QAPI 119 - Can Limiting Foley Insertions in the ED and Utilization in the ICU Reduce Cautis?

Background: Catheter-associated urinary tract infections (CAUTI) are one of the most frequent hospital-acquired infections in the acute care setting, resulting in avoidable days and cost, and a 22% increase in mortality. This entity saw a significant increase in CAUTI events in 2022, primarily related to avoidable retention of foley catheters. It was hypothesized that decreasing routine insertions in the Emergency Department (ED) and use of a retention algorithm in the Intensive Care Unit (ICU) could reduce device days and limit CAUTI events.

Methods: Infection Prevention, ED, and ICU performed an analysis of CAUTI events over past 4 years. The workgroup identified the following opportunities: refresh education for staff on appropriate foley indications, implement structured daily review of devices for necessity, refresh staff on Urinary Retention Algorithm with the use of straight catheterization and ultrasound assessments, increase use of external urinary catheters, and remove indwelling catheters as soon as clinically indicated. The population included in the study was all admitted ED patients and all ICU patients over one year. Process measures included foley insertions in the ED (number of insertions per 1000 ED visits) and foley utilization in the ICU (device days per patient days). The outcome measure was CAUTI events using National Healthcare Safety Network (NHSN) criteria. The goals were to decrease foley placements in the ED and ICU foley utilization by 20% respectively by end of 2023, and reduce CAUTI events by 20% by end of 2023.

Results: ED foley placements decreased from 10.5 per 1000 visits to 3.5 by January 2023 (66.7% decrease). ICU foley utilization decreased from 0.28 in August 2022 to 0.14 in March 2023 (50% decrease). Zero CAUTI events were identified for over 440 days.

Conclusions: This study found that a collaborative effort to decrease foley use in ED and ICU can reduce CAUTI events.