This Hospital Infection Don't Get No Respect

Cheryl Clark, for HealthLeaders Media , May 30, 2013

"The single most important way to prevent CLABSI is to put chlorhexidine gluconate rather than povidone-iodine in the central venous catheter tray," Saint says. "Once you do that, by default, people who insert the catheter will use chlorhexidine, and this single intervention will reduce infections 50%.

But with CAUTI, there is no such simple technical solution. The main interventions require more challenging behavior changes, "and that's the reason CAUTIs will not likely be decreasing at the same rate as CLABSIs," Saint says.

Sarah Krein, a co-author on the two papers with Saint, pointed out during an interview this week that many nursing staff don't fear the CAUTI as much as they do other infections because, "it's just one of those events that people think is very treatable. A lot of nurses have experienced UTIs themselves, and they haven't died."

Additionally, mortality from CAUTI is relatively rare, occurring usually when the infection gets into the bloodstream, which Saint says happens in only 1% to 3% of patients, and usually just to those who are already very sick with serious illnesses or compromised immune systems.

She and Saint say that providers also believe— lthough there is little evidence this is so and in fact the opposite may be true—that if they remove the catheter, the patient will be more likely to get out of bed and fall perhaps trying to find the bathroom. In fact, since having a catheter prompts the urge to urinate, patients may try to get out of bed more often, forgetting the catheter is attached.

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