Catching CAUTIs Midstream: Impact of a Nurse-driven Infection Prevention Initiative in a Neurotrauma Intensive Care Unit

Abstract

<h3>Background</h3> A preventable hospital-associated condition, Catheter-Associated Urinary Tract Infection (CAUTI) increases morbidity, mortality, and hospital length of stay and cost. Neurologic and injured patients are at high-risk for adverse outcomes associated with bladder dysfunction. Thus, higher utilization, reinsertion and infection rates related to indwelling urinary catheter use is reported in these complex populations. What is the impact of an innovative nurse-driven initiative to reduce CAUTI incidence in a neurotrauma intensive care unit (NTICU) to a Standardized Infection Ratio (SIR) < 1.0? <h3>Methods</h3> A nurse-led interprofessional team utilized a Define-Measure-Analyze-Improve-Control model to implement an evidence-based CAUTI prevention initiative. A 12-bed unit providing care to neurologic and injured patients in a level one trauma, academic medical center was the study setting. Cornerstone interventions included conduct of a staff culture of safety survey; revision of ICU Fever and Bladder Management Guidelines; interprofessional education; and use of a trial without catheter (TWOC) checklist to assess for catheter removal readiness. To sustain improvements, a nursing clinical team leader (CTL) driven initiative included daily patient rounds and audits of catheter care bundle and guideline compliance over a two-year period. Infection rates, device utilization rates and SIR were compared pre and post intervention. <h3>Results</h3> CAUTI rates reduce post intervention by nearly 40% (CAUTI rate 2017, 5.48; 2018, 2.91) and sustained through 2019 (2.97). The SIR for CAUTI reduce nearly 50% from 2.0 in 2017 to 1.06 in 2018 and sustained at 0.92 in 2019. No significant change in the utilization rate was noted (2017, 0.49; 2018, 0.55; 2019, 0.50). <h3>Conclusions</h3> At the unit level, a CTL driven initiative sustains quality improvements in catheter care bundle and guideline compliance, significantly reducing CAUTI incidence in a NTICU. Innovative use of an additional assessment checklist for catheter removal readiness may further support CAUTI reduction in high-risk neurologic and injured ICU populations.