Mohamad Fakih, MD, Senior Medical Director, Ascension Center of Excellence for Antimicrobial Stewardship and Infection Prevention, co-authored a recent article in the New England Journal of Medicine on a study about prevention of catheter-associated urinary tract infection (CAUTI) in the acute care setting.
The paper shared findings from a Comprehensive Unit-based Safety Program (CUSP) project called "On the CUSP: Stop CAUTI." The project led to a reduction in CAUTI – a common healthcare-associated infection – in non-intensive care units (ICUs) by 32 percent.
St. John Hospital and Medical Center in Detroit, part of Ascension Michigan, participated in the study; Karen Jones, RN, MPH, St. John Hospital and Medical Center, also served on The National Project Team with faculty from the University of Michigan, the Michigan Health & Hospital Association Keystone Center, and Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality.
"We are proud to see some of the work that was piloted at St. John Hospital and Medical Center was replicated and adopted in many other hospitals, leading to less patient harm," Dr. Fakih said.
"CAUTI is certainly not a 'sexy' healthcare-associated condition, but how a hospital addresses CAUTI likely says much about how such a facility attacks other endemic and mundane harms such as falls, delirium and pressure sores," Dr. Fakih says in this blog post.
In 2006, with the support of an Ascension grant, St. John Hospital and Medical Center piloted a nurse-led multidisciplinary approachto evaluate the need for urinary catheters. The pilot was associated with a 45 percent reduction of unnecessary use. Based on that work, St. John took part in a state-wide collaborative using a nurse-driven evaluation of urinary catheters in Michigan was associated with improvements in use of the device.
St. John faculty went on to participate in the On the CUSP: Stop CAUTI project, funded by the Agency for Healthcare Research and Quality (AHRQ) and coordinated by the Health Research and Educational Trust.
The paper describes findings from the first four (of nine) cohorts that participated in the initiative, which encompassed 926 units in 603 hospitals across 32 states, the District of Columbia, and Puerto Rico – including St. John.
By the end of the first four cohorts, researchers found no significant reduction in use of catheters or rate of CAUTI in the ICU setting, whereas CAUTI rates decreased by 32 percent and catheter use by 7 percent in non-ICUs.
"Patient safety has always been a primary objective for St. John Hospital and Medical Center. Participation in this study exemplifies our commitment to Ascension's Quadruple Aim of improving patient outcomes, provider and patient experience all at a lower overall cost of care," said Kevin Grady, MD, Chief Medical Officer and Director of Pulmonary-Critical Care Services at St. John Hospital and Medical Center. "We are honored to play a part in this national study, which has led to a significant reduction in CAUTIs."
St. John's participation with the On the CUSP: Stop CAUTI initiative parallels Ascension's System-wide efforts to reduce the utilization of catheters and rate of CAUTI. A study published in 2014 in the Annals of Emergency Medicine highlights the collaborative work of 18 Ascension emergency departments to reduce unnecessary urinary catheter use.
The Ascension study was led by Dr. Fakih and initiated under the Partnership for Patients program, an initiative of the Centers for Medicare and Medicaid Services. Through standardizing the process, the program resulted in a 30 percent reduction in use of newly placed catheters, which was sustained during a six-month period.
"Ascension continues to demonstrate its longstanding commitment to patient safety through efforts such as our ongoing participation with Partnership for Patients and AHRQ," said Ann Hendrich, PhD, RN, FAAN, Senior Vice President, Chief Quality/Safety and Nursing Officer for Ascension Health. "Our hospitals are leading the transformation of healthcare through implementing strategies that protect patients from avoidable harm and improve outcomes."