Using a Simple Daily Inventory in a Community Hospital MICU Demonstrates Major Reductions in CAUTI Rate

Abstract

SESSION TITLE: Critical Care in the ICU SESSION TYPE: Original Investigation Poster Discussion PRESENTED ON: Monday, October 24, 2016 at 12:00 PM - 01:30 PM PURPOSE: Millions of dollars are spent each year on preventable hospital acquired infections. Catheter associated urinary tract infections (CAUTI) are a significant contributing factor to morbidity in patients hospitalized in intensive care units (ICU). Studies have shown that increasing daily physician evaluation of continued catheterization can reduce the number of unnecessary days that a patient remains catheterized. Reducing the number of days that a patient is unnecessarily catheterized should reduce the incidence of associated infection. Beginning in July 2010, a simple catheter inventory worksheet was implemented at a community hospital. This inventory requires a once daily dialogue between the charge nurse and attending physician with regards to the necessity of ongoing urinary catheterization in MICU patients. This study explores the efficacy of this intervention in reducing the number of CAUTI in MICU patients. METHODS: In order to determine the effect of the intervention on CAUTI, we performed a negative binomial regression analysis. Using data on the number of catheter infections and the number of foley days, we calculated the CAUTI rate for 3 distinct periods: “pre” - the first year of the study, pre-intervention (July 2009 - June 2010); “immediate post” - the second year of the study, which is the first year directly following the implementation of the intervention (July 2010 - June 2011); “later post” - the third through sixth years of the study, after the intervention had been in place for over a year (July 2012 - June 2015). We then calculated the incident rate ratios (IRR) and corresponding p-values comparing the periods “pre” with “immediate post” and “pre” with “later post”. RESULTS: There was an average of 5.69, 1.24, and 2.47 CAUTIs per 1000 foley days in the “pre”, “immediate post”, and “later post” periods, respectively. The CAUTI rate was 77% lower in the “immediate post” period compared to the “pre” period and this difference is statistically significant (IRR = 0.23, p=0.0186). The CAUTI rate was 56% lower in the “later post” period compared to the “pre” period and this difference is statistically significant (IRR = 0.44, p=0.0331). CONCLUSIONS: The efficacy of this intervention was substantiated by a drastic reduction in the rate of CAUTI in ICU patients in the first year that the intervention was implemented. The reduction of CAUTI compared to baseline continued into subsequent years which suggests that implementation of this policy has sustained positive outcomes for the ICU. CLINICAL IMPLICATIONS: The excess expense associated with CAUTI presents extreme financial burden to hospitals, especially in hospitals that suffer strict budgetary constraints. In 2008 the Centers for Medicare and Medicaid Services implemented a policy that denies payment for certain preventable hospital acquired infections including CAUTI. The intervention described in this study has a zero monetary cost and carries the potential to prevent a large portion of financial loss in community hospitals. DISCLOSURE: The following authors have nothing to disclose: Abdullah Qureshi, Christine Altman, Bijou Hunt, May Lee No Product/Research Disclosure Information