QAPI 146 - No Catheter, No CAUTI! implementing Leadership Rounds to Decrease Device Utilization and CAUTI Rates in a 500-bed Acute Care Hospital

Background: The duration of catheterization is a key risk factor for developing a catheter-associated urinary tract infection (CAUTI). Over the last three years, our facility observed a significant increase in CAUTIs, in part due to challenges posed by the COVID-19 pandemic resulting in prolonged and unnecessary catheter use. Our team implemented weekly leadership rounds with the goal of identifying and removing devices without clear indications and providing education on assessing the necessity of catheters.

Methods: Leadership rounds began in 2/2023 and we collected data for nine months. The leadership team consisted of Infection Preventionists, nursing leaders, infectious disease epidemiologists, and hospital executives. Rounds occurred weekly on a designated unit selected based on recent CAUTI numbers, high catheter utilization, or low catheter maintenance bundle compliance. During rounds, the team engaged unit leadership and frontline nurses to discuss catheter indications. Results from rounds were captured using an electronic audit tool to provide real-time feedback and quantify progress. We used two process measures: 1) the percentage of catheters removed within 48 hours, and 2) the standardized utilization ratio (SUR) for urinary catheters, comparing the SUR in 1/2023 to 10/2023. Our primary outcome measure was the CAUTI standardized infection ratio (SIR), comparing the median monthly SIR from 1 year prior to the intervention to 9-months post-intervention.

Results: We removed 35% (54/153) of catheters assessed. The hospital SUR decreased from 0.72 to 0.60 and from 0.77 to 0.66, in acute care and intensive care units, respectively. The median monthly CAUTI SIR decreased by 48% from 0.99 in the year pre-intervention to 0.51 post-intervention.

Conclusions: A structured process to routinely assess device appropriateness prompts discontinuation of unnecessary catheters and results in a significant decrease in device utilization. Engagement with key stakeholders, including senior leadership and frontline staff, is crucial to the success and sustainment of this intervention.