The Effect of an Electronic Inference and Alerting Tool on Inpatient Urinary Catheter Use and Catheter-Associated Urinary Tract Infections (CAUTI)

Background:  The burden of CAUTI is well-established and an important target in infection control. As indwelling urinary catheter use is associated with urinary tract infection, early removal of all unnecessary catheters would be ideal. A system to continuously evaluate all urinary catheters in place, gauge their necessity, and electronically notify providers to remove unnecessary catheters would be an invaluable tool.

Objective:  : 1. Implement an electronic alert system to notify caregivers of potentially unnecessary urinary catheters. 2. Determine the tool's impact on hospital catheter days and CAUTI rates.

Methods:  This was a pilot study performed at two large tertiary care centers in Salt Lake City, UT over a twelve month period from 12/08 to 11/09. Each day, a computer algorithm identified hospitalized patients with a urinary catheter in place for ≥48 h and determined its necessity. Catheters not meeting criteria for retention prompted an electronic alert to the bedside nurse, indicating a catheter was in place that may be unnecessary, and encouraging them to assess ongoing need with the full care team. Criteria for retention included any of the following: urine output <200cc/day, blood pressure <90/60mmHg, Glasgow coma scale score ≤ 13, on mechanical ventilation or vasopressors, furosemide >80mg/day, or documented inability to get out of bed. Upon each alert, nurses were asked to indicate whether (a) the catheter has been/will be removed that day, (b) the necessity of the catheter will be reviewed, or (c) the catheter is still needed, and to remind them in 48 hours. Catheter-days and CAUTI rates during the intervention period were compared with the prior 12-month period (12/07 to 11/08).

Results:  Following activation of this system, the total catheter days at the first hospital decreased 13.2%, but at the second, the catheter days with intervention increased 3.0%, and neither was statistically significant. CAUTI rates also decreased at both institutions, but the decrease was not significant, when evaluated by facility or by individual unit.

Conclusions:  A system designed to automatically assess urinary catheter usage and electronically alert nursing staff to the presence of potentially unnecessary catheters did not have a significant impact on catheterization days or CAUTI rates during the study period. It is unclear at this time whether this was due to failure to respond to the alerts, reluctance to remove catheters, or other reasons. Further efforts will be directed at analyzing use of the tool, duration of individual catheters, and potential improvements to the system based on a nurse-wide survey.