Interventions to Reduce UTIs in the Critical Care Setting

Background: Unlike for other device related infections, there are few effective interventions to reduce catheter associated urinary tract infections (CAUTIs), with most interventions focusing on removal of the catheter. However, a sizable fraction of patients in the critical care setting require a urinary catheter.

Objective:  To decrease CAUTIs in the adult critical care setting via a series of interventions.

Methods:  We used an interrupted time series design to evaluate the impact of 3 interventions to reduce CAUTI in three adult ICUs (medical, surgical and neurosurgical) accounting for 42 beds in an 820-bed urban, academic medical center. The interventions were: daily bathing with chlorhexidine (CHG) beginning in Q4 2006, standardization of perineal care and implementation of an algorithm for urinary catheter removal starting in Q2 2007, and use of CHG for daily perineal care beginning in Q2 2008. CAUTI surveillance was performed utilizing CDC definitions by trained ICPs. Segmented regression modeling was performed to assess the changes in CAUTI rates attributable to the interventions.

Results: CAUTI rates fell from 7.6 to 4.7/1,000 catheter days from the first to second half of the intervention period (see figure for quarterly rates). Daily CHG bathing (P=0.0018), and standardization of perineal care with a catheter removal algorithm (P=0.0269) resulted in significant reductions in CAUTI. Use of CHG wipes for perineal care did not significantly reduce CAUTI though this may be due to inadequate data points, and analysis of the data using monthly rather than quarterly rates may demonstrate an effect.

Conclusions: Daily bathing with chlorhexidine, and standardization of perineal care with use of a catheter removal algorithm resulted in a significant reduction in CAUTI among adult critical care patients.