Reduction of Indwelling Urinary Catheter-Associated Urinary Tract Infections (CAUTI) through System-Wide Interventions

Background: CAUTI is the most common preventable hospital-acquired infection and leads to morbidity and cost. According to the SHEA/IDSA Practice Recommendations, the use of indwelling urinary catheters (catheters) contributes to 80% of urinary tract infections (UTI). Additional information from SHEA/IDSA states catheters should be properly secured after insertion.

In September 2008, PinnacleHealth System (PHS) began participation in the VHA Rapid Adoption Network – Reduction of CAUTI.  Data indicated a high use of catheters at PHS compared to other systems in the network. The goals of the network were to decrease catheter days and improve compliance with catheter tubing securement devices for an improvement in CAUTI rates.  A multi-disciplinary UTI Prevention Task Force was created at PHS in September 2008.

Objective: Reduce CAUTI through system-wide interventions in accordance with SHEA/IDSA recommendations.

Methods:  In March 2009, a CAUTI prevention video and post-test were distributed to staff that transport or provide care for patients with catheters.  Random audits for securement device compliance began in March 2009, and feedback is reported to nursing leadership.  In May 2009, an electronic workflow was implemented for physicians to verify necessity of the catheters. CAUTI Prevention Tips Sheets were created and distributed periodically beginning in July 2009.  In March 2010, a prevalence study was used to determine focus areas for interventions. CAUTI Prevention materials were made available on the PHS Infection Control website. The Centers for Disease Control and Prevention (CDC) definitions were used for infection surveillance with rates based on number of CAUTI per 1,000 catheter days.

Results:  Post-intervention periods I and II indicated a significant decrease in the use of catheters and a significant increase in the use of catheter securement devices from baseline.  The CAUTI rate in the first post-intervention period showed a 43% reduction in infections.  In the second post-intervention period, there was a 57% reduction of CAUTI from baseline.

 

	Baseline	Post-intervention Period I  Jul-Sep 2009	Post-intervention Period II Jul-Sep 2010
Catheter Use             (catheter days/patient days) Baseline – Oct-Dec 2008	34% (13,370/39,115)	30% (11,530/38,470) p=0.00001	27% (10,070/36,326) p=0.00001
Use of Securement Device(random observations) Baseline – March 2009	62% (41/66)	85% (157/185) p=0.00001	90% (167/186) p=0.00001
CAUTI                     (infections/catheter days) Baseline – Oct-Dec 2008	1.6 (21/13,370)	1.0 (12/11,530) p=0.1660	0.9 (9/10,070) p=0.1044

 

Conclusions:  Implementation of methods to increase compliance with SHEA/IDSA recommendations has decreased the number of CAUTI in the inpatient units of PHS.