2113. Process Change Implementation to Decrease Catheter-Associated Urinary Tract Infections

Abstract

BackgroundMore than 50% of catheter-associated urinary tract infections (CAUTI) occur within 5 days of urinary catheter (UC) insertion suggesting poor insertion technique. Breaks in sterile technique and inappropriate UC kit use were observed resulting in increased insertion-associated CAUTI (iCAUTI, CAUTI occurring ≤5 days post-UC insertion). Specific challenges with UC insertion were identified in the emergency department (ED, high patient flow) and critical care units (CCU, high acuity). The objective of the study was to change the UC insertion process in the ED and CCU to reduce iCAUTI.MethodsThe study included pre-intervention (August 2016–May 2017), implementation (June–December 2017) and post-intervention (January–March 2018) periods. The interventions were use of a buddy system for UC insertions and the reduction of UC insertions in the ED. The buddy system involved critical care nurses inserting UC catheters with another healthcare worker present to ensure correct process and identify breaches in sterile technique. The ED was notified of the patients who (1) received a UC within 24 hours of admission and (2) received the UC in the ED resulting in raised awareness and joint effort between ED and CCU. An iCAUTI rate was calculated for each of the three periods. The proportion of UCs inserted using the buddy system and the proportion of admitted patients with UCs inserted in the ED were calculated.ResultsThe iCAUTI rate decreased by 75.8% between pre-intervention (0.33 iCAUTI/100 UCs inserted) and implementation period (0.08) and increased slightly in post-intervention period (0.16). The ED demonstrated the largest decrease in iCAUTI rate between pre-intervention (0.40) and post-intervention (0.0). Buddy system adherence was 47.3% for the implementation and 58.2% for the post-implementation period. Patients who had UCs inserted in the ED decreased from 59.8% in pre-intervention, to 42.4% in implementation to 35.1% in the post-intervention period.ConclusionA decrease in iCAUTI was observed with the implementation of a buddy system and reduction of UC insertions in the ED. Sustainability of the iCAUTI reduction program will be successful with the use of tools such as electronic medical records as well as culture change and staff buy in. Future directions will include expanding the program to acute care floors.Disclosures All authors: No reported disclosures.