Awards and Career Milestones

HSR&D announces Health System Impact Award recipients

Drs. Sarah Krein and Sanjay Saint are recipients of the 2017 HSR&D Health System Impact Award. This award honors Health Services Research and Development-funded research that has had an important impact on clinical practice or policy within the VA health care system. It also acknowledges work that has been successfully translated into VA operations.

Krein and Saint earned the impact award for their efforts to make Veterans' care safer by reducing the risks of unneeded and potentially harmful urinary catheters. The researchers are part of the VA Center for Clinical Management Research in Ann Arbor, Michigan. Their work has significantly changed practice across VA. Moreover, it has also driven changes in urinary catheter practice across the U.S. private sector, and around the world.

Epidemiologic data have revealed that Foley catheters are a major source of infections—often putting patients at risk. Saint was the first to find that physicians often do not know if patients have urinary catheters, and the first to demonstrate that reminders can limit urinary catheterization. He was also the first investigator to conduct a randomized clinical trial comparing indwelling and condom catheters.

Saint and Krein teamed up to identify barriers and facilitators of infection-control practices in U.S. hospitals. Their research reinforced the need for the use of a "bladder bundle" to reduce catheter-associated urinary tract infections (CAUTI). A bladder bundle is a set of practices that were developed through the experiences of hospitals participating in the Michigan Health and Hospital Association's Keystone Center program to reduce unnecessary use of urinary catheters.

The success of the bladder bundle resulted in its national implementation in more than 1,000 hospitals through support of the Agency for Healthcare Research and Quality. A follow-up AHRQ-funded study, guided by Saint and Krein, focused on CAUTI reduction in both community-based nursing homes and VA Community Living Centers. CAUTI rates in community-based sites decreased by a remarkable 54 percent during that initiative.