Reduction of Catheter‐Associated Urinary Tract Infections through a Bundled Intervention in a Commilunity Hospital

Background:

Urinary tract infections (UTIs) are the most common type of nosocamial infection, with 80% associated with indwelling urinary catheters. The relative frequency of catheter‐associated UTIs (CAUTIs) imparts greater clinical and cost implications to patients and hospitals. Since Medicare and other payers stopped reimbursing hospitals for expenses incurred for the treatment of CAUTIs that are acquired during a hospital admission, the effectiveness and cost‐efficiency of CAUTI reduction strategies has gained relevance for individual hospitals. Strategies to actively reduce the risk of CAUTIs, especially those that are inexpensive and can be readily implemented, could be useful in many hospital settings,

Methods:

In a 276‐bed community hospital, we retrospectively examined the effect of a bundle of 3 evidence‐based interventions on the incidence of CAUTIs. The first intervention was the exclusive use of silver alloy catheters in the acute care areas of the hospital, the use of which had been sporadic in the hospital over the previous 3 years. The second intervention was a new securing device to limit movement of the indwelling catheter after insertion. The third intervention consisted of repositioning the catheter tubing, if it was found to be touching the floor. The first intervention was started in January 2009. In February 2009, the routine use of the second and third interventions was introduced after the hospital staff received education about both the methodology and the importance of properly implementing them. Rates of CAUTI were calculated per 1000 catheter days. February 2009 was considered to be a washout period because interventions such as these are typically not immediately effective.

Results:

The mean rate of CAUTI per 1000 catheter days before the full implementation of the 3 interventions, that is, from October 1. 2008, to January 31, 2009, was 6.1. However, after the full implementation of these interventions, that is, from March 1 to September 30, 2009, the rate was 3.2. The P value was 0.17. The sample size utilized for this study was relatively small, which may explain why the P value did not reach statistical significance. However, it is anticipated that with the accumulation of additional data over the next several months, that the results derived from these and planned future interventions, will achieve statistical significance.

Conclusions:

These preliminary results suggest that a bundle of 3 evidence‐based interventions can substantially reduce the incidence of CAUTI in a community hospital. These relatively simple interventions should be easily sustainable and could be readily transferable to other hospitals.

Author Disclosure:

Karen Clarke, MD, none; Bonnie Norrick, CLS, EDM, CIC, none; D. Tong, Emory University School of Medicine, $10,000 share of ownership in Davita Dialysis Unit, Atlanta, GA/no conflict of interest; B. Razavi, none; J. Stein, Emory University School of Medicine, Emory University, entitled to royalties under patent‐licensing arrangement through Emory University.