Impact of an Action Plan to Reduce Catheter Associated Urinary Tract Infections (CAUTI) at a Rehabilitation (Rehab) Facility

Background: CAUTI are a significant cause of infections in the residents of rehab facilities and have been associated with increased morbidity and mortality. We developed an intervention with the aim of reducing unnecessary catheterization in these facilities and preventing CAUTI in those rehab residents who may require an indwelling catheter.

Objective: To study the post-intervention effect on CAUTI at a Rehab facility.

Methods: Following baseline data collection for number of CAUTI per month, CAUTI rate, foley days (FD) and foley utilization ratio (FUR) at a 75 bed rehab facility, an Action Plan was implemented that included staff education in the strict assessment of catheter necessity, daily perineal hygiene, use of indwelling foley alternatives including bladder scans, and ensuring compliance with our institution’s foley bundle (documentation of need, keeping foley bag off floor and below the level of the bladder, and daily review for necessity and prompt removal if criteria unmet) along with CAUTI surveillance and feedback from the infection preventionist (IP). The monitoring part of Action Plan involved daily rounding by a supervisor or IP to determine continued need of catheters, weekly report of compliance with bundle, and review of CAUTI. Feedback was provided to the nurse leadership team, who reassessed staff foley insertion skills, reinforced foley care practices and provided further training as needed. Education flyers were also developed for raising awareness in patients and families.

After the first 90 days of the Action Plan (12/2008 to 02/2009), additional interventions were implemented. These included emptying of the drainage bag prior to patient transport, eliminating diaper use in catheterized patients with diarrhea, and perineal hygiene prior to all foley insertions. In order to control the serial correlation among the data, we used interrupted time series analysis to test for the intervention effect over the period of 15 months after the plan was officially incorporated in infection control protocol (06/2009 to 08/2010).

Results: A significant decrease in total CAUTI (1.36 to 0.53 /month; p=0.01) and the CAUTI rate (21.09 to 4.58 per 1000 catheter days; p=0.03) was observed in the post-intervention period (06/2009 to 08/2010) as compared to baseline (08/2007 to 05/2009); however there was no significant change in the FD (86.5 to 117.67 / month) and FUR (0.05 to 0.06 / month).

Conclusions: CAUTI may be significantly reduced in Rehab facilities by developing practice improvement programs which not only focus on reducing foley days but also on staff education that targets proper insertion skills and appropriate maintenance. Intense monitoring of staff practices and CAUTI rates along with frequent feedback to respective Rehab units can play a vital role in identifying those health care workers who may require further training and should be an integral part of the program.