Healthcare Policy and Catheter Associated Urinary Tract Infections

Galiczewski JM*

School of Nursing, Stony Brook University, USA

*Corresponding author: Janet M Galiczewski, Clinical Assistant Professor, Stony Brook University, School of Nursing, Critical Care Nurse, Medical Intensive Care Unit Long Island Jewish Medical Center, Northwell Health, Stony Brook University, School of Nursing, HSC Level 2- 204, Stony Brook, New York 11794-8240, USA

Received: November 17, 2016; Accepted: November 29, 2016; Published: November 30, 2016

Abstract

An increase in Catheter Associated Urinary Tract Infections (CAUTI) has prompted the development of infection control protocols in healthcare settings and changes in healthcare policy. The intention of these program and policy changes is to decrease the incidence of CAUTI and improve patient outcomes. Provisions in the American Medicare Modernization Act of 2003 and the Reduction Act of 2005 created the foundation for government funded reimbursement to be limited for healthcare associated infections. Since the establishment of this healthcare policy, interventions with the greatest impact on CAUTI rates have been identified through evidence-based research. Enacted healthcare policies for limiting reimbursement for CAUTI events has had an overall positive effect on the hospitalized patient population by deceasing CAUTI rates.

Keywords: Catheter Associated Urinary Tract Infection (CAUTI); Healthcare Policy

Introduction

Catheter Associated Urinary Tract Infections (CAUTI) account for over 35% of all Healthcare Associated Infections (HAI) reported in the Unites States [1]. Urosepsis from an indwelling catheter leads to a significant increase in patient morbidity and mortality and generates an economic and financial burden on healthcare systems [2]. The increase in CAUTI incidence has prompted the development of infection control protocols in healthcare settings and changes in healthcare policy. The intention of these program and policy changes is to decrease the incidence of CAUTI and improve patient outcomes [3].

Policy

Provisions in the American Medicare Modernization Act of 2003 and the Reduction Act of 2005 created the foundation for government funded reimbursement to be limited for healthcare associated infections [4]. In 2008, the incidence of CAUTI reached almost two million cases per year and the Centers of Medicare and Medicaid Services (CMMS) deemed CAUTI a “never event” limiting reimbursement [5]. A never event is considered preventable. In one calendar year, CAUTI can add up to almost 100,000 hospital days and over 400 million dollars [6]. As a result of these enacted policies, hospitals in the United States have implemented various programs and protocols aiming to reduce this HAI. Preventative measures such as educational strategies, catheter avoidance, policies for catheter insertion, catheter selection, daily necessity review and limiting catheter days have shown success in decreasing CAUTI rates nationally and abroad [7].

The Centers of Disease Control and Prevention’s National Healthcare Safety Network (NHSN) is the most widely used HAI tracking system in the United States. It is used by CMMS to evaluate a healthcare institution’s progress in combating CAUTI. National surveillance data and public health research provide supportive evidence that HAIs are responsible for negative patient outcomes, increased length of stay and major hospital debt [8,9]. Clearly based on this research data, CMMS needed to limit funding to institutions that did not reduce this preventable HAI.

Results

The goal of the CMMS policy was to provide a strong financial incentive for healthcare institutions to reduce the probability of patients acquiring urinary catheter infections by improving the quality of patient care [4]. Since the establishment of this healthcare policy, interventions with the greatest impact on CAUTI rates have been identified through evidence-based research. These interventions were bundled into protocol-based guidelines for catheter insertion to standardize care and to optimize patient outcomes [10]. A post policy study conducted by Peasah et al. (2013) concluded that the CMMS non-payment policy was significantly associated (p < 0.0001) with a decline in CAUTI rates.

Conclusion

The decline in the national CAUTI rate led to decreased healthcare costs and improved patient mortality and morbidity [11]. A higher standard of care has resulted in better patient outcomes. The enacted CMMS healthcare policy for limiting reimbursement for CAUTI events has had an overall positive effect on the hospitalized patient population.