Study reveals hospitals lag in urinary catheter safety, Mirage News reports

Only 49 percent of general hospitals and 32 percent of Department of Veterans Affairs hospitals maintain reminder systems or renewal mandates for urinary catheters, according to a study published on an unspecified date in JAMA Network Open and reported by Mirage News. That coverage gap persists despite 25 years of patient safety efforts to curb catheter-associated urinary tract infections.

Non-VA Hospital Prevention Practices Plateau or Decline

While non-VA hospitals increased their adoption of at least one of three core prevention practices from roughly 23 percent to nearly 70 percent over the prior two decades, that progress has recently plateaued or declined. The study evaluated 20 years of surveys administered every four years starting in 2005 to hospital infection prevention staff. Beyond the 49 percent of general hospitals utilizing physician reminder systems, 58 percent of non-VA facilities authorize nurses to remove unnecessary catheters without a doctor’s order. Among VA hospitals, those nurse-initiated removal protocols stand at 38 percent.

Portable bladder ultrasound scanners represent a more widely adopted control measure, with more than 70 percent of both VA and non-VA hospitals deploying the devices to guide catheter decisions.

Expert Assessment on Surveillance and Resource Gaps

Looking back over 20 years, it is encouraging to see how far hospitals have come in recognizing that urinary catheters are not benign devices and in building systems to use them more thoughtfully.

Sanjay Saint

Saint, a Professor Emeritus of Internal Medicine at the University of Michigan who is now at Northwell Health and the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, noted that ongoing vigilance remains necessary. At the same time, our findings are a reminder that progress is not self-sustaining, Saint stated, emphasizing that clinician reassessment prompts and nurse-removal policies must remain embedded in daily routines. Jennifer Meddings, a co-leader of the research and a professor at the U-M Medical School, expressed surprise that low-cost electronic reminders have failed to show significant recent improvement.

M. Todd Greene, an epidemiologist and research investigator at the VAAAHS and U-M, noted that future safety efforts should broaden beyond infection tracking. Expanding our tracking systems to better monitor, recognize, and prevent non-infectious complications will help to ensure we capture the full spectrum of device-related harms, Greene said.

Medicare Penalizes Hospitals with High Infection Rates

Federal reimbursement structures tie financial consequences directly to hospital infection rates. Medicare penalizes non-VA hospitals financially when traditional Medicare beneficiaries experience high rates of catheter-associated urinary tract infections, declining to reimburse institutions for the care costs associated with those infections. Public reporting platforms allow consumers to compare individual hospital infection rates.

To assist facilities with protocol implementation, the research team developed bladdersafe.org and launched a mobile application named BladderSafe to guide clinician decision-making. The platform includes a cost calculator designed to demonstrate long-term financial savings through reduced rates of bacteriuria, symptomatic urinary tract infections, and bloodstream complications.