Reduction In Catheter-associated Urinary Tract Infections Research Articles

Antimicrobial bathing of the critically ill for the prevention of healthcare-associated infection at a hospital in California

Background: Patients in the intensive care unit (ICU) have invasive lines increasing their risk for healthcare-associated infections (HAIs). Our objective was to determine if antimicrobial bathing with 2% chlorhexidine gluconate (CHG) compared to the colloidal silver-based antimicrobial product would reduce the incidents of central line–associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI). Methods: We performed a before-and-after study in four adult ICUs at a two-hospital facility in California. Prospective surveillance of CLABSI and CAUTI prevention bundles monitoring was established. The intervention consisted of daily bathing with CHG for all patients in the ICUs. A baseline period of one year was followed by an intervention period of one year. The incidence rates of CLABSIs and CAUTIs were compared between the baseline and intervention periods utilizing a t-test analysis. Results: A total of 10103 patients were included. At Facility A, a mean CLABSI rate of 2.43/1000 central line catheter days (CL) with 2149 patients days (Mean differences 95% CI -0.5–3.1; P>0.0975), during the baseline period followed by 1.11/1000 CL days with 2193 patient days in the intervention period. At Facility B, the mean CLABSI rate of 1.82/1000 CL days with 2976 patient days (Mean differences 95% CI -0.6–2.31; P>0.161) during the baseline period was followed by 1.01/1000 CL days with 2785 patient days in the intervention period. At Facility A, the mean CAUTI rate of 1.37/1000 indwelling catheter days (IUC) with 2149 ICU patient days (Mean difference 95% CI is 0.28–1.97; P 0.2160) was noted in the baseline period, followed by 0.45/1000 IUC days with 2785 in the intervention period. Conclusion: Daily bathing with CHG significantly reduced the incidence of CAUTI at Facility A. It is unclear why Facility A saw a statistically significant reduction in CAUTI, but Facility B did not. The difference in outcomes may be related to hospital size, service lines, supply constraints, and discrepancies in staffing. CHG bathing was not directly associated with a reduced risk of CLABSI at Facility A and B during our limited study, but it was encouraging enough that our organization will continue this intervention to obtain additional data to determine if bathing with CHG will reduce CLABSI and CAUTI.

A Stepwise Diagnostic Stewardship Approach to Reduce Unnecessary Urine Cultures, Asymptomatic Bacteriuria, and CAUTI Rate

Background: Clinically non-indicated asymptomatic bacteriuria (ASB) identification precipitates higher reported catheter-associated urinary tract infection (CAUTI) rates and urinary tract infection (UTI)-directed antimicrobial overuse. Published diagnostic stewardship interventions to reduce ASB were mostly tested individually and heterogeneously; hence the optimal bundle approach is yet to be defined. Methods: We performed a single-center sequential quasi-experimental study involving hospitalized, emergency, and long-term care patients at a VA healthcare facility, retrospectively comparing standard of care (period 1: 1/1/2022-6/30/2022) to adding dedicated provider education on facility-approved urine-culturing indications (period 2: 7/1/2022-1/19/2023), then adding an electronic clinical decision support (CDS) tool (Figure 1) mandating urine-culturing indications selections (period 3: 1/20/2023-6/30/2023), then prospectively adding real-time case-based physician-generated audit/feedback emails on ordering appropriateness (period 4: 7/1/2023-12/31/2023). We randomly sampled approximately 500 orders from each period and measured the impact on the rate of urine reflex/culture orders, the percentage of non-indicated orders and ASB, UTI-directed antimicrobial usage, and facility-wide CAUTI rates. Results: We analyzed 2140 urine reflex/culture orders (Table 1 and Figure 2). The mean monthly orders per 1000 bed-days and percentage of non-indicated orders decreased with each intervention to one-fourth of the initial values by period 4 (p=0.0002). The ASB rate among positive cultures was unchanged from periods 1 to 2 but started to decrease in period 3 with the biggest impact in period 4 (p=0.01). Non-indicated and ASB-directed antimicrobial courses both followed the previous pattern, dropping from 28% and 26% baseline to 6% and 4% by the study conclusion (p=0.015 and 0.008), respectively. Estimated UTI-directed antimicrobials decreased by 34% (363/551) with antimicrobial-days saved from 4093 to 2846 per 6-month period. CAUTI rate relatively declined with each intervention, along with a reduction in ASB-attributed CAUTI’s from 45% (5/11) initially to 20% (1/5) in period 4. Conclusion: A stepwise urine-culturing diagnostic stewardship approach of clinical education, electronic CDS tool, plus real-time audit/feedback decreased overall urine reflex/cultures, non-indicated ordering, ASB identification, unnecessary antimicrobials, and CAUTI rates, with the greatest impact after bundling all interventions including order appropriateness audit/feedback.

