When you enter a hospital, the last thing you want is to end up sicker than you started. But that happens all too frequently in U.S. hospitals, often because of preventable problems. A leading cause: urinary catheters. More than 30 percent of hospital-acquired infections involve those devices, making catheter associated urinary tract infections, or CAUTIs, one of the most common kinds of hospital-acquired infections, according to the national Centers for Disease Control and Prevention. Some research suggests the infections contribute to thousands of deaths a year.
Now, for the first time, our hospital Ratings include information on how well hospitals in your community and across the country compare in preventing the infections, and on how they stack up on other measures of hospital performance.
Cascading problems
A urinary catheter is a tube that’s threaded through your urethra into your bladder, allowing urine to drain into a bag. That helps measure urine output, and the device is essential for patients who can’t get out of bed or use a bedpan.
But infections can occur when bacteria travel along the outside or inside of the catheter into the bladder or kidney, or when urine flows back into the tube, contaminating it. And sometimes catheters are left in longer than necessary, or used mainly for the convenience of the hospital staff. That’s worrisome, since the longer the catheters are in, the greater the potential for infection. For each day a patient has a catheter, the risk of infection increases by five percent, researchers estimate.
And while urinary tract infections might not sound serious, they can be. “They’re often the first thing that goes wrong when you’re in the hospital, which can trigger a cascade of other problems,” said Lisa McGiffert, who heads Consumer Reports Safe Patient Project, which aims to stop preventable medical errors, including hospital infections.
For example, urinary tract infections sometimes spread to the bloodstream, which can lead to deadly complications. More often, the infections are treated with antibiotics—which in turn puts patients at increased risk of adverse drug reactions, development of antibiotic resistant infections, or a dangerous intestinal infection caused by a bacterium called Clostridium difficile, said Sarah S. Lewis, M.D., an epidemiologist with the Duke Infection Control Outreach Network at Duke University. That infection, called c. dif., is now rampant in U.S. hospitals. All told, research suggests that urinary tract infections in hospitals contribute to more than 13,000 deaths a year.
For all those reasons, “There is a high priority now on CAUTI prevention,” Carolyn Gould, M.D., who leads the acute care team in the division of healthcare quality promotion at the CDC, said.
For example, the Centers for Medicare & Medicaid Services no longer pays most hospitals for the treatment of certain hospital-acquired infections, including urinary tract infections, figuring if the problem happened in the hospital, the hospital should be financially responsible.
In addition, hospitals must now report some infection rates to the government, with the hope that the information will help hospitals track the problems and take steps to improve. In addition, the data is made publicly available, which is why we can now include it in our hospital Ratings.
What we found
Our analysis of that information provides a snapshot of how hospitals all across the country compare in preventing the infections. We looked at infection rates in ICUs from April 2012 through March 2013 in about 2,300 hospitals in all 50 states plus Washington, D.C., and Puerto Rico.
The good news: Some hospitals have been able to eliminate the infections from their intensive care units. More than 400 hospitals (or 18 percent) reported zero infections, which earns them our top Rating.
The bad news: More than 300 hospitals earned our lowest Rating, indicating they had at least twice the national average number of those infections.
Why are so many doing so poor? Researchers from Columbia University and the CDC suggest it may be in part because hospitals have not yet focused on CAUTIs to the same extent that they have other kinds of infections. For example, while up to 97 percent of adult hospital intensive care units have put in place a policy to reduce central-line-associated bloodstream infections, no more than 68 percent had taken similar steps to prevent CAUTIs in those units. And among hospitals that had instituted policies, only up to a quarter were following them. In contrast, up to nearly three quarters of hospitals followed protocols to prevent central-line infections.
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What good hospitals are doing
At the Robert Wood Johnson University Hospital Rahway in New Jersey, preventing urinary tract infections is a priority—and efforts have paid off. The hospital reported no infections during this period and thus received our highest Rating.
What does it do? Hospital staff discusses each patient’s need for a catheter once a day, during morning rounds. Twice a day, ICU nurses complete a checklist for each patient to assess the appropriateness of the catheter. “If the patient doesn’t meet the appropriate indication for each item on the list, the catheter is removed,” Debra Toth, R.N., nurse manager of the critical care unit, said. But rather than wait for a doctor to make the call or write the order, which could take time, “all nurses are empowered to remove the catheter,” based on a set of evidence-based guidelines, says Angela DeCillis, R.N., nurse manager of one of the telemetry floors at the hospital.
What you can do
If you or someone you care for is in the hospital, take these steps to reduce the risk of developing a urinary tract infection from a catheter.
- Make sure you really need one. Chances are there is a good reason for starting a catheter, but sometimes they might be put in mainly for the hospital’s convenience. If you feel you can go to the bathroom on your own or use a bedpan, say so.
- Ask every day if you still need the catheter. If the answer is yes, ask why. If the answer is no, ask to have the catheter removed.
- Make sure everyone washes his or her hands. That means cleansing hands thoroughly with soap and water or an alcohol-based hand rub before and after touching the catheter. The area where the catheter is inserted should be sterilized, too.
- Check for a leg strap. That helps secure the catheter and keeps it lower than the bladder. Nurses should regularly check how the catheter is positioned and maintained.
- Make sure the bag is emptied regularly. And that the catheter is cleaned.
- Watch for fever. That’s usually the first sign of a urinary tract infection. If you suspect a problem, speak up. “It is really important to be persistent if there is a problem,” McGiffert said. “CAUTI is a preventable infection that can get out of hand quickly if you don’t get it taken care of.”
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Find Hospital Ratings
Click on the map at right to find Ratings of hospitals nationwide (available to subscribers). The Ratings includes information on hospitals in all 50 states plus the District of Columbia and Puerto Rico. Get involved with Consumer Reports SafePatientProject to see what you can do to reduce the risk of patient harm in the U.S. health care system.
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