Sarah Krein, PhD, RN
Sarah Krein PhD, RN, and Sanjay Saint, MD, MPH, are recipients of the 2017 HSR&D Health System Impact Award. This award honors HSR&D- and QUERI-funded research that has had a direct and important impact on clinical practice or clinical policy within the VA healthcare system – and that has been successfully translated into VA’s policy or operations.
Part of HSR&D’s Center for Clinical Management Research (CCMR) in Ann Arbor, MI, Drs. Krein and Saint earned the Impact Award for their scientific and operational efforts to make Veterans’ care safer by reducing the risks of unneeded and harmful urinary catheters. Their work has significantly changed practice across VA. Moreover, their work has driven changes in urinary catheter practice in the U.S. private sector and around the world.
Epidemiologic data have revealed that, rather than a simple convenience in caregiving, Foley catheters are a major source of iatrogenic infections—putting patients at risk. Dr. Saint, funded in part through a VA HSR&D Career Development Award, was the first to find that physicians are often unaware which patients have urinary catheters, the first to demonstrate that reminders can limit urinary catheterization, and the first to conduct a randomized trial comparing indwelling and condom catheters. Drs. Saint and Krein teamed up to lead their pioneering HSR&D-funded study to identify barriers and facilitators of the use of key infection prevention practices in U.S. hospitals. This research reinforced the need for a “Bladder Bundle” to reduce catheter-associated urinary tract infection (CAUTI) – one that focuses on multiple ways to decrease use of urinary catheters and increase the use of best infection control practices.
Sanjay Saint, MD, MPH
Drs. Saint and Krein then assisted VA’s National Center for Patient Safety (NCPS) in developing its VA-nationwide CAUTI Breakthrough Series. CAUTI rates fell from 2.37 per 1,000 catheter days before the Series to 1.06 per 1,000 catheter days during implementation. The success of the Bladder Bundle resulted in its national implementation – in more than 1,000 hospitals – through the support of the Agency for Healthcare Research and Quality (AHRQ). A follow-up AHRQ-funded study, guided by Drs. Saint and Krein, focused on CAUTI reduction in both community-based nursing homes and VA Community Living Centers, and CAUTI rates in community-based sites decreased by a remarkable 54% during that initiative.
Drs. Krein and Saint also focus on implementing practices to improve patient safety and have consistently produced findings that help VA reduce and prevent inadvertent harm to patients from the care they receive. HSR&D congratulates Drs. Krein and Saint on this well-deserved award and is grateful for their work on improving patient safety for our nation’s Veterans and the greater patient population.