Implementation of authority guidelines and innovation with emphasis on prevention of healthcare-associated symptomatic catheter-associated urinary catheter infections (CAUTIs)

INTRODUCTION:  The 600-bed hospital embraced the CMS challenge to address healthcare-associated infections (HAIs) as “never-events” by focusing on improving team communication, patient safety and quality through interventions to decrease the rates of symptomatic healthcare catheter-associated urinary tract infections (CAUTIs). The Hospital Board established a goal to reduce the count of symptomatic CAUTIs by 10%, from a baseline (Jan 2008–Dec 2008) of 57 symptomatic CAUTIs to 51 symptomatic CAUTIs in Fiscal Year/FY 2010 (July 2009–June 2010).

METHODS:  This prospective cross-sectional study consisted of a multidisciplinary project management team approach, directed by the Hospital Epi- team, including Clinical Nurse Specialists; front line staff; the IPC Committee; Clinical Analysts; all Medical Staff and and Clinical Educators used to implement the initiative. A CAUTI bundle was implemented by: setting clear expectations for indications for indwelling urinary catheter use (an indwelling catheter policy which included criteria for catheter use); catheter insertion using aseptic technique and sterile equipment; use of small size catheters; catheter maintenance; hand hygiene; documentation of catheter placement); daily assessment of the continued need for indwelling urinary catheter by a multidisciplinary team; the use of a bladder scanner before catheter placement; the use of intermittent catheterization when indicated and the promotion of education of direct care givers in all clinical areas.

RESULTS:  The hospital realized a 63% reduction in symptomatic CAUTIs from MRSA cases of colonization and infection between the 2008 period (Jan 1, 2008-Dec 31, 2008) and 2009 period (Jan 1, 2009-Dec 31, 2009).  As of March 2010, the rate was at 17 cases of CAUTIs, which was well below the target of 51 cases for the fiscal year (which ended in June 30, 2010).

CONCLUSIONS:  The reduction in the incidence of CAUTIs, was associated with the use of the urinary catheter infection prevention bundle strategies, which were largely driven by the multidisciplinary project management team members at this hospital.