Healthcare-associated infections are common, costly, and potentially deadly. However, effective prevention strategies are underutilized, particularly for catheter-associated urinary tract infection (CAUTI), one of the most common healthcare-associated infections. Conferring to Kennedy, Greene, & Saint (2016), “healthcare-associated infections affect 5% to 10% of all hospitalized patients each year in the United States, account for nearly *45 billion in direct hospital costs, and cause nearly 100,000 deaths annually.” Because catheter-associated urinary tract infection (CAUTI) is one of the most common healthcare-associated infections in the United States and is reasonably preventable, the Centers for Medicare and Medicaid Services stopped reimbursing hospitals in 2008 for the additional costs of caring for patients who develop CAUTI during hospitalization.
CAUTI has significant clinical and economic consequences. Catheter-associated bacteriuria may be associated with excess mortality, even after controlling for under-lying factors such as severity of illness and comorbidities; hospital-onset bloodstream infection resulting from a urinary source has a case fatality of 32.8%. In addition, each episode of CAUTI is estimated to cost at least $600 while urinary-tract-related bloodstream infection costs at least $2,800. Consequently, CAUTIs result in as much as $131 million excess direct medical costs nationwide annually (Chenoweth, & Saint, 2016).
Under quality aspect, consulting between nurses and physician and inserting catheters when absolutely necessary is a requisite to prevent associated infection. Also, removing the catheter as soon as it is no longer needed, a maneuver which may be prompted by automated computer stop orders is a quality aspect that has helped stop urinary tract infection.
Reducing CAUTI requires both nurse and physician support. Although a physician order has been historically viewed as essential to place or discontinue the catheter, nurses may be empowered to make decisions about removal without a physician order in some settings, and they are most affected with respect to workload if the catheter is discontinued. In a recent survey, “the vast majority of nurses viewed themselves as responsible for the evaluation and discontinuation of the catheter, but only two-thirds thought it does not affect their workload” (Chenoweth, & Saint, 2016). Most of the work to reduce unnecessary urinary catheter use involves a nurse-driven assessment for appropriateness, with many requiring physician approvals for discontinuation.