***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: Background Hospitalized patients frequently have urinary catheters inserted for inappropriate reasons . This can lead to urinary tract infections and other complications . Objective To assess whether stop orders for indwelling urinary catheters reduces the duration of inappropriate urinary catheterization and the incidence of urinary tract infections . Design A r and omized controlled trial was conducted in three tertiary-care hospitals in Ontario , Canada . Patients with indwelling urinary catheters were r and omized to prewritten orders for the removal of urinary catheters if specified criteria were not present or to usual care . Participants Six hundred ninety-two hospitalized patients admitted to hospital with indwelling urinary catheters inserted for ≤48 h. Measurements The main outcomes included days of inappropriate indwelling catheter use , total days of catheter use , frequency of urinary tract infection , and catheter reinsertions . Results There were fewer days of inappropriate and total urinary catheter use in the stop-order group than in the usual care group ( difference −1.69 [ 95 % CI −1.23 to −2.15 ] , P < 0.001 and −1.34 days , [ 95 % CI , −0.64 to −2.05 days ] , P < 0.001 , respectively ) . Urinary tract infections occurred in 19.0 % of the stop-order group and 20.2 % of the usual care group , relative risk 0.94 ( 95 % CI , 0.66 to 1.33 ) , P = 0.71 . Catheter reinsertion occurred in 8.6 % of the stop-order group and 7.0 % in the usual care group , relative risk 1.23 ( 95 % CI , 0.72 to 2.11 ) , P = 0.45 . Conclusions Stop orders for urinary catheterization safely reduced duration of inappropriate urinary catheterization in hospitalized patients but did not reduce urinary tract infections BACKGROUND Although urinary tract infection ( UTI ) is the most common hospital-acquired infection in the United States , to our knowledge , no national data exist describing what hospitals in the United States are doing to prevent this patient safety problem . We conducted a national study to examine the current practice s used by hospitals to prevent hospital-acquired UTI . METHODS We mailed written surveys to  infection control coordinators at a national r and om sample of nonfederal US hospitals with an intensive care unit and > or=50 hospital beds ( n=600 ) and to all Veterans Affairs ( VA ) hospitals ( n=119 ) . The survey asked about practice s to prevent hospital-acquired UTI and other device-associated infections . RESULTS The response rate was 72 % . Overall , 56 % of hospitals did not have a system for monitoring which patients had urinary catheters placed , and 74 % did not monitor catheter duration . Thirty percent of hospitals reported regularly using antimicrobial urinary catheters and portable bladder scanners ; 14 % used condom catheters , and 9 % used catheter reminders .  VA hospitals were more likely than non-VA hospitals to use portable bladder scanners ( 49 % vs. 29 % ; P=.001 ) , condom catheters ( 46 % vs. 12 % ; P=.001 ) , and suprapubic catheters ( 22 % vs. 9 % ; P=.001 ) ; non-VA hospitals were more likely to use antimicrobial urinary catheters ( 30 % vs. 14 % ; P=.001 ) . CONCLUSIONS Despite the strong link between urinary catheters and subsequent UTI , we found no strategy that appeared to be widely used to prevent hospital-acquired UTI . The most commonly used practice s -- bladder ultrasound and antimicrobial catheters -- were each used in fewer than one-third of hospitals , and urinary catheter reminders , which have proven benefits , were used in < 10 % of US hospitals Background : Nosocomial infections occur in approximately 10 % of patients in intensive care units ( ICUs ) . Several studies have shown that a quality improvement initiative can reduce nosocomial infections , mortality , and cost . Context : Our hospital is located in Northern Mississippi and has a 28 bed Medical-Surgical ICU unit with 95 % occupancy . We joined the ICU collaborative with the IMPACT initiative of the Institute of Healthcare Improvement ( IHI ) in October 2002 . A preliminary prospect i ve before ( fiscal year ( FY ) 2001–2 ) and after ( FY 2003 ) hypothesis generating study was conducted of outcomes result ing from small tests of change in the management of ICU patients . Key measures for improvement : Nosocomial infection rates , adverse events per ICU day , average length of stay , and average cost per ICU episode . Strategy for change : Four changes were implemented : ( 1 ) physician led multidisciplinary rounds ; ( 2 ) daily “ flow ” meeting to assess bed availability ; ( 3 ) “ bundles ” ( sets of evidence based best practice s ) ; and ( 4 ) culture changes with a focus on the team decision making process . Effects of change : Between baseline and re-measurement periods , nosocomial infection rates declined for ventilator associated pneumonia ( from 7.5 to 3.2 per 1000 ventilator days , p = 0.04 ) and bloodstream infections ( from 5.9 to 3.1 per 1000 line days , p = 0.03 ) , with a downward trend in the rate of urinary tract infections ( from 3.8 to 2.4 per 1000 catheter days , p = 0.17 ) . There was a strong downward trend in the rates of adverse events in the ICU as well as the average length of stay per episode . From FY 2002 to FY 2003 the cost per ICU episode fell from $ 3406 to $ 2973 . Lessons learned : A systematic approach through collaboration with IHI ’s IMPACT initiative may have contributed to significant improvements in care in the ICU setting . Multidisciplinary teams appeared to improve communication , and bundles provided consistency of evidence based practice s. The flow meetings allowed for rapid prioritization of activity and a new decision making culture empowered team members . The impact of these changes needs to be assessed more widely using rigorous study design BACKGROUND The indwelling urinary tract catheter ( IUTC ) is an important aspect of medical care . We studied the prevalence of the unjustified use of the IUTC in hospitalized medical patients and identified situations associated with its unjustified use . METHODS This prospect i ve study involved 202 patients admitted to either the medical intensive care unit ( n = 135 ) or the medical floors ( n = 67 ) of a tertiary care university hospital who were catheterized during the hospital admission . An independent observer assessed the indication of initial catheterization  by chart review and interview with the patient and the nurse . The need for continued catheterization  was assessed daily by the same observer . The proportion of unjustified IUTC placement was determined using the study guidelines . Complications as a direct consequence of catheter use were recorded . RESULTS Of the 202 patients who were studied , the initial indication for the placement of an IUTC was found to be unjustified in 21 % ( 95 % confidence interval [ CI ] , 15 % to 27 % ) . Continued catheterization  was unjustified in 47 % ( 95 % CI , 42 % to 57 % ) of 912 patient-days with IUTC studied . In the medical intensive care unit , 64 % ( 95 % CI , 58 % to 70 % ) of the total unjustified patient-days with IUTC result ed from its excessively prolonged use for monitoring urine output . Urinary incontinence was found to be the major cause of unjustified initial ( [ 52 % ] 95 % CI , 32 % to 74 % ) and continued ( [ 56 % ] 95 % CI , 50 % to 62 % ) use of IUTC in the noncritical care areas . Catheter-related urinary tract infection requiring intravenous antibiotics or continuous bladder irrigation with amphotericin B was observed in 5 % of the patients . CONCLUSIONS The IUTCs are significantly overused in hospitalized medical patients and careful attention to this aspect of medical care may reduce catheter-related complications by primary prevention Catheter-associated urinary tract infection ( CAUTI ) is one of the most common types of nosocomial infection . Reducing the duration of catheterization may be a key intervention in CAUTI prevention . We carried out a prospect i ve time-sequence , non-r and omized intervention study in five departments of our university hospital . We wished to determine the impact of daily reminders from nurses to physicians to remove unnecessary urinary catheters four days after insertion . The intervention significantly decreased the duration of catheterization in two out of five departments . The frequency of late CAUTI ( LCAUTI ) among catheterized patients in all five departments decreased from 10.6 to 1.1 per 100 patients ( P = 0.003 ) and the incidence of LCAUTI decreased from 12.3 to 1.8 per 1000 catheter-days ( P = 0.03 ) . Logistic regression analysis showed that duration of catheterization and iterative catheter changes were associated with LCAUTI . This study demonstrates that a simple measure can reduce the frequency of LCAUTI By failing to prepare , you are preparing to fail . Benjamin Franklin , inventor of the flexible urinary catheter Catheter-associated