Catheter-associated urinary tract infection (CAUTI) reduction in a neuroscience intensive care unit: A multidisciplinary approach

Utilizing a multidisciplinary approach to identify catheter-associated urinary tract infection (CAUTI) risks in Neuroscience intensive care patients admitted for aneurysmal subarachnoid hemorrhage, our CAUTI rate decreased from 5.903 per 1,000 catheter days (June 2020-June 2021) to 0.371 per 1,000 catheter days in our postintervention time period (July 2021-March 2023). A review of our clinical treatment guideline to optimize the timing of indwelling urinary catheters and medication management related to bowel regimens has resulted in a sustained CAUTI reduction, particularly in postaneurysmal subarachnoid hemorrhage patients in the Neuroscience intensive care unit.

IMPACT OF RESIDENT & NURSING EDUCATION TOWARDS HAND HYGIENE TO REDUCE THE INCIDENCE OF CATHETER ASSOCIATED URINARY TRACT INFECTION

Background: Catheter associated urinary tract infections(CAUTIs) are the most common health care acquired infection and leading cause of morbidity. The aim of this study is to determine the incidence of CAUTI and impact of resident and nursing education towards hand hygiene to reduce CAUTI. Methods: The study was conducted in Chirayu medical college, Bhopal after approval from institutional Research Committee for a period of 3 months. Admitted patients are enrolled in our study, according to given inclusion and exclusion criteria with their written informed consent. 7 Days nursing education will be done with informative illustrative charts 30 minutes daily for 7 days following which the Intensive Care Unit will be observed for reduction in incidence of CAUTI rates for a period of 3 months. Results And Conclusion: In our stuty. the incidence of CAUTI preintervention was 35.6% and decreases to 9.2% post intervention which suggests that aseptic insertion of indwelling catheters and evidence-based care bundle utilization are not only important in the reduction of CAUTIs also the nursing autonomy with patients and situational awareness promoted through catheter necessity discussions are keys in delivering timely care reduces CAUTIS and length of catheter days.

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

<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.

Implementation of Standardized Catheter Cleansing Cloths at an Inpatient Rehab Facility

<h3>Background</h3> A higher than expected number of catheter-associated urinary tract infections (CAUTIs) was occurring at an inpatient rehab facility (IRF). Patients at IRFs often have indwelling urinary catheters (IUCs) for medical conditions like neurogenic bladder or urinary retention conditions. It is essential to provide consistent care and maintenance of IUCs for patients with long-term or chronic urinary catheters to prevent infection. Variability exists in the frequency, procedure, and availability of products for catheter care. <h3>Methods</h3> The quality improvement project, using lean methodology, took place over a six-month period at a 38 bed IRF to include patients with an IUC. The catheter cleansing cloths were used daily and as needed on patients with an IUC. The improvement project assessed if the daily use of the catheter cleansing cloths reduced the incidence of CAUTI at an IRF. A daily tracking tool was developed to monitor catheter device utilization and record daily documentation of urinary catheter care with the designated cleansing cloths. <h3>Results</h3> In the 12 months prior to the implementation of the catheter cleansing cloths, the IRF had seven CAUTIs. In the six months since the start of using the cloths, the IRF had zero CAUTIs. The Standardized Utilization Ratio (SUR) for the IRF in the six months prior to implementing daily device monitoring was 1.458. In the first six months of daily device monitoring, the SUR was 1.014. <h3>Conclusions</h3> The quality improvement project revealed a standardized process for daily catheter care is associated with a reduction in CAUTI. This project also notes an association between the daily monitoring of IUC devices and a reduction in catheter device utilization. Using catheter cleansing cloths for daily catheter care may be a great resource to provide consistent and predicable care for patients with IUCs.

