Creation of a Measurable Daily Assessment Tool for Indwelling Urinary Catheter (IUC) Need Reduces IUC Utilization

Background: With many third-party payers denying reimbursement for nosocomial infections, there is increasing incentive to reduce nosocomial catheter-associated urinary tract infection (CAUTI) rates. Studies have shown that daily assessment of continued indwelling urinary catheter (IUC) need diminishes usage, therefore decreasing infections. However, no standardized specific assessment tool has been suggested. We hypothesized that creation of a three component measurable urinary tract infection (UTI) bundle with daily IUC assessment, insertion checklist, and confirmation of aseptic insertion technique would decrease IUC utilization and thus UTI rates.  We report on the implementation of the daily assessment component.

Objective: To determine the effectiveness of daily assessment of continued IUC need to decrease utilization.

Methods: Baseline IUC utilization data on two representative medical and surgical units were collected via once daily snapshot (medical unit for 14 days, surgical unit for eight days).  A multidisciplinary UTI group was later created, which developed a daily IUC assessment tool including three prompts: 1) discussion of IUC need, 2) indications for continued use, and 3) plans to discontinue.  Acceptable indications included: perioperative requirement, urine output monitoring, management of acute urinary retention or obstruction, incontinence with sacral/perineal wounds, and end of life/comfort care. This tool was used three times per week to capture snapshot data and was progressively rolled out on 14 units, eight medical and six surgical, from May through October 2009. A subanalysis was performed for the two units where baseline data were collected comparing device utilization ratios (DURs) during the baseline and intervention periods by chi square (Stata/IC v.11.0, College Park , TX).

Results: The daily IUC assessment tool was successfully implemented on all units with 563 (91%) patients having IUCs discussed (median 100%, range 49% to 100%). Overall, 22% (123/563 discussed) of the IUCs were considered for same day removal. 

The subanalysis of IUC DUR in two units is shown in the table below.  Comparison of the baseline and intervention periods showed a decrease in overall DUR from 12.7% to 7.7% (p=0.003).  

Conclusions: We have created a measurable daily IUC assessment tool as a component of a UTI bundle that was implemented on 14 units with an overall success rate of 91%.  Daily IUC assessment decreased IUC utilization on two units and should decrease CAUTI rates.