urinary tract infection is the most frequent health c areas sociated infection in the United States ( 1 , 2 ) . Urinary catheter use is common , with approximately 1 in 5 patients admitted to an acute care hospital receiving an indwelling catheter ( 1 , 3 ) , and the rate of catheter use is even higher among Medicare patients ( 4 ) . Infection frequently occurs after placement of urinary catheters ; each day of catheter use is associated with an approximately 5 % increase in bacteriuria ( 5 ) , which is asymptomatic most of the time ( 3 , 6 ) and usually requires no treatment . Because clinicians must distinguish asymptomatic bacteriuria from symptomatic urinary tract infection to avoid unnecessary administration of antimicrobial therapy , we provide a clinical definition of asymptomatic bacteriuria in Table 1 ( 7 ) . Each episode of catheter-associated urinary tract infection costs at least $ 600 ( 3 , 8 , 9 ) , and each episode of urinary tractrelated bacteremia costs at least $ 2800 ( 3 , 10 ) . Because catheter-associated urinary tract infection is common , costly , and believed to be reasonably preventable , the Centers for Medicare & Medicaid Services ( CMS ) chose it as 1 of the complications for which hospitals no longer receive additional payment to compensate for the extra cost of treatment ( as of 1 October 2008 ) . Thus , from a hospital 's perspective , catheter-associated urinary tract infection may become an even more costly complication ( 1113 ) . Table 1 . Clinical Definition of Asymptomatic Bacteriuria Because of the possible far-reaching consequences of the CMS rule changes and the high frequency of catheter-associated infection , our aim in this Perspective is to provide practical and timely information and guidance for hospital-based administrators , policymakers , epidemiologists , and clinicians . We first address the preventability of catheter-associated urinary tract infection , then discuss the CMS rule changes about payment for treatment of catheter-associated urinary tract infection . Finally , we offer our assessment of the possible consequences of the rule changes as well as our guidance for hospital administrators and clinicians . How Preventable Is Catheter-Associated Urinary Tract Infection ? The Centers for Medicare & Medicaid Services were asked to select hospital-acquired complications that could reasonably be prevented through the application of evidence -based guidelines . Does catheter-associated urinary tract infection fit this criterion ? Perhaps . More than 2 decades ago , the Centers for Disease Control and Prevention proposed some recommended practice s for preventing catheter-associated urinary tract infection that appropriately emphasize the benefits of h and hygiene , aseptic catheter insertion , and proper maintenance by using a closed urinary drainage system ( 14 ) . More recently , the Healthcare-Associated Infections Allied Task Force from the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America provided an evidence -based compendium of the various practice s available ( 15 , 16 ) . With regard to catheter-associated urinary tract infection , the compendium focused on the importance of maintaining an appropriate infrastructure for infection surveillance and prevention , education , and training of health care personnel about catheter-associated urinary tract infection , appropriate insertion and maintenance of the indwelling catheter , consideration of alternatives to indwelling catheter use ( for example , condom and intermittent catheterization ) , and early removal of the indwelling catheter by using reminders or stop orders ( 15 , 16 ) . Of note , practice s also can be bundled together , as demonstrated by the approach used in Michigan intensive care units to reduce the incidence of vascular catheterrelated infection ( 17 ) . Studies of multimodal interventions include such interventions as educational programs directed at nurses , physicians , or both ( included nearly universally in the studies we review ed for this article ) ; restricting the initial placement of indwelling urinary catheters in various setting s ( for example , emergency department , intensive care unit or inpatient floor , preoperative area or operative room ) ; systems to remind physicians or nurses 
    Output:
    
Urinary catheter reminders and stop orders appear to reduce the rate of CAUTI and should be strongly considered to enhance the safety of hospitalized patients