EHR Integrated Urine Culture Algorithm Is an Effective Diagnostic Stewardship Strategy

<h3>Background</h3> Diagnostic stewardship can be a high-impact, low-effort strategy to optimize clinical outcomes through implementation of evidence-based guidelines and electronic health record (EHR) decision support. Published practice guidelines indicate appropriate indications for diagnostic urine cultures for evaluation of urinary tract infection. <h3>Methods</h3> A multidisciplinary team reviewed current evidence-based practice guidelines and developed a urine culture algorithm including a list of approved indications and updated urinalysis (UA) reflex to culture criteria. The protocol was implemented into the electronic health record, including requirements for the providers to list an approved indication for urine culture, and updated UA reflex criteria. Number of urine cultures tested, number of catheter-associated urinary tract infection (CAUTI) events, and CAUTI rate was assessed pre and post protocol implementation. <h3>Results</h3> Urine cultures, CAUTIs, and CAUTI rates were reviewed for one year prior to implementation and one year after implementation, 03/2019-02/2020 and 03/2020-02/2021. Comparing the baseline year of data to the year after implementation revealed that the implementation of the urine culture algorithm resulted in a 23.5% reduction in the amount of urine culture tests completed (p<.001). A 15.9% CAUTI reduction and a 23.3%5 CAUTI rate reduction were also obtained. <h3>Conclusions</h3> Diagnostic stewardship can be an important part of an infection prevention program. The implementation of an evidence-based urine culture algorithm resulted in a statistically significant reduction in urine culture tests. A reduction in CAUTI events and CAUTI rates were also obtained. Integrating the algorithm into the electronic medical record and obtaining input from a multidisciplinary team were key components to achieving successful implementation.

A single institution pre-/post-comparison after introduction of an external urinary collection device for female medical patients.

External urinary collection devices (EUCDs) may serve as an alternative to indwelling urinary catheters (IUCs) and decrease the rate of catheter associated urinary tract infections (CAUTIs). PureWick® is a novel female EUCD; however, no study has definitively proven benefit regarding reduction of CAUTIs. We sought to compare the CAUTI rate and IUC days before and after availability of the PureWick® EUCD at a single institution. We provide a descriptive analysis of female medical patients receiving an EUCD. A retrospective review of adult female patients admitted to a single institution on a medical service who received an IUC and/or an EUCD was performed. Patients who received an IUC in the 3 months before EUCD availability (PRE) were compared to patients who received an IUC and/or EUCD in the 12 months after (POST). Out of 848 female patients, 292 received an EUCD in the POST cohort and overall, 656 received an IUC (259 (100%) PRE vs. 397 (67.4%) POST). Compared to the PRE cohort, the POST cohort had a higher number of IUC days (median, 3 vs 2days, p = 0.001) and a higher rate of CAUTI (infections per 1000 catheter days, 9.3 vs 2.3, p = 0.001). The rate of UTI associated with EUCD use was 9.8 infections per 1000 device days. While EUCDs might appear to be a promising alternative to IUCs for female patients, this single center pre-/post-analysis found that both the number of IUC days and the CAUTI rate increased after introduction of a female EUCD.

To Assess the Incidence of Catheter Associated Urinary Tract Infection and Evaluate the Effectiveness of Evidence based Practice Protocol for Prevention of Catheter-associated Urinary Tract Infections (CAUTI) in Adult Critical Care Patients

Background: UTIs are the most common type of healthcare-associated infection. Among UTIs acquired in the hospital, approximately 75% are associated with a urinary catheter, which is a tube inserted into the bladder through the urethra to drain urine. The most important risk factor for developing a CAUTI is prolonged use of the urinary catheter. Therefore, catheters should only be used for appropriate indications and should be removed as soon as they are no longer needed. Aim: The aim of the study is to prevent CAUTIs in adult critical care patients, by using evidence based practice protocol. Materials and Methods: A Quasi Experimental one group pretest posttest research design was used. 200 staff nurses were selected from hospitals by using purposive sampling technique. Biophysical measures like signs and symptoms of CAUTI and urine culture was done to assess the incidence of CAUTIs in adult critical care patients before administration of evidence based practice protocol. Result: The overall incidence rate of CAUTI in adult critical care patients was 11.1%. A Comparison of Pre and Post test level of Knowledge of Staff Nurse’s regarding CAUTIs shows that 46(23.0%) had poor knowledge before intervention and it was reduced 2(1.0%) after intervention. None of the staff nurse had excellent knowledge before intervention and was increased 12(6.0%) after intervention, 23(11.5%) had pre test good knowledge and was increased to 122(61.0%) in post test. Pre test mean knowledge of staff nurse regarding CAUTIs was 13.68 whereas post test knowledge score was 16.5 and was statistically significant with p-value &lt;0.0001. Conclusion: This approach shows for reduction of CAUTIs in critical care settings. The same type of protocol or education programme might be adopted for the other health care associated infections.

