3053 — What Practices Are U. S. Hospitals Using to Prevent Hospital-Acquired Urinary Tract Infection and Why? A Mixed-Methods Study

Saint S (HSR&D COE, Ann Arbor), Kowalski CP (HSR&D COE, Ann Arbor), Krein SL (HSR&D COE, Ann Arbor)

Objectives:
Though urinary tract infection (UTI) is the most common nosocomial infection, no national data describe what U.S. hospitals are doing to prevent this problem. We conducted a national mixed-methods study, employing both quantitative and qualitative evaluation, to describe the current practices used by U.S. hospitals – VA and non-VA – to prevent nosocomial UTI and elucidate the key factors influencing a hospital’s decision to use certain practices.

Methods:
The quantitative phase entailed mailing written surveys to infection control coordinators at a national random sample of non-VA (n = 600) and all VA hospitals (n = 119). The survey asked about practices to prevent nosocomial infection, including UTI. The qualitative phase included semi-structured interviews with 86 individuals at 14 hospitals and in-person visits to 6 geographically diverse hospitals in order to identify factors influencing the use of various practices.

Results:
The survey response rate was 72%. Overall, 30% of hospitals regularly used antimicrobial urinary catheters and portable bladder scanners; 14% regularly used condom catheters in men; and 9% regularly used catheter reminders. VA hospitals were more likely than non-VA hospitals to use bladder scanners (49% vs. 29%, p < .001), condom catheters (46% vs. 12%, p < .001), and suprapubic catheters (22% vs. 9%, p < .001); non-VA hospitals were more likely to use antimicrobial catheters (30% vs. 14%, p = .002). Several qualitative themes emerged: 1) though preventing nosocomial UTI was a low priority, the value of early catheter removal was recognized; 2) sites that made UTI prevention a high priority focused on non-infectious complications of catheter use (e.g., patient immobility) and had committed champions; and 3) external forces – such as public reporting – influenced preventive activities.

Implications:
VA hospitals differed from non-VA hospitals in the use of several practices to prevent nosocomial UTI. However, catheter reminders are used in less than 10% of both VA and non-VA facilities, despite evidence of benefit.

Impacts:
We found several practical strategies that may promote UTI preventive practices, such as highlighting non-infectious complications of catheterization, supporting a dedicated champion (who need not be a physician), and – in VA hospitals – utilizing goal-sharing teams to motivate preventive activities.