March 06, 2012

Catheters, infections and ... you don't want to know

Elizabeth Newman, McKnight's Senior Editor

Urinary catheters were on my radar twice last week. The first involved a late-night trip to the vet with an unhappy cat. Said cat, Eli, spent about 36 hours hooked up to a urinary catheter before deciding to yank it out himself and insist on going to a home-based care environment. He did not care for either the catheter or his roommates. Perhaps you have been there.

The second was the indictment of a county official on my old home turf who allegedly asked his taxpayer-funded security detail to empty his catheter bag after he had back surgery (and it turns out that may have been one of the least gross things he did, according to this story).

Felines and county executives aside, urinary catheterization is a hot topic in long-term care. Last year, the Centers for Disease Control updated its catheter-association urinary tract infection (CAUTI) guidelines for the first time since 1981. Among its quality recommendations are installing alert systems as reminders to remove a catheter, and to have protocols for nurse removal of catheters. In 2010, an expert panel recommended that physicians should place 95% of catheter orders.

Earlier this year, the American Association of Critical-Care Nurses (AACN) issued a practice alert stressing the use of pre- and post-catheterization assessments to monitor catheter use and to nip infections early.

This is not just an academic or patient-care issue: It's one that's related to reimbursement. It's on the Centers for Medicare & Medicaid Services' Top Ten list for hospital-acquired infections, and CMS issued a rule last year that lets Medicaid not pay for preventable conditions, including pressure ulcers and CAUTIs.

As long-term care institutions become a part of a bundled payment system or Accountable Care Organizations, best practices in reducing CAUTIs will become standard. The good news is that there has been significant reduction in CAUTIs since 1990 and there are new ideas on how to engage clinicians.

But more discussion needs to happen among healthcare personnel, especially when forming care plans for senior residents. Have you found an effective way to reduce CAUTIs? If so, please share in the comments below.