Quality Assurance and Performance Improvement
According to the Centers for Disease Control and Prevention (CDC), Catheter Associated Urinary Tract Infections (CAUTIs) are associated with increased morbidity, mortality, healthcare costs, and length of stay. The purpose of this performance improvement (PI) initiative is to decrease CAUTIs for inpatients for 2018. An inter-professional CAUTI workgroup addressed this by implementing evidence based practices (EBPs) and interventions focused on processes.
The setting was a 397 bed, urban, acute-care, teaching hospital. The sample included inpatients with indwelling urinary catheters. In 2017, the CAUTI rate was above the benchmark established by the National Healthcare Safety Network. The goal was to decrease CAUTIs in 2018, as reflected by the Standardized Infection Ratio (SIR) - a statistical summary measure that tracks Hospital Acquired Infections over time. An inter-professional workgroup was developed to review the data, perform a gap analysis and implement a corrective action, preventative action plan. The CDC guidelines for prevention of CAUTI (2009) was used as the source for EBP and PI. Interventions focused on processes included: a two-person urinary catheter insertion checklist (wingman), non-invasive alternatives to urinary catheters, daily audits of bundle compliance and device removal (nurse driven protocol), urinary retention protocol, and guidelines for indications for urine culturing. After implementing these interventions, the number of CAUTIs was measured.
Interventions (wingman, audits, guidelines, and protocols) decreased CAUTIs from 15 to 2. The overall, 12 month, rolling rates for SIR improved for Intensive Care Units (ICU) from 0.94 to 0.45, and for Non-ICU from 1.51 to 0.24. Non-invasive alternatives and the nurse driven device removal protocol improved catheter utilization rates for ICU from 0.55 to 0.43. There was no statistical change for non-ICU device utilization rates.
This PI initiative found that an inter-professional workgroup focused on process interventions can reduce CAUTI in both ICU and non-ICU inpatient settings.