Quality Assurance and Performance Improvement
Background : Outcome data in 2017 from a 400-bed hospital in Michigan demonstrated an opportunity for improvement in the reduction of hospital-acquired catheter-associated urinary tract infections (CAUTIs) and Clostridium difficile infections (CDIs). Inappropriate urine cultures and C. difficile toxin tests were being collected, leading to an increased risk of over diagnosis involving cases of colonization as opposed to true hospital-acquired infection. Our aim was to develop a multi-disciplinary process that would lead to sustainable practice in reducing hospital-acquired CAUTIs and CDIs.
Methods : Best practices were reviewed to design a daily culture monitoring process that met the needs for the hospital. Based on that process, all urine cultures and C. difficile toxin tests were reviewed by Infection Prevention, nursing leadership, and the Infection Prevention Medical Director. If the culture was not clinically indicated, the order would be cancelled. A CDI policy was created and implemented for early identification, testing, and appropriate isolation of cases. All indwelling urinary catheters were monitored daily to assess the appropriateness in order to potentially reduce the length of device utilization. Emphasis on the hospital’s antimicrobial stewardship program was increased to monitor the appropriateness of antibiotic use.
Results : From 2017 to 2018, the CAUTI rate reduction was 65% (9 cases and 3 cases, respectively) and CDI rate reduction was 60% (35 cases and 15 cases, respectively). The average SIR for 2017 and 2018 for CAUTI was 0.759 and 0.297, respectively and for CDI was 0.706 and 0.308, respectively.
Conclusions : Based on the results, monitoring urine cultures and C. difficile toxin test appropriateness is an achievable and sustainable practice to reducing hospital-acquired CAUTIs and CDIs. Daily multi-disciplinary collaboration is essential to the sustainability of reducing these infections.