ABOUT CATHETER ASSOCIATED URINARY TRACT INFECTIONS (CA-UTI’s)
Catheter Associated Urinary Tract Infections (CA-UTI’s) are significant unintended iatrogenic events in healthcare. The identification of a CA-UTI, whether accurately diagnosed, is often associated with additional testing, treatment, and length of stay for patients. If not diagnosed properly, there is an additional associated unnecessary cost borne by the healthcare system. CMS and other payers have penalties in place for organizations that have “too many” CA-UTI’s that are publicly reportable.
In 2022, St. Joseph’s Health had a total of 11 publicly reportable CAUTI’s. In addition, we had an additional 36 CAUTI’s that were not reportable but rose to the level of not being reimbursed by payers. The reason payers did not reimburse the hospital is because all CA-UTI’s are caused by the hospital and are considered preventable. The medical condition occurred on our watch since the condition was not present when the patient arrived at the hospital.
Did you know CA-UTI is an important metric measured in our Leap Frog Score? Likewise, CA-UTI is a major factor in determining our CMS Pay for performance scores? It is also a major part of CMS star rating determinations. Did you know a study from Yale hospitals revealed that 87% of urine cultures leading to CA-UTI were inappropriate? More than 50% of infections identified by urine culture are not treated, begging the question of why order a urine culture at all on these patients?
There is reason to believe CA-UTI should be a never event. True CA-UTI should be prevented with meticulous Foley bundle compliance and Foley care. Physicians play a huge role in preventing CA-UTI’s. You can help by critically evaluating whether you really need a Foley, critically evaluating once or twice daily whether a Foley is necessary and critically evaluating every U/A with reflex to culture you order.
There are excellent studies that demonstrate many urine cultures are ordered inappropriately. False positive CA-UTI is a major problem for us. This occurs when a urine and culture is ordered on a patient with a Foley while in the hospital without symptoms or another alternative source is equally as likely to cause the suspected infection. Remember that when a culture is ordered on a Foley it will come back positive for an organism most of the time forcing the provider document infection related to the catheter. Be careful what you wish for. If it is the only possible source for the infection, then it is very appropriate to order the culture but please be sure the patient has symptoms related to the catheter. Please only order U/A with reflex when there are clear UTI symptoms present. Avoid ordering urine with reflex to culture for fever alone, cloudy urine, strong urine smell, visible sediments, or blood-tinged urine as these cultures have a very low yield. Let’s all do our part in markedly reducing the number of urine cultures that we send, especially on Foley catheters.
Contact Dr. Russell Firman with questions at (315) 372-4484.
Thank you to Dr. Douglas Barton, CMO at St. Peter’s Health Partners, and Dr. Philip Falcone, CMO at St. Joseph’s Health, for contributing to this topic.