Abstract W P344: Being the Change You Wish to See: Reducing the Incidence of False-Positive Catheter-Associated Urinary Tract Infections in a Neuroscience Population

Abstract

Background and Purpose: The formation of a bacterial biofilm on an indwelling urinary catheter is considered to be a leading cause for diagnosed urinary tract infections in the intensive care setting (Djeribi, Bouchloukh, Jouenne, & Menaa, 2012). Bacterial biofilms (colonization) are thought to develop between one to five days (Saint & Chenoweth, 2003). Neuroscience patients are of particular interest when examining biofilm formation, as their underlying disease processes pose unique challenges to decreasing indwelling catheter device days, including neurogenic bladder, need for euvolemic fluid volume states, et cetera. The purpose of this quality improvement initiative was targeted at reducing the number of diagnosed false-positive CAUTI. Methods: For a period of February 2014- July 2014, nurses in two neurosciences intensive care units at a large academic center piloted an intervention targeted at reducing the number of diagnosed false-positive CAUTI, thought to occur as a result of catheter colonization or biofilm formation. For the intervention, patients who received an order for a urine culture who had an indwelling catheter for equal to or greater than five days had their indwelling catheter changed. Urine cultures were subsequently obtained from the new indwelling catheter. Results: Data for the months ( February 2014-July 2014) included a total of 87 patients from the neurosciences intensive care units who met the criteria for an indwelling catheter change, in the event that they had a urine culture ordered on or after device day five. Twenty six patients had their indwelling catheter changed prior to urine specimens being obtained. Five of the twenty six obtained from the new indwelling catheters demonstrated growth at the time the reports were finalized. Compared to previous CAUTI rates for the same time period in 2013 we have reduced the absolute numbers from 30 to 13. Conclusions: The organization’s infection control board reviewed the data and permission was granted to extend the pilot to all adult ICU. The preliminary data does suggest bacterial biofilm may contribute to the rate of CAUTI in the neuroscience population.