Skip to main content Accessibility help

A Multicenter Qualitative Study on Preventing Hospital-Acquired Urinary Tract Infection in US Hospitals

  • Sanjay Saint (a1) (a2) (a3), Christine P. Kowalski (a1), Jane Forman (a1), Laura Damschroder (a1), Timothy P. Hofer (a1) (a2) (a3), Samuel R. Kaufman (a2) (a3), John W. Creswell (a4) and Sarah L. Krein (a1) (a2)...



Although urinary tract infection (UTI) is the most common hospital-acquired infection, there is little information about why hospitals use or do not use a range of available preventive practices. We thus conducted a multicenter study to understand better how US hospitals approach the prevention of hospital-acquired UTI.


This research is part of a larger study employing both quantitative and qualitative methods. The qualitative phase consisted of 38 semistructured phone interviews with key personnel at 14 purposefully sampled US hospitals and 39 in-person interviews at 5 of those 14 hospitals, to identify recurrent and unifying themes that characterize how hospitals have addressed hospital-acquired UTI.


Four recurrent themes emerged from our study data. First, although preventing hospital-acquired UTI was a low priority for most hospitals, there was substantial recognition of the value of early removal of a urinary catheter for patients. Second, those hospitals that made UTI prevention a high priority also focused on noninfectious complications and had committed advocates, or “champions,” who facilitated prevention activities. Third, hospital-specific pilot studies were important in deciding whether or not to use devices such as antimicrobial-impregnated catheters. Finally, external forces, such as public reporting, influenced UTI surveillance and infection prevention activities.


Clinicians and policy makers can use our findings to develop initiatives that, for example, use a champion to promote the removal of unnecessary urinary catheters or exploit external forces, such public reporting, to enhance patient safety.


Corresponding author

Room 7E08, 300 N. Ingalls, Ann Arbor, MI 48109-0429 (
Veterans Affairs Health Services Research and Development Service, Room 11H, 2215 Fuller Road, Ann Arbor, MI 48105 (


Hide All
1.Burke, JP. Patient safety: infection control—a problem for patient safety. N Engl J Med 2003;348:651656.
2.Gerberding, JL. Hospital-onset infections: a patient safety issue. Ann Intern Med 2002;137:665670.
3.Haley, RW, Culver, DH, White, JW, Morgan, WM, Emori, TG. The nationwide nosocomial infection rate: a new need for vital statistics. Am J Epidemiol 1985;121:159167.
4.Haley, RW, Hooton, TM, Culver, DH, et al.Nosocomial infections in U.S. hospitals, 1975-1976: estimated frequency by selected characteristics of Patients. Am J Med 1981;70:947959.
5.Saint, S, Wiese, J, Amory, JK, et al.Are physicians aware of which of their patients have indwelling urinary catheters? Am J Med 2000;109:476480.
6.Johnson, JR, Kuskowski, MA, Wilt, TJ. Systematic review: antimicrobial urinary catheters to prevent catheter-associated urinary tract infection in hospitalized Patients. Ann Intern Med 2006;144:116126.
7.Karchmer, TB, Giannetta, ET, Muto, CA, Strain, BA, Farr, BM. A randomized crossover study of silver-coated urinary catheters in hospitalized Patients. Arch Intern Med 2000;160:32943298.
8.Brosnahan, J, Jull, A, Tracy, C. Types of urethral catheters for management of short-term voiding problems in hospitalised adults. Cochrane Database of Syst Rev 2004:CD004013.
9.Cornia, PB, Amory, JK, Fraser, S, Saint, S, Lipsky, BA. Computer-based order entry decreases duration of indwelling urinary catheterization in hospitalized Patients. Am J Med 2003;114:404407.
10.Huang, WC, Wann, SR, Lin, SL, et al.Catheter-associated urinary tract infections in intensive care units can be reduced by prompting physicians to remove unnecessary catheters. Infect Control Hosp Epidemiol 2004;25:974978.
11.Saint, S, Kaufman, SR, Rogers, MA, Baker, PD, Ossenkop, K, Lipsky, BA. Condom versus indwelling urinary catheters: a randomized trial. J Am Geriatr Soc 2006;54:10551061.
12.Saint, S, Lipsky, BA, Goold, SD. Indwelling urinary catheters: a one-point restraint? Ann Intern Med 2002;137:125127.
13.Warren, JW. Catheter-associated urinary tract infections. Int J Antimicrob Agents 2001;17:299303.
14.Warren, JW. The catheter and urinary tract infection. Med Clin North Am 1991;75:481493.
15.Stamm, WE. Catheter-associated urinary tract infections: epidemiology, pathogenesis, and prevention. Am J Med 1991;91:65S71S.
16.Maki, DG, Tambyah, PA. Engineering out the risk for infection with urinary catheters. Emerg Infect Dis 2001;7:342347.
17.Saint, S, Chenoweth, CE. Biofilms and catheter-associated urinary tract infections. Infect Dis Clin North Am 2003;17:411432.
18.Saint, S, Lipsky, BA. Preventing catheter-related bacteriuria: can we? should we? how? Arch Intern Med 1999;159:800808.
19.Saint, S, Kowalski, CP, Kaufman, SR, et al.Preventing hospital-acquired urinary tract infection in the United States: a national study. Clin Infect Dis 2008;46:243250.
20.Krein, SL, Hofer, TP, Kowalski, CP, et al.Use of central venous catheter-related bloodstream infection prevention practices by US hospitals. Mayo Clin Proc 2007;82:672678.
21.Krein, SL, Olmsted, RN, Hofer, TP, et al.Translating infection prevention evidence into practice using quantitative and qualitative research. Am J Infect Control 2006;34:507512.
22.Patton, MQ. Qualitative Research and Evaluation Methods. 3rd ed. Thousand Oaks, CA: Sage Publications; 2002.
23.Weiss, RS. Learning From Strangers: the art and method of qualitative interview studies. New York: The Free Press; 1994.
24.Sandelowski, M. Focus on research methods: whatever happened to qualitative description? Res Nurs Health 2000;23:334340.
25.Mason, J. Qualitative Researching. Thousand Oaks, CA: Sage Publications; 2002.
26.Sandelowski, M, Barroso, J. Writing the proposal for a qualitative research methodology project. Qual Health Res 2003;13:781820.
27.Creswell, JW. Educational Research: Planning, Conducting, and Evaluating Quantitative and Qualitative Approaches to Research. Upper Saddle River, NJ: Merrill/Pearson Education; 2002.
28.Greenhalgh, T, Robert, G, Macfarlane, F, Bate, P, Kyriakidou, O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q 2004;82:581629.
29.Pear, R. Medicare says it won't cover hospital errors. The New York Times August 19, 2007:A1.

Related content

Powered by UNSILO

A Multicenter Qualitative Study on Preventing Hospital-Acquired Urinary Tract Infection in US Hospitals

  • Sanjay Saint (a1) (a2) (a3), Christine P. Kowalski (a1), Jane Forman (a1), Laura Damschroder (a1), Timothy P. Hofer (a1) (a2) (a3), Samuel R. Kaufman (a2) (a3), John W. Creswell (a4) and Sarah L. Krein (a1) (a2)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.