National trends in the frequency of bladder catheterization and physician-diagnosed catheter-associated urinary tract infections: Results from the Medicare Patient Safety Monitoring System

Background It is unclear if bladder catheterization and catheter-associated urinary tract infection (CAUTI) rates have changed since the implementation of public reporting in 2011. Methods We analyzed data from the Medicare Patient Safety Monitoring System, a national, chart abstraction–based surveillance system, for hospitalized adults with a principal discharge diagnosis of heart failure (HF), acute myocardial infarction (AMI), or pneumonia and patients who had undergone certain major surgeries. We assessed bladder catheterization frequency (percentage of patients catheterized) and risk-adjusted CAUTI frequency (percentage of catheterized patients developing CAUTI) from 2009-2014. Results Bladder catheterization frequency declined significantly (6.6% for AMI patients, 8.0% for HF patients, and 5.7% for surgical patients). For pneumonia patients, there was a nonsignificant increase of 1.1%. The risk-adjusted CAUTI rate among AMI patients decreased by 9.7% each year relative to the year before. For surgical patients, the decrease was 9.1% per year. There was no significant decline among HF or pneumonia patients. The overall burden of CAUTI among surgical patients was higher than for the other conditions because surgical patients were more likely to be catheterized. Conclusions There were statistically significant declines in observed bladder catheterization frequency and adjusted CAUTI frequency in some patient populations between 2009 and 2014.