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Abstract

Introduction: The prevention of hospital-related infections continues to be a major concern for Accountable Care Organizations (ACOs) who are interested in optimal patient outcomes. The prevalence of hospital acquired catheter-associated urinary tract infections (CAUTI) remains a subject that requires ongoing research in the implementation of standardized protocols for improved patient outcomes. Methods: A multidisciplinary team implemented an evidence-based quality improvement practice change to examine the use of a CAUTI bundle in both a Surgical/Trauma (SICU) and a Medical Intensive Care Unit (MICU). Historical data of CAUTI incidence was used for comparison. Phase 1 included staff education followed by daily audits and data collection of bundle compliance over a 3 month period. Interim analysis of the data suggested further optimization of the maintenance catheter bundle. Key changes included implementation of routine foley catheter changes every 7 days and twice a day pericare. Data collection is ongoing. Results: The initial maintenance bundle compliance was 80% for the SICU and 71% for the MICU with both units increasing to 100% at the end of 3 months. CAUTI incidence rate for 2012 was 22 cases for SICU and 40 cases for MICU. During the first phase there were 102 catheter insertions equally divided between AM and PM shifts. Compliance with the insertion bundle after initial education was 97% increasing to 100% at the end of 3 months. Post-initiation of the bundle did result in a reduction overall in the first quarter of 2013 cases with 11 MICU cases and 7 SICU cases reported. Subsequently, the implementation of routine catheter change and pericare resulted in a 55% MICU and 86% SICU reduction in CAUTIs the 3rd quarter of 2013. Barriers to reduction included the following; compliance with ongoing maintenance cares, not changing foley catheters, and the presence of staff awareness. Conclusions: Implementation of CAUTI bundles may result in reduction of catheter associated infections; however population specific interventions may be needed to achieve sustained reduction in CAUTIs.