BERKELEY, CA (UroToday.com) - Over the past year, Barry Aron, MD, FACS, Chair/Urology, Shady Grove Adventist Hospital,* implemented the CAUTI Challenge at his institution with an objective of reducing the incidence of catheter associated urinary tract infections (CAUTIs).
Herein, Dr. Aron presents the process and outcomes of implementing the protocol, described on UroToday.
He reports the CAUTI rates as a function of patient days. “Since all patients who enter the hospital are at risk,” Dr. Aron states, “this is a logical denominator.” He notes that the CDC and regulatory agencies in the US define infection days as 1,000 catheter days. “This misses the point that once the catheter is inserted, infection becomes inevitable, and then measuring infections per catheter day misses the point.” Further, “by only measuring infections associated with catheters that have already been placed, it fails to acknowledge the impact of decreased catheter utilization.” And finally, “once an institution has reduced its catheter utilization, only the sickest patients are left with catheters and they invariably get infected, so the infection rate goes up.”
Dr. Aron cites the following example to illustrate these points: “If a hospital eliminates all of its indwelling catheters except one, and that patient becomes infected, the infection rate is 100%.” He has also provided a CAUTI infection control update from Shady Grove Adventist Hospital reviewing results from 2007 through 2010 year-to-date.
In his assessment of the UroToday CAUTI Center, Dr. Aron said, “Your CAUTI Center has become the focal point for our hospital's transition to an enlightened catheter discipline policy. As a result, CAUTIs have fallen by more than 50%, and we are still improving. This should be required reading for anyone who hospitalizes a patient and even for many urologists who still resist the removal of their beloved catheters.”
Barry Aron, MD, FACS, a graduate of New York University School of Medicine, trained in Urology at NYU-Bellevue Medical Center in New York. After serving in the US Air Force he entered private practice in Rockville, Maryland. He has practiced at Shady Grove Adventist Hospital since it opened in 1979 and served as Chair of Surgery and President of the Medical Staff. For many years he was active in training Urology residents at Georgetown University and preceptoring Family Practice Residents at George Washington University.
He currently serves as Chair of Urology at Shady Grove, where he has been active in their CAUTI reduction initiative.
*Shady Grove Adventist Hospital is a 336-licensed bed acute care facility located in Rockville, MD. Opened in 1979, the hospital has since added a four story patient tower, including private rooms – 48 for new moms and their babies – and a high tech surgery department for inpatients and outpatients. The vision of the hospital is to be a leader in the provision of care and clinical services, an innovator in health and medical management, and an active participant in education and research.