Catheter-associated urinary tract infection reduction in critical care units: a bundled care model

Catheter-associated urinary tract infections (CAUTIs) represent approximately 9% of all hospital acquired infections, and approximately 65%–70% of CAUTIs are believed to be preventable. In the spring of 2013, Boston Medical...

Intentional Leadership Rounds: A Proactive Approach to CAUTI Reduction

Background Catheter-associated urinary tract infections (CAUTI) are the most common preventable hospital-acquired infection. Our facility's rate of CAUTI was above the risk adjusted expected rate. Using intentional leadership rounds, we sought to reduce indwelling urinary catheter (IUC) utilization and thus reduce CAUTI events. Methods Using the Plan-Do-Study-Act model and a Pareto tool for data collection, intentional leader rounds were completed by an Infection Prevention (IP) nurse on two 20-bed medical-surgical units (Neuro-Oncology and Surgical). Units were identified using the National Healthcare Safety Network (NHSN) targeted assessment for prevention (TAP) strategy as units with excess burden of CAUTIs. An IP nurse rounded with nurse providers on each of these units daily (Monday – Friday) for five months, interacting with the nurse to determine if the indication for the IUC was appropriate, if care and maintenance were completed, and if the catheter could be removed or an external catheter placed. The standardized utilization ratio (SUR) was used to determine a decrease in catheter utilization and the standardized infection ratio (SIR) was used to track CAUTIs over time. Results After five months of leadership rounding on Neuro-Oncology and Surgical, the SUR decreased 22% and 12% respectively on each of these units. There were no additional CAUTI events identified during this time frame. Observations from leader rounds identified collaboration between IP and staff nurses to discover barriers on the units and engaged staff in problem-solving. In addition, sustained change was facilitated through the building of interpersonal relationships between IP and the bedside nurse. Conclusions Urinary device utilization was reduced on each unit and there were no additional CAUTI events identified. Integrating leader rounds as an added strategy to reduce CAUTIs connects leaders with clinical staff. Intentional leader rounding along with evidence-based practices to reduce preventable infections and patient harm should be integrated as a proactive overall prevention strategy.

Marine Microbial-Derived Antibiotics and Biosurfactants as Potential New Agents against Catheter-Associated Urinary Tract Infections.

Catheter-associated urinary tract infections (CAUTIs) are among the leading nosocomial infections in the world and have led to the extensive study of various strategies to prevent infection. However, despite an abundance of anti-infection materials having been studied over the last forty-five years, only a few types have come into clinical use, providing an insignificant reduction in CAUTIs. In recent decades, marine resources have emerged as an unexplored area of opportunity offering huge potential in discovering novel bioactive materials to combat human diseases. Some of these materials, such as antimicrobial compounds and biosurfactants synthesized by marine microorganisms, exhibit potent antimicrobial, antiadhesive and antibiofilm activity against a broad spectrum of uropathogens (including multidrug-resistant pathogens) that could be potentially used in urinary catheters to eradicate CAUTIs. This paper summarizes information on the most relevant materials that have been obtained from marine-derived microorganisms over the last decade and discusses their potential as new agents against CAUTIs, providing a prospective proposal for researchers.

Build upon basics: An intervention utilizing safety huddles to achieve near-zero incidence of catheter associated urinary tract infection at a department of Veterans Affairs long-term care facility

BackgroundWhen traditional interventions are used in long term care for catheter associated urinary tract infection (CAUTI) prevention, residual rates are still high despite a decrease. We conducted a quality improvement study focusing our interventions on patient and staff behavioral patterns identified through a structured huddle process to improve upon the basics for CAUTI prevention. MethodsBaseline was from January 2016 to March 2017; the intervention period was from April 2017 to June 2020. We implemented a systematic huddle to determine root cause of each CAUTI and applied lessons throughout the facility. We measured the monthly CAUTI incidence per 1000 urinary catheter days and analyzed the reduction in CAUTI during the intervention period. ResultsCAUTI decreased by 73% during the intervention period compared to the baseline period, with an IRR of 0.27 (95% confidence interval [CI]: 0.11-0.66; P = .004). The number of catheter days per month increased by 4% in the intervention period (17,407 in 39 months) compared to the baseline period (6,440 in 15 months) with IRR of 1.04 (95% confidence interval [CI]: 1.01-1.07; P = .008). No patterns were noted in organisms responsible for CAUTI. ConclusionsOur findings stress the importance of looking beyond the traditional interventions for CAUTI prevention in long term care population. By doing this, interventions can be customized for this special population to achieve optimal outcomes.

