Auditing CAUTI Best Practices Bundle Adherence in a 24-bed Neurovascular/Cardiovascular/Intensive Care Unit

Abstract

BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are the most common healthcare-associated infection (HAI) in the United States. The Centers for Disease Control and Prevention (CDC) recommends monitoring, and documentation of auditing catheter care practices. To reduce CAUTI rates in the Neurovascular/Cardiovascular/Intensive Care Unit (ICU), a Minnesota hospital conducted audits of CAUTI bundle compliance between March 1st and October 30th, 2018 and measured the correlation between bundle compliance and incidence of CAUTI. METHODS Three audits on patients with indwelling catheters were conducted weekly in the ICU using the Joint Commission's CAUTI tracer tool. Staff on the unit floor were given verbal feedback in real time. Compliance was reported to hospital leadership weekly. ?Incidence of CAUTI was tracked monthly and reported to the National Healthcare Safety Network (NHSN) and hospital leadership. Using SAS version 9.4 a Poisson regression analysis was ?conducted to determine correlation between individual elements of the tracer and ICU infection rates. Adherence to the entire bundle was also examined. RESULTS No statistically significant correlation was found between compliance with elements of the tracer and CAUTI rates. Correlation between adherence to the full bundle and CAUTI rates was found to be approaching significance (p=0.06). The most common noncompliant elements of the tracer were missing indications for catheter placement in the order, dependent loops, and missing tamper evidence seals. CAUTI rates in the ICU increased during this time period while audit compliance remained constant. CONCLUSIONS Auditing CAUTI bundle compliance did not reduce CAUTI rates in this ICU. We were able to determine areas to focus on when educating staff on best practices to prevent CAUTI. Adhering to a CAUTI bundle is best practice, but auditing bundle compliance does not have an appreciable effect on CAUTI rates. Facilities should focus more on initial education around best practices to prevent CAUTI than on maintenance auditing.