Infection Control

CDC updates guidelines on CAUTI prevention

Briefings on Infection Control, March 1, 2010

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Although it's not one of the most dangerous healthcare-associated infections (HAI), catheter-associated urinary tract infections (CAUTI) have quickly become the most frequently occurring infection. CAUTIs worry hospital IPs and CEOs equally since a high infection rate can increase morbidity and mortality, cost, and length of stay.

A study published in the January 2002 Infection Control and Hospital Epidemiology found that 123 CAUTIs diagnosed by a hospital laboratory were responsible for an additional $20,662 in extra costs due to diagnostic tests and $35,872 in extra medication costs. Additionally, CMS lists CAUTIs among its never events, which means it will not reimburse hospitals if a patient acquires this infection.

A CDC public health report published in 2007 found that in 2002, CAUTIs accounted for 36% of HAIs in U.S. hospitals among adults and children outside of the ICU, more than any other infection. Further, CAUTIs are often associated with drainage systems that promote the growth of MDROs and can lead to unnecessary antimicrobial use.

Until now, IPs were forced to consult outdated CDC guidelines dating back to 1981. But as of November 2009, the CDC, along with the Healthcare Infection Control Practices Advisory Committee (HICPAC), has released updated recommendations for the prevention and management of CAUTIs. According to the guidelines, "an estimated 17%–69% of CAUTI may be preventable with recommended infection control measures, which means that up to 380,000 infections and 9,000 deaths related to CAUTI per year could be prevented."

The new recommendations address new research and technological advancements surrounding CAUTIs, including patients in nonacute care settings and those who may require long-term urinary catheterization, in which the risk for infection is much greater, says Carolyn V. Gould, MD, MSCR, medical epidemiologist at the CDC's Division of Healthcare Quality Promotion in Atlanta. The revised guideline also includes recommendations for performance measurement and quality improvement programs and high-priority recommendations to help with appropriate implementation.

"The guideline development process started in 2007, so at that point there was about 26 years' worth of literature that needed to be reviewed and evaluated," Gould says.
The committee used a new Grading of Recommendations Assessment, Development and Evaluation Working Group approach to create these guidelines, which provides more transparency for the reader and offers specific links in the appendixes to available evidence that explains the rationale for each recommendation.

"This is really the first in a series of guidelines that utilized an updated methodology for reviewing the literature that was a little bit more transparent, more systematic, and, very importantly, reproducible so we would have an easier mechanism for reproducing the guidelines more frequently," Gould says.

In with the old and the new
Many of the core key recommendations have not changed since 1981, Gould says, but now there is even more evidence to prove their effectiveness. The following long-standing best practices are essentially the same for prevention of CAUTIs:

  • Ensuring that catheters are replaced only for appropriate indications and are removed when those indications no longer exist
  • Inserting catheters using aseptic technique and sterile equipment and adhering to universal precautions
  • Properly training healthcare workers
  • Ensuring that the urinary drainage system remains closed
  • Ensuring that catheters are properly maintained with unobstructed urine flow

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