Reducing Indwelling Urinary Catheter Utilization Results in Reduction of Associated Urinary Tract Infections

Abstract

<h3>Background</h3> Catheter Associated Urinary tract infections (CAUTIs) are the fifth most common type of healthcare-associated infection (HAI), resulting in increased morbidity/mortality. The most important risk factor for developing a CAUTI is prolonged use of indwelling urinary catheters (IUCs). One of the strategies to prevent a CAUTI is to reduce IUC utilization. During the 12-month period from July 2019 through June 2020, the CAUTI Standard Infection Ratio (SIR) for our Medical Center was 1.86 with 21 observed cases. The Standard Utilization Ratio (SUR) was 0.89. <h3>Methods</h3> A Plan Do Study Act (PDSA) cycle was used in this performance improvement project. In order to address high CAUTI incidences, a multi-disciplinary performance improvement task force composed of nursing directors, physicians, infection prevention, and the supply chain was initiated in August 2020. The Chief Medical Officer, Chief Nursing Officer and Chief Operating Officer highlighted the gravity of the situation at every team meeting. One action taken was the initiation of the "Holy Moley Remove That Foley" campaign. The purpose of the campaign was to review appropriateness of IUCs during daily multi-disciplinary rounds using "IUC appropriateness checklist" and complete the "IUC insertion checklist" prior each IUC insertion house-wide including the Emergency Department. Bladder scans were encouraged to assess for retention and to follow a nurse driven protocol to use external urinary devices. The hospital's education department provided education and ongoing competency evaluations during this campaign. <h3>Results</h3> The actions above resulted in SIR of 0.58, SUR of 0.71 and 7 incidences during July 2020 through June 2021. This is a statistically significant SIR reduction with two-tailed t test, p value of 0.0049. <h3>Conclusions</h3> By engaging a multi-disciplinary team that includes non-nursing departments, a significant reduction in CAUTIs was achieved. This project highlights that the involvement of several disciplines is needed to prevent HAIs.