Cranberry Products for the Prevention of Catheter-Associated Urinary Tract Infections

In this review, we examine the current literature regarding the use of cranberry and other complimentary methods for the prevention of catheter-associated urinary tract infections (CAUTIs). Some studies have suggested cranberry products may have a positive effect in reducing the incidence of CAUTIs in patients with normal bladder function receiving short-term catheterization, while other studies have failed to show the benefits of cranberry products for the reduction of CAUTIs. While there is some data suggesting cranberry-derived products may reduce CAUTIs in specific patient populations, there is currently overall insufficient clinical data to recommend broad usage of cranberry products for the reduction of CAUTIs. Many of the studies reviewed have significant limitations in size, design, and lack standardization.

Implementation of a Female External Urinary Catheter Reduces Indwelling Urinary Catheter Use and Catheter-Associated Urinary Tract Infections

Background: Using alternatives to indwelling urinary catheters plays a vital role in reducing catheter-associated urinary tract infections (CAUTIs). We assessed the impact of introducing female external catheters on urinary catheter utilization and CAUTIs. Methods: In a 500-bed academic medical center, female external catheters were implemented on October 1, 2017, with use encouraged for eligible females with urinary incontinence but not meeting other standard indications for urinary catheters. Nurses were educated and trained on female external catheter application and maintenance, and infection prevention staff performed surveillance case reviews with nursing and medical staff. We determined the number of catheter days for both devices based on nursing documentation of device insertion or application, maintenance, and removal. We used the CAUTI and DUR (device utilization ratio) definitions from the CDC NHSN. Our primary outcomes were changes in DUR for both devices 21 months before and 24 months after the intervention in both intensive care units (ICUs) and non-ICU wards. We used a generalized least-squares model to account for temporal autocorrelation and compare the trends before and after the intervention. Our secondary outcome was a reduction in CAUTIs, comparing females to males. Results: In total, there were 346,213 patient days in 35 months. The mean rate of patient days per month increased from 7,436.4 to 7,601.9 after the implementation of female external catheters, with higher catheter days for both urinary catheters (18,040 vs 19,625) and female external catheters (22 vs 12,675). After the intervention, the DUR for female external catheters increased (0 vs 0.07; P &lt; .001) and for urinary catheters the DUR decreased (0.12 vs 0.10; P &lt; .001) (Fig. 1). A reduction in urinary catheter DUR was observed in ICUs (0.29 vs 0.27; P &lt; .001) but not wards (0.08 vs 0.08; P = NS) (Fig. 2). Of the 39 CAUTIs, there was no significant overall change in the rate per 1,000 catheter days (1.22 vs 0.87; P = .27). In females (n = 20 CAUTI), there was a 61% reduction in the CAUTI rate per 1,000 catheter days (0.78 vs 0.31; P = .02), but no significant change in the rate in males (0.44 vs 0.56; P = .64). The CAUTI rate per 1,000 catheter days among females decreased in the ICUs (1.14 vs 0.31; P = .04) but not in wards (0.6 vs 0.33; P = .96). Conclusions: In a setting with a baseline low UC DUR, successful implementation of female external catheters further modestly reduced UC DUR and was associated with a 61% decrease in CAUTI among females in the ICU but not in wards. Further interventions to better identify appropriate patients for female external catheters may improve patient safety and prevent patient harm.Funding: NoneDisclosures: None

A National Intervention to Reduce Undesirable Urinary Tract Events in Internal Medicine Wards

