SOURCE: VHA

February 17, 2010 11:17 ET

VHA Regional Network Initiative Helps Hospitals Save Money and Improve Patient Care

Arkansas and Oklahoma Hospitals Dramatically and Quickly Reduce Rate of Most Common Health Care-Associated Infection

IRVING, TX--(Marketwire - February 17, 2010) -  Catheter-associated urinary tract infections are the most frequently occurring health care-associated infection. While costly to the health care system, many CAUTIs are largely preventable and in February 2009, VHA Inc., the national health care network, working with hospitals in Arkansas and Oklahoma, set out to reduce the incidence of these infections. Eight hospitals participated in a VHA-sponsored Rapid Adoption Network focused on CAUTIs, and within six months, they had reduced CAUTIs by 60% in those hospital units where new standards of care were implemented. This means fewer patients endured extended hospital stays from unnecessary urinary tract infections and the hospitals didn't have to expend extra resources to treat them.

Each year, more than one million patients in U.S. acute-care hospitals and extended-care facilities develop CAUTIs, which make patients miserable, extend hospital stays and cost health care providers millions annually. In fact, CMS estimates the total cost to the health care system for treatment of CAUTIs to be as much as $450 million each year. VHA estimates the costs could actually reach $1 billion annually when factoring in various ancillary costs.

"The fact that CAUTIs are so prevalent has led some to believe that they are unavoidable. That's not true. We can probably prevent 70% of them," said Bruce Naylor, MD, vice president of clinical improvement for VHA's regional office in Oklahoma City. Naylor guided the hospital teams for VHA.

"I think it would be possible for hospitals across the U.S. to implement what these hospitals have done, and if they did, the savings could be significant and patients would be grateful," Naylor said.

Prior to participating in this program, the aggregate rate of CAUTIs for the group was 4.28 CAUTIS per 1,000 catheter days. While this rate was within the current national range for CAUTIs, which is between 3.1 to 7.5 CAUTIs per 1,000 catheter days, the hospitals saw the opportunity for improvement by implementing corrective measures.

As a result, the CAUTI rate for the hospitals in the VHA initiative dropped dramatically during the fourth quarter of 2009, to 1.7 CAUTIs per 1,000 catheter days -- well below the national average. This improvement means that 38 fewer CAUTIs occurred during that time period than were predicted, based on the baseline rates. Additionally, VHA predicts that the impact of the program, along with the associated cost savings, will be even larger than initially reported since the hospitals have yet to roll the initiative out to all nursing units. 

"The VHA program to reduce catheter-associated urinary tract infections was even more successful than we anticipated. In our hospital, we have virtually eliminated CAUTIs in the ICU, and those are our sickest patients. We couldn't be more pleased," said Patricia Dorris, the president of INTEGRIS Southwest Medical Center in Oklahoma City.

The hospitals participating in the VHA program are:

  • Comanche County Memorial Hospital, Lawton, Okla. 
  • INTEGRIS Southwest Medical Center, Oklahoma City 
  • McAlester Regional Health Center, McAlester, Okla. 
  • Norman Regional Health System, Norman, Okla.
  • Sparks Regional Medical Center, City, Fort Smith, Ark.
  • St. Bernards Medical Center, Jonesboro, Ark.
  • Unity Health Center, Shawnee, Okla.
  • Washington Regional Medical Center, Fayetteville, Ark.

Although most CAUTIs are asymptomatic and add only $500 to $1,000 to the direct costs of acute-care hospitalization, including laboratory tests and antibiotics, asymptomatic infections commonly precipitate unnecessary testing and antimicrobial-drug therapy and are associated with longer stays in the hospital. Based on 2007 MEDPAR data, Naylor said each patient hospitalized in Arkansas or Oklahoma who develop a CAUTI , stayed in the hospital four days longer and cost nearly $3,500 more when compared with similar patients without infections. 

Based on those figures, this small project saved the eight hospitals about $35,000 in direct costs, and by potentially avoiding extra days in the hospital, as much as $130,000 in total care costs.

Naylor identified the most common causes of CAUTIs to include:

  • Failure to place the catheter using sterile technique (e.g., handwashing and using barrier precautions such as sterile gloves, drape, sponges, antiseptic solution, and single-use packets of sterile lubricant)
  • Catheterizing patients unnecessarily for convenience of the nursing team 
  • Prolonged catheterization after a medical indicated catheterization
  • Failure to provide daily checks to see if the catheterization is still necessary and failure to remove the catheter when the patient is able to void on his own (nearly 50% of hospitals in some studies don't monitor catheterized patients regularly to verify that the catheter is still needed)
  • Variances in standards of nursing care for catheters (failure to secure the catheter, faulty positioning of the catheter and bag) both on the clinical floor, but also when patients go to X-ray, physical therapy, and other areas of the hospital
  • Failure to use the smallest possible catheter to minimize urethral trauma

The fact that the lowest CAUTI rates occurred during the fourth quarter of 2009 for the eight hospitals suggests to Naylor that the changes made in the processes of care are becoming established and more reliable to replicate. 

Naylor noted that 12% to 25% of hospitalized patients will receive indwelling urinary catheters, with a daily risk of infection in the range of 3% to 5%. Patients in the emergency department, surgical patients and older patient are more likely to be catheterized than others. 

About VHA

VHA Inc., based in Irving, Texas, is a national network of not-for-profit health care organizations that work together to drive maximum savings in the supply chain arena, set new levels of clinical performance, and identify and implement best practices to improve operational efficiency and clinical outcomes. Formed in 1977, through its 16 regional offices, VHA serves more than 1,400 hospitals and more than 25,500 non-acute care providers nationwide.

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