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Reducing Catheter-associated Urinary Tract Infections in Nursing-home Residents

A recent report highlights a successful effort to prevent catheter-associated urinary tract infection (CAUTI) in people residing in nursing homes. CAUTI is a chronic, costly, and potentially dangerous problem for people living in managed care facilities. Residents of nursing homes may use a urinary catheter for several reasons including urinary incontinence, urinary retention, urinary obstruction, accurate measurement of urinary output, required immobilization following trauma or surgery, and hospice or palliative care. Unfortunately, CAUTI can lead to hospitalization, cause a life-threatening condition called sepsis, and result in the spread of bacteria that are resistant to antibiotic treatment in this vulnerable population. While efforts to reduce such infections have included approaches to reducing the frequency of catheter usage, strategies need to be developed and tested to prevent infections in people who continue to require the use of urinary catheters.

Researchers now have reported the success of a multicomponent strategy to reduce CAUTI, as tested in 404 community-based nursing homes in 38 states. The strategy included, for example, training in proper aseptic (germ-free) insertion of catheters, catheter care and incontinence care planning, and catheter removal. Other components of the strategy addressed empowering facility teams, offering solutions to overcome barriers, resident and family engagement, and effective communications. This multi-pronged strategy did not reduce the frequency of catheter use, yet it succeeded in decreasing urinary tract infection rates by 54 percent—as compared to the infection rate at the same facilities before the study began.

The compelling results of this Agency for Healthcare Research and Quality (AHRQ)-led study, to which NIDDK and other organizations provided additional support, suggest this approach would be highly beneficial for people in nursing homes nationwide. To facilitate adoption of these methods, AHRQ has developed a toolkit to reduce CAUTI and other healthcare-associated infections in long term care facilities.

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