Background: Catheter-associated urinary tract infection (CAUTI) is considered a preventable healthcare-associated infection. Many local and national interventions using multimodal prevention measures have targeted CAUTI incidence as the primary outcome. Other undesirable events related to urinary catheters and infections such as overuse of urine culturing and antimicrobial prescribing for asymptomatic bacteriuria, are not captured by CAUTI surveillance, and may not be the targets of such interventions. The aim of this study was to assess the impact of expanded national surveillance targeting various aspects of urinary tract infections, culturing and treatment practices, and catheter use in internal medicine wards. Methods: The Israeli National Center for Infection Control (NCIC) issued CAUTI prevention guidelines and initiated in 2016 a urinary tract event surveillance system that targets the incidence of CAUTI, urinary catheter utilization ratio, and the proportion of urine cultures sent and patients treated in the absence of symptoms. The surveillance is conducted for 1 month 3 times per year. Hospitals are required to report all positive urine cultures (&gt;100,000 CFU) collected in internal medicine wards, along with the following data: admission date, symptoms of infection, dates of urinary catheter use, and antibiotic treatment. These data enable the NCIC to validate hospital classifications of each event. In addition, during each surveillance month, hospitals conduct point-prevalence surveys of compliance with CAUTI prevention measures. An electronic data collection form with built-in algorithms supports the local teams during the surveillance process. Results: Between 2016 and 2019, a total of 3,028 positive urine cultures not present on admission were reported by internal medicine wards in 30 hospitals. A significant decrease was observed in the incidence of CAUTI (from 4.7 to 2.9; P &lt; .001) and in the proportion of asymptomatic bacteriuria treated with antibiotics (from 31% to 20%; P = .02) (Table 1). The catheter utilization ratio decreased from 0.25 to 0.23 (P &lt; .001). The rate of cultures sent from asymptomatic patients decreased from 1.5 to 1.1 (P &lt; .01). Point-prevalence surveys in internal medicine wards detected a significant increase in the use of closed urinary drainage systems (from 79% to 97% in 2018, P &lt; .001) and documentation of a daily nurse assessment of the need for a catheter (from 74% to 81%, P &lt; .001). Conclusions: National surveillance of undesirable urinary tract events resulted in a significant reduction in CAUTI, antibiotic treatment for ASB, and the rate of cultures sent from asymptomatic patients. A small decrease was observed in catheter utilization ratio. CAUTI surveillance programs should include other undesirable urinary tract events.Funding: NoneDisclosures: None

Catheter-Associated Urinary Tract Infection Reduction in the Solutions for Patient Safety Pediatric Safety Engagement Network

Background: Catheter-associated urinary tract infections (CAUTIs) are a leading cause of healthcare-associated infection. Catheter insertion and maintenance bundles have been developed to prevent CAUTIs, but they have not been extensively validated for use in pediatric populations. We report the CAUTI prevention efforts of a large network of children’s hospitals. Methods: Children’s hospitals joined the Solution for Patient Safety (SPS) safety engagement network from 2011 through 2017 and elected to participate in CAUTI prevention efforts, with 26 hospitals submitting data initially and 128 participating by the end. CAUTI prevention recommendations were first released in May 2012, and insertion and maintenance bundles were released in May 2014 (Table 1). Hospitals reported on CAUTIs, patient days, urinary catheter line days (CLD), and they tracked reliability to each bundle. For the network, control charts were used to plot CAUTI rates, urinary catheter utilization, and reliability to each bundle component. Results: Following the introduction of the pediatric CAUTI insertion and maintenance bundles, CAUTI rates across the network decreased 61.6%, from 2.55 to 0.98 infections per 1,000 CLD (Fig. 1). Centerline shifts occurred both before and after the 2015 CDC CAUTI definition change, which may also have contributed to a centerline shift. Urinary catheter utilization rates did not decline during the intervention period. Network reliability to the insertion and maintenance bundles increased to 95.4% and 86.9%, respectively. Conclusions: Insertion and maintenance bundles aimed at preventing CAUTIs were introduced across a large network of children’s hospitals. Across the network, the rate of urinary tract infections among hospitalized children with indwelling urinary catheters decreased 61.6%.Funding: NoneDisclosures: None

Catheter-Associated Urinary Tract Infection Reduction in a Pediatric Safety Engagement Network.

