Reduction of Catheter‐Associated Urinary Tract Infections Through a Bundled Intervention in a Community Hospital

Background:

Urinary tract infections (UTIs) are the most common type of hospital‐acquired infection, and 80% are associated with indwelling urinary catheters. The relatively high frequency of catheter‐associated UTIs (CAUTIs) leads to significant clinical and financial concerns for both patients and hospitals. Because Medicare no longer covers the costs of treating CAUTIs, the development of cost‐effective strategies to reduce their incidence has received increased attention.

Methods:

We retrospectively examined the effect of a bundle of 4 evidence‐based interventions, introduced in staggered fashion, on the incidence of CAUTIs in a 276‐bed community hospital. Rates of CAUTIs per 1000 catheter‐days were estimated and compared using exact methods based on the Poisson distribution. 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. A 2‐month run‐in period began when the first intervention was started, in January 2009, and ended when the routine use of the second and third interventions was introduced the following month. The fourth intervention, which was implemented in October 2009, was the removal of indwelling urinary catheters on postoperative day 1 or 2 for most surgical patients.

Results:

For the 3‐month baseline (October 1–December 31, 2008) before the run‐in period, the mean rate of CAUTIs per 1000 catheter‐days was 5.6 and that for January 1–February 28, 2009, was 7.3. For the 7 months after full implementation of the first 3 interventions (March 1‐September 30, 2009), the mean rate of CAUTIs per 1000 catheter‐days was 3.0 and showed a significant reduction compared with January 1–February 28, 2009 (P = 0.04). For the 7 months after the implementation of the fourth intervention (October 1, 2009–April 30, 2010), the mean rate of CAUTIs per 1000 catheter‐days decreased further to 1.9, which was significantly lower than the rate for January 1–February 28, 2009 (P = 0.03).

Effect of Staggered Interventions on CAUTI Rate

Conclusions:

A bundle of 4 evidence‐based interventions reduced the incidence of CAUTIs by two thirds in a community hospital. These relatively simple interventions should be easily sustainable and could be readily transferable to other hospitals.

Disclosures:

K. Clarke ‐ none; B. Norrick ‐ none; J. Stein ‐ none; D. Tong ‐ none; A. Wang ‐none; K. Easley ‐ none; Y. Pan ‐ none; P. Hill ‐ none; D. Williams ‐ none