Reduction of Catheter Associated Urinary Tract Infections on Medical-Surgical Units in a Teaching Hospital

Background: Catheter associated urinary tract infection (CAUTI) is the most frequent healthcare acquired infection (HAI). This enormous burden of prevalence impacts patient morbidity and mortality, and adds to the unnecessary health care costs. CAUTI rates in Fiscal Year (FY) 2009 at our facility were significantly above national benchmarks. Objective: To implement evidence-based interventions as part of a multi-disciplinary initiative to decrease the incidence of CAUTI on our Medical Surgical (M/S) Units. Methods: Our 515 bed acute care facility in the Southwestern United States has 7 M/S nursing units with 243 inpatient beds. In May, 2009, a multidisciplinary CAUTI Performance Improvement (PI) team was chartered to review the literature and perform a gap analysis comparing our current practice with evidence-based recommendations. The team was divided into three groups to evaluate and make recommendations for improvement in different aspects of urinary catheter management including insertion, maintenance, and necessity. A 3 month pilot of recommended practices was implemented on 3 units in June, 2009. The “insertion group” focused on establishing appropriate criteria for indwelling urinary catheters, use of alternatives where appropriate, and on insertion techniques. During the study period, we found that 58% of indwelling catheters on M/S patients were placed in the Emergency or Peri-Operative areas. Special attention was focused on these care settings to ensure compliance with the insertion criteria, determining continued necessity and/ or removal of catheters in the post anesthesia care unit. The “maintenance group” focused on technical aspects of caring for patients with indwelling catheters including perineal and catheter care, bag placement, tubing securement, specimen collection, and hand hygiene. The team found that 38% of CAUTIs were associated with catheters in place greater than 7 days. The “necessity group” worked to increase awareness of unnecessary catheters and reinforce timely discontinuation. A catheter necessity scoring tool was incorporated into the electronic medical record. A catheter necessity order set was developed and implemented to promote early discontinuation and a bladder scanning protocol was implemented to prevent unnecessary re-insertion of catheters. Results: During the 3 month intervention phase, the 3 participating M/S units had a significant reduction in CAUTI from the previous 3 months (59% reduction, p< .000001). The 4 non-intervention M/S units had a significant increase in CAUTI during the study period (9% increase, p= .04). Our multidisciplinary effort led to a significant decrease in device days (22% reduction, p< .000001) and in CAUTI rates (78% reduction, p< .000001) from FY 2009 to FY 2010. Conclusions: Implementation of evidence-based practices for CAUTI prevention can significantly impact CAUTI rates.