Quality Assurance and Performance Improvement
Background: Catheter-associated urinary tract infections (CAUTI) are preventable infections with significant impact on patient outcomes and hospital reimbursement. Per the Center for Disease Control and Epidemiology (CDC), the risk of CAUTI increases 3-7% per day of urinary catheter use. Until recently, no device to replace indwelling urinary catheters in women was adequate for monitoring urine output. Within our 394-bed, acute care hospital, 59% of CAUTIs in 2017-18 occurred in females. Of those, 80% were indicated for urine output monitoring. This project objective was to decrease indwelling urinary catheter use in female patients, thereby reducing risk of CAUTI.
Methods: A successful search was conducted to assess the availability of an external female catheter designed to accurately monitor urine output in immobile female patients. A pilot evaluation conducted in the Medical and Critical Care wards resulted in overwhelmingly positive feedback from both healthcare workers and patients. The product accurately monitored urine output, while avoiding skin moisture or breakdown. Contraindications for use included urinary retention, bowel incontinence, skin breakdown and menstruation. The product was approved and implemented on all adult inpatient units in July 2018. Pre-implementation (August 2017-June 2018) and post-implementation (July 2018-October 2018) CAUTI standardized infection ratios (SIR) and urinary catheter standardized utilization ratios (SUR) were calculated and compared using National Healthcare Safety Network (NHSN) analysis tools. All adult inpatient units, except maternal child health, were included in the study.
Results: Statistically significant decreases in urinary catheter SUR were noted pre- to post-implementation (1.06 to 0.93; p < 0.001). Non-significant increases in CAUTI SIR were also identified (0.53 to 0.62; p=.77).
Conclusions: Indwelling catheter utilization was reduced in immobile female patients by offering an external product capable of accurate urine output measurement. Although CAUTI SIR was not decreased, reduced indwelling catheter utilization could lessen the number of CAUTIs in female patients.