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 multipronged and multidisciplinary intervention was to reduce the foley catheter utilization rate and the incidence of CAUTI in our 550 bed tertiary care center. We present the institution wide tactics hospitalists collaborated with and strategies specific to the section of hospital medicine.
Description: A CAUTI domain team made up of infectious disease nurses was set up. This team interacted regularly with nurse managers, charge nurses and nurse educators to perform a root cause analysis of each CAUTI case. Findings were disseminated among the nursing staff. A nurse driven foley removal protocol is currently being developed. Foley utilization and CAUTI incidence data were shared with all hospital units and service line leaders on an ongoing basis. 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, encouraging removal of any catheters inserted in the intensive care unit or emergency department and calling out limited, specific indications as being appropriate for inserting a foley catheter (extensive wounds, hospice care and acute urinary retention). Three 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 rates) are below one on all medicine floors. Rolling Standardized Infection Rates ( SIR’s) have decreased from 1.1 to 0.5. There have been zero CAUTIs among patients cared for by hospitalists for the months of July, August, September and October 2018. This compares favorable with 4 CAUTIs in a similar time period in 2017, and 11 CAUTIs during all of Financial Year (FY) 2018. We conclude that a sustained, multipronged and multidisciplinary approach can yield favorable results in CAUTI reduction in the inpatient setting. Provider education and feedback with be continued throughout FY 2019 with the goal of meeting our target reduction in CAUTIs from 11 in FY 18 to 4 in FY 19.