Background: Catheter Associated Urinary Tract Infection (CAUTI) is the most common hospital acquired infection and constitutes upto 40% of all Healthcare Associated Infections. Urinary catheter is used in 15% to 25% of hospitalized patients and often utilized for inappropriate indications. Daily risk of Urinary Tract Infection (UTI) is 3 to 7% with the use of a catheter and the prolonged and unnecessary use of a catheter leads to most CAUTIs. It is challenging to reduce the utilization of foley catheters and incidence of CAUTIs.
Purpose: The purpose of our multi-pronged and multi-disciplinary intervention which was started around mid 2017 was to reduce the foley catheter utilization rate and the incidence of CAUTI in our 550 bed tertiary care center. Though we were able to bring the rate of CAUTI to zero among patients cared by hospitalists in 4 out of 12 months in 2018, compelling challenge ahead was to maintain if not to better it. Here we present the institution wide tactics hospitalists collaborated with and strategies specific to the section of hospital medicine which helped maintain zero CAUTI in 9 out of 12 months in the year 2019 .
Description: A CAUTI domain team made up of infectious disease nurses was set up. This team liased with nurse managers, charge nurses, and nurse educators. Findings were disseminated among the nursing staff. A nurse driven foley removal initiative was made universal. Foley utilization and CAUTI incidence data were shared with all hospital units and service line leaders on monthly basis and root cause analysis was done regarding any index cases. Hospitalist best practices included education on using external catheters for both male and female patients, changing a chronic foley prior to sending a urine-analysis (UA), ordering a UA instead of a UA with reflex culture, use of boric acid tubes for urine culture ( to prevent bacterial overgrowth), encouraging removal of any catherers inserted in the intensive care unit or emergency department and calling out limited, specific indications as being appropriate for inserting a foley cathether (extensive wounds, hospice care and acute urinary retention). Several educational sessions targeting residents, faculty and advanced practice providers were conducted. Monthly feedback on physician specific CAUTI rates was included in the provider dashboard. Reminders on tactics were communicated to providers on a monthly basis via the section newsletter.
Conclusions: Use of above mentioned strategies resulted in significant drop in CAUTI rates. Standard Utilization Rates (SUR, observed to expected foley utilization) are consistently below one on all medicine floors. It has gone further down from 0.95 on Nov 2018 to 0.80 on oct 2019. Standardized Infection Rates ( SIR’s) have further decreased from 0.55 to 0.34 during the same period. There have been zero CAUTIs among patients cared for by hospitalists in 9 out of 12 months from Nov 2018 to Oct 2019 and only 3 CAUTIs were diagnosed among our patients during the same period. This compares favorably with 5 CAUTIs during all of financial year in 2018 and 11 CAUTIs during the similar time period in 2017. We conclude that a sustained, multipronged and multidisciplinary approach can yield favorable results in CAUTI reduction in the inpatient setting. This result also highlights the need for future studies on innovative technologies and use of multifaceted interventions to facilitate elimination of CAUTI.