QAPI 148 - Prospective Surveillance of Indwelling Devices Decreased Rates of Bloodstream and Urinary Tract Infections

Background: Prevention guidelines for central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) show strong evidence for bundling process measures. When an infection does occur, a retrospective drilldown is inherently flawed as the principal driver of performance improvement. There is seldom sufficient evidence in the medical record or in the staff’s memory to offer significant actionable items. Focusing infection prevention (IP) capacity on the prospective hard wiring of process measure bundles will reduce infection rates more than standalone, retrospective drilldowns.

Methods: A prospective surveillance model was developed which concentrated IP resources at the bedside, working alongside nurses and providers. The intervention began in March 2022 and continued through February 2023. Each day, IPs audited at least 25% of all central lines (CL) and indwelling urinary catheters (IUC). Each IUC was evaluated for appropriate indication and candidacy for external urinary management. Each CL was monitored for appropriate indication as well as elements of an all-or-nothing CLABSI Composite maintenance bundle. The Standardized Infection Ratio (SIR) of both CLABSI and CAUTI were tracked along with the process measures during the intervention period.

Results: Upon initiation of the surveillance model, the CLABSI Composite was 34.7%. At the conclusion of the intervention period, the composite was 62.1%. The CLABSI SIR was reduced from 1.517 to 0.664. Before the surveillance model began, utilization of IUC was 121.46 (device days per 1000 patient days). Upon completion, that utilization was 82.29. Conversely, utilization of external urinary management devices increased from 78.07 to 90.31. In this period, the CAUTI SIR was reduced from 0.583 to 0.314.

Conclusions: Dedicating IP resources at the bedside in a prospective prevention model increases compliance of device maintenance practices and decreases risk from unnecessary indwelling devices. These improvements of process measure bundles help to decrease CLABSI and CAUTI SIR.