The Agency for Healthcare Research and Quality issued in April its annual quality report including data on rates of healthcare-associated infections (HAI) in adult hospital patients tracked in the report. Five specific HAIs are tracked because of their high incidence and high costs, one of which is postoperative catheter-associated urinary tract infections (UTIs). The five are also targeted because they stem from categories housing "Never Events" because they never should happen in the course of a normal hospital stay when care meets established standards and protocols.
The term "Never Event" was first introduced in 2001 by the National Quality Forum (NQF), in reference to particularly shocking medical errors (such as wrong-site surgery) that should never occur. The NQF initially defined 28 such events in 2002. Four years later, the NQF revised and expanded the list. Over time, the list has been expanded to signify adverse events that are unambiguous (clearly identifiable and measurable), serious (resulting in death or significant disability), and usually preventable. The list is grouped into six categorical events: surgical, product or device, patient protection, care management, environmental, and criminal1. Not coincidentally, in August 2007, the Centers for Medicare and Medicaid (CMS) announced that beginning in 2008 it would no longer reimburse hospitals for costs associated with certain infections and complications occurring during hospitalization, including catheter-associated UTIs.2 These are also referred to as nosocomial UTIs. CMS for the first time, made a national policy statement drawing a direct connection between payment to hospitals for care and quality of the service provided.
Catheters are associated with colonization of bacteria and increased risks of clinical infection. While single-use, sterile catheters reduce the risks, they do not prevent UTIs. Although catheters specially coated with antimicrobial agents such as nitrofurazone have received considerable attention of late, they come at a sixfold increase in cost and raise questions about how to best select the most appropriate patients for their use.
Despite all of the attention and focus on this topic and other "Never Events," the latest quality report from AHRQ reveals postoperative catheter-associated UTIs increased by 3.6 percent in 2009. Such a fact begs the question of whether the attention and focus are where they need to be.
Nearly a decade ago, Kunin (2001) declared there is no need to wait for a mechanical or chemical answer to the problem of nosocomial UTIs because the culprits are "unnecessary and prolonged use of indwelling urinary catheters when they are no longer needed."3 This echoed a similar declaration published six years earlier by a group of clinicians.4
In the end, as with the practice of intermittent catheterization for physically emptying the bladder of stored urine, there is no substitute for maintaining proper care, while remaining alert to symptoms of UTI. There's help for that from NAFC and other reliable online sources. Make sure you or a loved one is getting the level of care they deserve.