Reducing CAUTIs: Quality Improvement Journey on the Reduction and Prevention of Catheter-Associated Urinary Tract Infections

Research Objectives: To investigate and implement methods to decrease hospital-acquired Infections, focusing on catheter-associated urinary tract infections (CAUTIs).

Design: Inpatient Quality Improvement Initiative (QI).

Setting: Gaylord Hospital, an independent long-term acute care hospital.

Participants: Interdisciplinary clinical care team, Information Technology Department support staff, and inpatients with an indwelling catheter.

Interventions: An interdisciplinary clinical care team at Gaylord Hospital, led by the Manager of Infection Prevention, collaborated with Quality and Safety, Nursing, Licensed Practitioners, and IT to initiate a powerful task force focused on reducing all hospital-acquired infections. This task force utilized CDC surveillance methods to identify and track device-associated infections (i.e. CAUTIs) and provided education about each step of the assessment, placement, maintenance, justification, and removal of catheters. The specific focus of the interdisciplinary team, along with biweekly rounding guided by the Manager of Nursing Quality Outcomes, increased institutional awareness at all levels. This was evident hospital-wide, from the patient to the clinical staff, as it led to accountability for each indwelling urinary catheter.

Main Outcome Measures: Indwelling catheter use and CAUTI rates.

Results: Compared to the 12-month reference period (3/1/2020 to 2/28/2021), the 12-month QI period (3/1/2021 to 2/28/2022) observed a significant mean (95% CI) reduction in Foley catheter use [217 (182, 251) to 112 (73, 152); p = 0.0006]; the mean (95% CI) monthly Foley use per 1000 patient days was similarly reduced [61 (52, 70) to 33 (21, 44); p = 0.0009]. Further, CAUTIs were reduced from eight in FY2020 to three in FY2022. When the historical rate of CAUTIs (2013-present) was considered, a significant negative trend (slope = -3.454; r = 0.6736; p = 0.0036) was observed. With a continued interdisciplinary team focus on education and assessment, this reduction in CAUTIs has been maintained through the following year.

Conclusions: By intentionally focusing on the goal of reducing CAUTIs, this interdisciplinary team approach, which assesses the use of every indwelling urinary catheter in each patient during every shift, has the potential to reduce indwelling catheter use and prevent CAUTIs.

Author(s) Disclosures: No conflicts to declare.