Helping Hospitals Prevent Urinary Tract Infections
This week, the federal government will stop paying hospitals for the cost of treating preventable urinary tract infections that develop in hospitalized Medicare patients. Many private insurers are expected to follow suit soon, in an effort to improve patient safety by aiming directly at hospitals' bottom lines.
But hospitals still struggle to prevent UTIs, most of which arise directly from the use of the urinary catheters that drain the bladders of many hospitalized patients. In fact, UTIs are the most common in-hospital infection that patients face, and can lead to serious and potentially deadly complications.
Now, a new $1.7 million, four-year grant from the National Institutes of Health will help Michigan hospitals tackle this problem head on. It funds an effort by the University of Michigan Health System and the VA Ann Arbor Healthcare System to help hospitals understand the best ways to prevent UTIs and avoid costs they can't recoup.
The grant will allow a team from the U-M/VA Patient Safety Enhancement Program to study the efforts hospitals are making to prevent UTIs, in order to see what tactics are working the best, and what factors stand in the way of effective prevention programs. The team will also help some Michigan hospitals directly with their prevention programs, and see what impact those efforts have on infection rates.
The new project dovetails with the Hospital-Associated Infection project that 112 Michigan hospitals are now participating in through the Keystone Center for Patient Safety & Quality at the Michigan Health & Hospital Association.
In a previous effort, the MHA Keystone Center showed that lives and dollars were saved when Michigan hospitals took specific standard steps to prevent infections in intensive care units. The findings are being heeded by hospitals around the country.
Now, the MHA Keystone Center has rolled out a set of Catheter-Associated Urinary Tract Infection Prevention Practices (also called the "bladder bundle" for short) that hospitals statewide are beginning to implement. The new grant will help reveal the true impact of the MHA Keystone "bladder bundle" project, and uncover barriers that might stand in the way of better UTI prevention. As with the ICU project, the results of the 'bladder bundle' project are expected to help hospitals nationwide.
The grant comes from the National Institute of Nursing Research, because of the important role that nurses play in inserting, maintaining and removing catheters, and therefore in preventing catheter-associated UTI. The grant will be overseen by two principal investigators, a nurse and a physician, which is an increasingly common approach to interdisciplinary and team-based science.
Sarah Krein, Ph.D., RN, an assistant professor in the U-M Department of Internal Medicine and research investigator in the U-M/VA patient safety program, is one of the grant's principal investigators.
"Nurses are the ideal 'champions' for UTI prevention in hospitals, and this project will allow us to identify specific day-to-day tactics that are most likely to help nurses in having the greatest impact on preventing UTI," says Krein. "However, strategies for effectively reducing catheter-related infection rates often require broader organizational changes, and this project will help us to better understand how to make those changes possible."
Sanjay Saint, M.D., MPH, the director of the U-M/VA PSEP and a professor of internal medicine at U-M, is also a principal investigator on the project.
"With the change in Medicare reimbursement for catheter-related UTIs, hospitals have more impetus than ever to overhaul the way catheters are used within their inpatient units," says Saint. "Ultimately, the ones who stand to benefit most are patients, who will avoid the discomfort and pain that often come with catheters, as well as the risk of infections that can quickly become serious in susceptible patients."
Saint and Krein have worked together on a number of previous catheter-related research projects, including a paper published in January that gave the first national-level picture of hospitals' catheter-related policies and programs.
That study, published in the journal Clinical Infectious Diseases, revealed a chaotic situation, with less than half of hospitals' having a system to track which patients are using a catheter at any given time, and three-quarters lacking a way to tell how long a patient has had a catheter. The risk of infection increases every day that a patient uses a catheter.
The new project will test the effectiveness of specific catheter-related practices, including the implementation of "reminders" that prompt nurses and physicians on a regular basis to consider whether a certain patient still needs a catheter; standard protocols that call for the removal of a catheter unless a physician orders otherwise; alternative devices that collect urine without inserting a catheter into the ureter; catheters coated with antimicrobial agents such as silver; and portable bladder ultrasound monitoring that can reveal a full bladder in a non-catheterized patient.
So far, 35 of the 112 Michigan hospitals participating in the MHA Keystone Hospital-Associated Infection effort have committed to implementing the "bladder bundle" practices. More are expected to adopt it in coming months.
The project also includes researchers from St. Joseph Mercy Healthcare System the St. John Health System and the Keystone Center.
"Michigan hospitals are again leading the way in applying low-tech, evidence-based best practice to prevent patient harm," said MHA president Spencer Johnson. "We are delighted to see such an important grant be awarded to the University of Michigan which will help determine how to best implement this important work in hospitals across the country."