We’ve posted previously about the dangers of catheter-related bloodstream infections and the option of using safer technology to prevent them. With the emergence of a new, safer device for urinary catheterization, it’s time to apply the same logic to catheter-associated urinary tract infections (CAUTIs).
The association between CAUTIs and the common use of Foley catheters is outlined in this new multimedia white paper. For results of a national survey of infection preventionists about CAUTIs, click here.
Some background on the issue:
Urinary tract infections are the most common healthcare-associated infection (HAI) and about 75% are tied to use of a urinary catheter, says the CDC. CAUTIs can kill people and maim budgets. They lead to an attributable 13,000 deaths a year in the U.S.
CAUTIs add anywhere from over $400 million (CDC) to over $3 billion annually (APIC) to U.S. healthcare costs. They also threaten a hospital’s bottom line — because Medicare, Medicaid, and many private insurers don’t reimburse for the infections and the Affordable Care Act (AKA Obamacare) penalizes hospitals for high CAUTI rates.
For more on what infection preventionists say about CAUTIs, see results of a national survey we conducted this year, available here.
The various recommended protocols to prevent CAUTIs include steps such as:
- Only using catheters when indicated (studies suggest the catheters are substantially overused
- Leaving the catheter in place only as long as necessary
- Applying strict safety standards for catheter insertion and maintenance, and
- Using alternatives whenever possible.
But even if these protocols were sufficient to prevent most CAUTIs – and they’re not, for reasons we’re about to explain – there are barriers to them being as effective as intended.
For instance, most hospitals require a physician’s order before a nurse can remove the catheter. That means the physician has to find the time and also agree that the catheter is no longer required and can come out. Obviously, such policies can and do cause delays that increase the danger of infections and other complications. In addition, pressed by a million-item to-do list, nurses can forget a catheter was placed or not have the time to follow through on a checklist.
So protocols aren’t a perfect preventive. Nor are they adequate in the zero-tolerance environment created by public and private payers.
But here’s the real kicker: Even if the protocols were followed perfectly, they still wouldn’t be sufficient because many CAUTIs and other catheterization-associated complications are caused by design issues with the standard urinary catheter itself.
The new multimedia white paper outlining these challenges is available here.
As research shows, the standard device known as the Foley catheter has a poorly designed tip that can damage the delicate mucosal lining of the bladder and the natural defense against infection it provides. The Foley also has poorly situated, exposed drainage eyes. Sometimes as the bladder drains, the wall will collapse around the catheter tube that contains the eyes and be sucked into the holes. This, too, injures the mucosal lining and can also block urine from draining through the catheter. Both problems are potential precursors to infection.
How can such a widely used device be prone to such problems? Well, the Foley was first introduced in 1937 and hasn’t been fundamentally updated since. Imagine that was true of cars — and you were driving today on a crowded freeway without seatbelts, air conditioning, antilock brakes, and power steering.
A national survey that we conducted this year shows that clinicians recognize the shortcomings of the Foley. For results of the survey, click here. The Foley is configured so that the tip and drainage eyes are fully exposed with a single retention balloon to hold the catheter in place.
A new alternative to the Foley catheter is the Duette™ Urinary Drainage System, developed by Poiesis Medical. The Duette™ was created to address the CAUTI-causing flaws of the Foley catheter. The Duette™ instead uses two balloons — a retention balloon and a bladder protection balloon. Upon inflation, the tip is subsumed within the bladder protection balloon to prevent it from causing pressure damage to the mucosal lining and bladder wall. In addition, the Duette smartly has its drainage situated between the two balloons, to prevent aspiration of the mucosal lining and wall into the drainage eyes, thereby ensuring proper drainage.
Early clinical experience at two large Florida hospitals has shown that the Duette™ can substantially decrease infection rates. Because it can be both placed and removed like a basic Foley, there are no obvious barriers to hospitals’ transitioning to the Duette™ – other than the usual ones related to trying something different. The financial incentives to reduce CAUTIs – such as non-reimbursement and costly penalties – should tend to speed up the change process. We’ll write more about CAUTIs as the story unfolds.