Catheter-Associated Urinary Tract Infection: Single Institution Experience

Abstract

SESSION TITLE: Sepsis II SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: Catheter associated urinary tract infections (CAUTI) are directly associated with longer stays in the ICU and hospital, increased health care cost and increased risk of disability and death. We list key strategies that was attempted to reduced CAUTI in our institution. METHODS: As part of a performance improvement project, we collected CAUTI data per 1000 Foley catheter days for the years 2012-2015. This was collected every quarter in a mixed 31 bed medical/surgical intensive care unit. CAUTI was defined based on the national healthcare safety network definition. Standard staff and nurse driven protocol was used for urinary catheter care. Due to increased CAUTI rates per 1000 Foley catheter days, comprehensive unit based safety program (CUSP) was introduced in the 3rd quarter of 2013. The CUSP model introduced has 5 key components, namely: assemble the team, engage senior leadership, understand the science of safety, identify and learn from defects and implement teamwork and communication tools. In addition to the CUSP model, technical aspects that were focused upon include appropriate catheter use intervention, proper catheter insertion and maintenance intervention and prompt catheter removal. Staff education and coaching support was provided through monthly webinars, coaching calls and learning sessions. This was aimed primarily at nursing and resident physicians. Compliance to these steps was monitored during daily interdisciplinary rounds. RESULTS: For the year 2012, per quarter the rate of CAUTI per 1000 Foley catheter days were 3.5, 3.2, 0.9 and 1.1 respectively. There was an increase in CAUTI per 1000 Foley catheter days to 7.0, 4.3 for the 1st and 2nd quarter that peaked to 8.2 followed by 5.6 for the 3rd and 4th quarter. The CUSP initiative and other catheter use, insertion and maintenance took effect after the 3rd quarter of 2013. This intervention led to a decrease in CAUTI rates to 1.9, 4.2, 3.7, 2.5 per 1000 Foley catheter days for the year 2014 per quarter. For the year 2015 CAUTI rates are 2.5, 4.4, and 1.5 (per 1000 Foley catheter days) per quarter until the 3rd quarter. As a comparison for the years 2012-2015 the national healthcare safety network pooled mean has ranged from 2.2-2.4 per 1000 Foley catheter days. CONCLUSIONS: Despite CUSP and other comprehensive catheter based initiatives introduced in the ICU, it is frustrating to note that there has been no significant impact in the reduction of CAUTI. This emphasizes the need to develop more approaches that will deliver better results in reducing CAUTI. CLINICAL IMPLICATIONS: Reduction of catheter associated urinary tract infections in the intensive care unit needs multiple approaches at different levels DISCLOSURE: The following authors have nothing to disclose: Arjun Madhavan, Paris Charilaou, Amy Gram, Patricia Ford No Product/Research Disclosure Information