• Sanjay Saint, M Todd Greene, Christine P Kowalski, Sam R Watson, Timothy P Hofer, and Sarah L Krein.
• VA Ann Arbor Healthcare System and Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109-2800, USA. saint@med.umich.edu
• JAMA Intern Med. 2013 May 27; 173 (10): 874-9.

ImportanceDespite the national goal to reduce catheter-associated urinary tract infection (CAUTI) by 25% by 2013, limited data exist describing prevention practices for CAUTI in US hospitals and none associate national practice use to CAUTI-specific standardized infection ratios (SIRs).ObjectivesTo identify practices currently used to prevent CAUTI and to compare use and SIRs for a national sample of US hospitals with hospitals in the state of Michigan, which launched a CAUTI prevention initiative in 2007 ("Keystone Bladder Bundle Initiative").Design And SettingIn 2009, we surveyed infection preventionists at a sample of US hospitals and all Michigan hospitals. CAUTI rate differences between Michigan and non-Michigan hospitals were assessed using SIRs.ParticipantsA total of 470 infection preventionists.Main Outcome MeasuresReported regular use of CAUTI prevention practices and CAUTI-specific SIR data.ResultsMichigan hospitals, compared with hospitals in the rest of the United States, more frequently participated in collaboratives to reduce health care-associated infection (94% vs 67%, P < .001) and used bladder scanners (53% vs 39%, P = .04), as well as catheter reminders or stop orders and/or nurse-initiated discontinuation (44% vs 23%, P < .001). More frequent use of preventive practices coincided with a 25% reduction in CAUTI rates in the state of Michigan, a significantly greater reduction than the 6% overall decrease observed in the rest of the United States.Conclusions And RelevanceWe observed more frequent use of key prevention practices and a lower rate of CAUTI in Michigan hospitals relative to non-Michigan hospitals. This may be related to Michigan's significantly higher use of practices aimed at timely removal of urinary catheters, the key focus area of Michigan's Keystone Bladder Bundle Initiative.

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