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Catheter associated urinary tract infections are one of the most common hospital acquired infections.   449,334 infections occur each year at a cost of between $862 to $1007 for each infection.1   s Infections not associated with sepsis cost an average of $600 and those associated with sepsis an average of $2,800.2     Approximately 20% of patients admitted to a hospital receive a urinary catheter and each day 5% of these patients develop bacteria in their urine, however, most are asymptomatic and require no treatment.2    

One of the keys to prevention is to be sure the catheter is inserted using a meticulous sterile technique and to leave it in place for as short of a time as possible.3   Biofilms which promote infections can also be reduced by the use of lecithin/silver-coated catheters.4   

        
  MRSA Infections
  C. Diff.  Infections
  CLABSI Infections
  CAUTI Infections
  VAP  Infections
  Prevention of Events

In addition, it has been shown that the rate of urinary tract infections are sensitive to the registered nursing staffing levels in hospitals.5  Decreasing the number of patients that a registered nurse is responsible for lessens the chance of urinary tract infections.

To try to decrease the incidence of these infections Medicare has included them on a nonpayment list.   Actually, Medicare's billing is not simple.  Medicare does not bill for each service but a flat rate for the main admitting diagnosis called a "DRG".   The reimbursement for some but not all  "DRG"s may be increased by including a co-morbidity or major co-morbidity.   With certain DRGs, a catheter associated urinary tract infection may be coded as a co-morbidity and if associated with sepsis as a major co-morbidity.  However, if pre-existing, there will be no increase in payment.6   

A reported confounding factor is that hospital coders often only look at doctors' notes which often poorly document the status of the catheter.  The end result is that a significant number of hospital acquired infections are miscoded as being present on admission and/or not associated with catheter placement.7    

References 

  1. Scott, RD: CDC: Direct Medical Costs of Healthcare Acquired Infections and Benefits of Prevention. Table 6, Page 13, March 2009.  http://www.cdc.gov/ncidod/dhqp/pdf/Scott_CostPaper.pdf

  2. Sanjay Saint, MD, MPH; Jennifer A. Meddings, MD, MSc; David Calfee, MD, MS; Christine P. Kowalski, MPH; and Sarah L. Krein, PhD, RN Catheter-Associated Urinary Tract Infection and the Medicare Rule Changes Annals of Internal Medicine. Jun, 2009; 150 p 877-884. http://www.annals.org/content/150/12/877.full 

  3. Fakih MG, Dueweke C, Meisner S, Berriel-Cass D, Savoy-Moore R, Brach N, Rey J, DeSantis L, Saravolatz LD. Effect of nurse-led multidisciplinary rounds on reducing the unnecessary use of urinary catheterization in hospitalized patients. Infect Control Hosp Epidemiol. 2008 Sep;29(9):815-9. http://www.ncbi.nlm.nih.gov/pubmed/18700831  

  4. Kumon H, Hashimoto H, Nishimura M, Monden K, Ono N. Catheter-associated urinary tract infections: impact of catheter materials on their management. Int J Antimicrob Agents. 2001 Apr;17(4):311-6. http://www.ncbi.nlm.nih.gov/pubmed/11295414

  5. Needleman J, Buerhaus P, Mattke S, Stewart M, Zelevinsky K. Nurse-staffing levels and the quality of care in hospitals. N Engl J Med. 2002 May 30;346(22):1715-22. http://www.ncbi.nlm.nih.gov/pubmed/12037152

  6. Economic Impact of CAUTI. Take Every Precaution Technique and Technology.    http://www.takeeveryprecaution.com/education_economic.html

  7. Meddings J, Saint S, McMahon LF Jr. Hospital-acquired catheter-associated urinary tract infection: documentation and coding issues may reduce financial impact of Medicare's new payment policy. Infect Control Hosp Epidemiol. 2010 Jun;31(6):627-33.  http://www.ncbi.nlm.nih.gov/pubmed/20426577