Preventing Hospital‐Acquired Urinary Tract Infection in the United States: A National Study
1Veterans Affairs Ann Arbor Healthcare System, 2Department of Internal Medicine, University of Michigan Medical School, 3Veterans Affairs/University of Michigan Patient Safety Enhancement Program, 4University of Michigan School of Public Health, and 5Saint Joseph Mercy Health Care System, Ann Arbor, Michigan
Background.
Although urinary tract infection (UTI) is the most common hospital‐acquired infection in the United States, to our knowledge, no national data exist describing what hospitals in the United States are doing to prevent this patient safety problem. We conducted a national study to examine the current practices used by hospitals to prevent hospital‐acquired UTI.
Methods.We mailed written surveys to infection control coordinators at a national random sample of nonfederal US hospitals with an intensive care unit and 
50 hospital beds (
) and to all Veterans Affairs (VA) hospitals (
). The survey asked about practices to prevent hospital‐acquired UTI and other device‐associated infections.
Results.The response rate was 72%. Overall, 56% of hospitals did not have a system for monitoring which patients had urinary catheters placed, and 74% did not monitor catheter duration. Thirty percent of hospitals reported regularly using antimicrobial urinary catheters and portable bladder scanners; 14% used condom catheters, and 9% used catheter reminders. VA hospitals were more likely than non‐VA hospitals to use portable bladder scanners (49% vs. 29%; 
), condom catheters (46% vs. 12%; 
), and suprapubic catheters (22% vs. 9%; 
); non‐VA hospitals were more likely to use antimicrobial urinary catheters (30% vs. 14%; 
).
Conclusions.Despite the strong link between urinary catheters and subsequent UTI, we found no strategy that appeared to be widely used to prevent hospital‐acquired UTI. The most commonly used practices—bladder ultrasound and antimicrobial catheters—were each used in fewer than one‐third of hospitals, and urinary catheter reminders, which have proven benefits, were used in <10% of US hospitals.
Received 2 July 2007; accepted 4 September 2007; electronically published 4 December 2007.
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(See the editorial commentary by Nicolle on pages 251–3)
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The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.