Background: Catheter-associated urinary tract infection (CAUTI) is one of the most common device-associated infections in hospitals. Both technical aspects – appropriate catheter use, aseptic catheter insertion, proper catheter maintenance – and socio-adaptive components, such as unit culture and behavior change, are important in preventing CAUTI.
Methods: The “On the CUSP: Stop CAUTI” national program, funded by the Agency for Healthcare Research and Quality and led by the Health Research & Educational Trust, was conducted to reduce CAUTI in both intensive care units (ICUs) and non-ICUs. The main features of the program were: 1) information dissemination to sponsor organizations and hospitals; 2) data collection; and 3) guidance on essential CAUTI prevention practices and key socio-adaptive aspects. Catheter utilization and CAUTI rate data were collected during three phases: baseline (3 months), implementation (2 months) and sustainability (12 months). Multilevel negative binomial models were used to assess changes in catheter utilization and CAUTI rates.
Results: A total of 985 units (58.2% non-ICUs, 41.8% ICUs) from 640 hospitals in 30 states participated in the first four cohorts (additional cohorts are underway or being enrolled). Overall, CAUTI rates decreased by 14.5% (IRR: 0.86 (0.76-0.96), p=0.009). Among non-ICUs, catheter utilization decreased by 6.8% (IRR: 0.93 (0.90-0.96), p<0.001) and CAUTI rates decreased by 32.2% (IRR: 0.68 (0.56 – 0.82), p<0.001). Catheter utilization and CAUTI rates remained stable in the ICU.
Conclusions: A national program focusing on both technical and socio-adaptive aspects of CAUTI prevention appears to reduce CAUTI rates and catheter use in non-ICUs.