Beginning October 1, the Centers for Medicare & Medicaid Services (CMS) will reduce payment for several preventable events, including catheter-associated urinary tract infections (CA-UTI), and facilities looking for ways to reduce the number of UTIs should consider using an age-old metal to assist them in their efforts.
A new study shows that silver-coated catheters have the potential to reduce the number of CA-UTIs.In fact, St. Vincent's Rehabilitation Hospital in Sherwood, AR, where the study was conducted, completely eliminated UTIs in the six months following the switch to silver-coated catheters. In the four months before silver-coated catheters were added, study authors Jackie Kassler, RN, and Josh Barnett, RN, CRRN, had detected 10 CA-UTIs.
"Ionic silver is effective against gram-positive and gram-negative bacteria, as well as fungi," according to Medline, Inc., the Mundelein, IL-based manufacturer of the catheters used in the study. Therefore, the coatings on the catheters can be effective against several UTI pathogens, including:
- Vancomycin-resistant enterococci
- Escherichia coli
- Candida albicans
- Staphylococcus aureus
UTIs are the most common hospital-associated infection, accounting for more than 40% of the total number of infections reported by acute care hospitals and affecting an estimated 600,000 patients per year, according to the CDC.
The CDC reports that 66%-86% of these infections occur after urinary catheterization or other instrumentation of the urinary tract. "Although not all catheter-associated urinary tract infections can be prevented, it is believed that a large number could be avoided by the proper management of the indwelling catheter," it states.
The switch to the silver catheters at St. Vincent's was made in conjunction with other recognized practices to reduce associated infections, such as immediately removing catheters that are no longer needed and avoiding catheters whenever possible, according to the study, "A Rehabilitation Hospital Experience with Ionic Silver Foley Catheters," published in the April Urologic Nursing, the official journal of the Society of Urological Nurses and Associates.
Not a new technology
Silver catheters have been on the market for a decade, and the data from this study support other studies that have tested the efficacy of silver-coated catheters, says Maureen Spencer, RN, MEd, IC manager at New England Baptist Hospital in Boston and an APIC member. Although the benefits of these catheters have been documented, few facilities are currently using the technology, likely due to the cost of the devices, she says. UTIs are relatively inexpensive to treat, which reduces the incentive to adopt a costly technology, says Spencer.
"Some facilities don't want to spend the extra money," she says. However, according to the study authors, the "cost of a CA-UTI can be a significant financial burden on both the patient and the facility." Cost was a main consideration when the facility made the decision to switch to the silver catheter.
What many facilities don't consider when weighing the cost of the devices is how much infections may be costing them-not in dollars spent to treat the infections, but in beds lost to patients who have had to extend their stay or be readmitted due to infection, says Spencer.
Reducing infections vastly increases the number of available beds and allows a facility to be more profitable, she adds.
In addition to implementing the use of silver-silicone closed-system devices, New England Baptist stopped the routine use of antibiotics, such as Bactrim, postoperatively to prevent CA-UTIs.
Instead, it only uses Bactrim if a patient develops postoperative urinary retention and needs to be recatheterized.
Ultimately, St. Vincent's made the decision to switch because hospital leaders thought it would provide better care for patients, according to the study.
Choosing a catheter
Although many facilities have opted against using silver catheters in the past, CMS' new policy reducing payment for CA-UTIs may spur many facilities to reconsider. If anything, the financial benefits of using them may become clearer, Spencer says. There are several brands of silver catheters on the market. Spencer's facility opted for a non-latex brand of silver catheter because the facility has a high proportion of patients who have become allergic to latex during repeated orthopedic surgery procedures.
Spencer says her facility didn't specifically compare the number of UTIs prior to and after it began using the technology, but it currently has a very low incidence of CA-UTIs. Those that occur are generally the result of urinary retention developed in the wake of surgery.
Training is key
If your facility opts to switch to silver catheters, make sure your staff members are properly trained on the technology, says Spencer. There are differences between traditional and silver catheters, so staff members should receive proper training and education. Catheter manufacturers offer training on the proper use of the devices.
Facilities should also ensure that staff members are trained in other practices, such as catheter removal and avoidance, to further reduce the potential for infection.
"Everyone is looking for ways to reduce their infection rate to zero," Spencer says.
"But you need a marriage of good practice, good education, and good products to achieve it," says Jennifer Tomes, director of marketing for urology at Medline.