Background: In long-term acute care (LTAC) facilities, catheter-associated urinary tract infection (CAUTI) incidence is high due to patients’ multiple critical medical problems and comorbidities. We sought to decrease CAUTI incidence, lowering the Standardized Infection Ratio (SIR) of observed over expected CAUTIs and the Standardized Utilization Ratio (SUR) to reduce overutilization of catheters.Previously, there was no systematization of indwelling catheter management or fever and urine culture management at our Long-Term Acute Care Hospital (ELTACH), nor its affiliated hospitals. The SIR was consistently higher than the target of 1.
Methods: Based on a thorough gap analysis, we created bladder management algorithms for Indwelling Catheter Management and Fever and Culture. We identified CAUTI champions for each of our hospital facilities. This helped in maintaining Bundle Audit Completion and maintenance of our Bundle compliance scores. The bladder management algorithm was finalized systemwide, and monthly meetings were held to discuss barriers, successes from audits, interprofessional round data input, and real-time education. We then conducted ongoing education of nursing staff and physicians on the bladder management algorithm, catheter bundle compliance, perineal care, and use of urinalysis and urine culture orders.Our measures were monthly and 3-month rolling SIRs; monthly SUR; comparison from intervention initiation in July 2023 till April 2025. We performed descriptive statistical analyses using our electronic medical record system dashboard.
Results: We reduced our 1-month SIR from a high of 7.07 in June 2023 (the month prior to implementation) to a low of 1.76 in November 2024; in 9 separate months, no CAUTIs were observed, resulting in an SIR of 0. The 3-month SIR fell from 6.86 in August 2023 to 1.87 in April 2025. We observed no change in the SUR. We observed a small rise in SIR January-June 2025, largely caused by spike in incidence in February and April that we traced to new wipes that contained dimethicone, which increased bioburden. Once we replaced these wipes, the SIR once again began to drop.
Conclusions: Although we have seen gradual improvement in the SIR, additional updated gap analyses and educational interventions are still needed. Key facilitators for success were staff education, implementation of bladder management protocols, utilization of orders for urinalysis andurine culture algorithm in ordering for urinary sepsis, and most notably, nursing buy-in and champion support. Limiting factors included the need for ongoing education of the staff, particularly among PRN providers.