Highlights of a poster presentation at the APIC Annual Conference, June 2014
Issue: Catheter-associated urinary tract infections (CAUTI), the most common healthcare-associated infection, lead to substantial morbidity and increased healthcare costs. In 2011, at an 810-bed academic hospital, we set a 2-year hospital-wide quality goal of 5% CAUTI reduction each year from the previous year. Achievement of the goal was tied to a hospital-wide employee financial incentive. Unit-level Six-Sigma projects guided our multidisciplinary strategy to three focus areas for urinary catheters: appropriate insertion indication, maintenance, and timely removal.Project: Physicians developed an approved list of catheter insertion indications and were required to select an approved indication when placing electronic orders. We began performance feedback weekly with unit-level days since last CAUTI reports and monthly CAUTI rate and catheter device utilization reports. General CAUTI prevention education was provided to nursing and medical staff, and specific education was developed for units identified with higher CAUTI rates. Nursing/ physician teams on each unit developed a daily mechanism to assess each patient’s need for continued catheter use (e.g., rounding tools, posted signage with each patient’s catheter days).
Results: After CAUTI rates slightly increased in 2009-2010, we were able to achieve an additional 13% reduction in CAUTI rates during our hospital-wide quality goal years (FY2012-FY2013), (Figure 1, 2.78 to 2.42 infections per 1000 catheter days). Despite unit-based efforts to reduce urinary catheter days, our device utilization ratio remained relatively constant over the time period (0.28 in 2009 to 0.25 in 2013). By engaging all units in this goal, we were able to achieve more consistent practices for urinary catheter insertion, maintenance, and removal through larger scale multi-disciplinary efforts which resulted in lower CAUTI rates.
Lessons Learned: A hospital-wide CAUTI reduction goal was selected since we had previously demonstrated that >50% of CAUTI occurred in non-intensive care units. Despite implementation of the approved indications for use and unit-based mechanisms for assessing continued daily need, device utilization remained constant. To address device utilization on a broader scale, a nurse-driven standing order protocol for catheter removal was initiated. This protocol also requires daily nursing documentation for continued catheter need using the physician-generated indications.
