Reduction of CAUTI rates organization wide begins in the Emergency Department

Abstract

BACKGROUND In quarter four of 2017, 40% of Catheter Associated Urinary Tract Infections (CAUTI) were attributed to the insertion of the indwelling urinary catheter in the Emergency Department (ED). Institutional guidelines for indwelling urinary catheter insertion in the ED, coupled with physician and nurse champions is associated with a reduction in unnecessary utilization. Sterile procedures should be done in a sterile environment and not rushed. In common practice, indwelling urinary catheters are placed in the ED in an urgent manner. This practice can lead to CAUTI. Restricting indwelling urinary catheter insertions in the ED can lower HAI CAUTI. METHODS A Plan Do Study Act (PDSA) process was used for this quality improvement project. The infection prevention team met with ED leaders and discussed the necessity of “Foley Free ED”. Baseline data over two quarters was tracked, information on total number of foleys inserted, appropriateness of indication and presence of orders were analyzed. It was observed that indwelling urinary catheter were often inserted without orders or appropriate indications. The action plan included ED specific indwelling urinary catheters insertion guidelines with alternative external devices, interprofessional staff education plan, and weekly review of adherence of new guidelines. RESULTS A two Tailed t-Test for the pre and post implementation period resulted with a p-value of 0.04. This indicates that the difference between the insertion rates are statistically significant. As a result of the “Foley Free ED” project, insertion rates have been reduced by 66% and CAUTI rates declined from 3.17 in June 2018 to 0.96 in November 2018 which is a 70% reduction. CONCLUSIONS Implementation of “Foley Free ED” is associated with reduction of CAUTI cases attributed to indwelling urinary catheters inserted in the ED. In quarter four of 2017, 40% of Catheter Associated Urinary Tract Infections (CAUTI) were attributed to the insertion of the indwelling urinary catheter in the Emergency Department (ED). Institutional guidelines for indwelling urinary catheter insertion in the ED, coupled with physician and nurse champions is associated with a reduction in unnecessary utilization. Sterile procedures should be done in a sterile environment and not rushed. In common practice, indwelling urinary catheters are placed in the ED in an urgent manner. This practice can lead to CAUTI. Restricting indwelling urinary catheter insertions in the ED can lower HAI CAUTI. A Plan Do Study Act (PDSA) process was used for this quality improvement project. The infection prevention team met with ED leaders and discussed the necessity of “Foley Free ED”. Baseline data over two quarters was tracked, information on total number of foleys inserted, appropriateness of indication and presence of orders were analyzed. It was observed that indwelling urinary catheter were often inserted without orders or appropriate indications. The action plan included ED specific indwelling urinary catheters insertion guidelines with alternative external devices, interprofessional staff education plan, and weekly review of adherence of new guidelines. A two Tailed t-Test for the pre and post implementation period resulted with a p-value of 0.04. This indicates that the difference between the insertion rates are statistically significant. As a result of the “Foley Free ED” project, insertion rates have been reduced by 66% and CAUTI rates declined from 3.17 in June 2018 to 0.96 in November 2018 which is a 70% reduction. Implementation of “Foley Free ED” is associated with reduction of CAUTI cases attributed to indwelling urinary catheters inserted in the ED.