about evidence-based advances in infection prevention.