Catheter-associated urinary tract infections (CAUTIs) are a leading cause of health care-associated infection. Catheter insertion bundles (IBs) and maintenance bundles (MBs) have been developed to prevent CAUTIs but have not been extensively validated for use in pediatric populations. We report the CAUTI prevention efforts of a large network of children's hospitals. Children's hospitals joined the Children's Hospitals' Solutions for Patient Safety engagement network from 2011 to 2017, using an open start time engagement approach, and elected to participate in CAUTI prevention efforts, with 26 submitting data initially and 128 at the end. CAUTI prevention recommendations were first released in May 2012, and IBs and MBs were released in May 2014. Hospitals reported on CAUTIs, patient-days, and urinary catheter-line days and tracked reliability to each bundle. For the network, run charts or control charts were used to plot CAUTI rates, urinary catheter use, and reliability to each bundle component. After the introduction of the pediatric CAUTI IBs and MBs, CAUTI rates across the network decreased 61.6%, from 2.55 to 0.98 infections per 1000 catheter-line days. Centerline shifts occurred both before and after the 2015 Centers for Disease Control and Prevention CAUTI definition change. Urinary catheter use rates did not decline during the intervention period. Network reliability to the IBs and MBs increased to 95.4% and 86.9%, respectively. IBs and MBs aimed at preventing CAUTIs were introduced across a large network of children's hospitals. Across the network, the rate of urinary tract infections among hospitalized children with indwelling urinary catheters decreased 61.6%.

Small Patients and Tiny CAUTI Rates: Sustained CAUTI Reduction in a Children's Hospital

<h3>Background</h3> The pediatric catheter associated urinary tract infection (CAUTI) prevention team was formed in August 2015 to address a patient safety need. CAUTI rates, specifically in the pediatric intensive care unit (PICU), was consistently above national benchmarks, resulting in unnecessary harm to patients. <h3>Methods</h3> The CAUTI prevention team is a multidisciplinary team made up of bedside staff, physicians, and specialists. The team discusses metrics, bundle compliance and new products, and makes recommendations for Foley use and care. Education is provided regularly to bedside staff and physicians, with real time notification of CAUTI events. Since the development in 2015, the team has been able to move from general CAUTI education to specific and targeted reduction tactics. The team provides real-time notification to bedside staff to discuss Foleys in place greater than 2 days in order to facilitate removal. The team also provides weekly personalized utilization rates to ICU physicians for their own trending. Additionally, the team has expanded standardized patient bathing across the hospital, and developed tools for decreased discomfort and anxiety during catheterization processes. <h3>Results</h3> Since the team was formed in 2015, sustained improvement has been seen in CAUTI reduction with a 56% decrease hospital-wide and a 67% decrease specifically in the pediatric intensive care unit (PICU). Additionally, a process shift for Foley utilization in the PICU was seen in August 2016, and has been sustained to date. Prior to committee formation, Foley utilization was as high as 30%. In the last quarter, utilization averaged 10%, a 66% decrease. <h3>Conclusions</h3> The team has established, and more importantly sustained, standards for Foley use and care that have had significant impact on CAUTI rates in our hospital, preventing our patients from harm.

Multi-Pronged CAUTI Reduction Strategy

<h3>Background</h3> Catheter associated urinary tract infection (CAUTI) rates were identified as a concern at a large regional medical center (>500 beds). Inpatient chart audits were conducted revealing: nurse initiated indwelling catheter removal protocols inconsistently applied, catheters inserted for urinary retention without supporting documentation, catheters frequently inserted in the emergency department (ED), and inconsistent nursing care documentation. Based on our findings a multi-disciplinary, multi-pronged plan to improve the quality of care related to indwelling catheters and reduce CAUTI was deployed. <h3>Methods</h3> An interdisciplinary team was organized, gap and root-cause analyses were performed. The urinary retention assessment pathway (URAP) was developed to support the nurse initiated indwelling catheter removal protocol. A campaign, Foley Reduction in the ED, was established to reduce initial insertion of indwelling catheters. On the inpatient units, device rounds were implemented to reinforce appropriate nursing practice. An external catheter was made available for female patients. Standardized CAUTI prevention content was provided at orientation as well as annual education for all nursing staff. <h3>Results</h3> Improvements were observed after implementation of the URAP and inpatient device rounds; an emphasis on prevention of insertion of indwelling urinary catheters in the ED; and education regarding proper care and maintenance. A reduction in CAUTI Standardized Infection Ratio from 0.85 in 2018 to 0.662 and a slight decrease in the Standardized Utilization Ratio from 0.931 in 2018 to 0.856 was noted in 2019. <h3>Conclusions</h3> A comprehensive CAUTI prevention strategy for a large regional medical center focusing on clinical education, catheter insertion in the ED, and consistent catheter care and nurse initiated indwelling catheter removal in the inpatient units has led to a reduction of CAUTI and usage of indwelling catheters. While there have been marked improvements, continued monitoring and process improvement will be imperative.