QAPI 150 - Quality Initiative to Provide Alternative External Catheters to Reduce Utilization of Indwelling Catheters and Infection Rates

Background: Increased use of indwelling urinary catheters can lead to catheter-associated urinary tract infections (CAUTI). Poor external devices and a need to reduce urinary catheter days, prompted a quality initiative to expand alternatives to urinary catheters.

Methods: The quality improvement initiative took place during September 2022 though April 2023 in a 1,018 bed academic medical center. The initiative involved collaboration between infection prevention, materials management, nursing, and urology. The use of plan-do-study-act quality improvement was used to improve use of external urinary catheter devices. The male condom catheter used prior to this initiative was not utilized due to its design. A new male condom catheter was initiated in September, 2022, to improve usage, adherence, and output measurement. In addition, in April, 2023, a second male external urinary catheter device was brought in for retracted anatomy. Standard utilization and CAUTI rates were compared prior to and following implementation of the alternative devices. In addition, utilization of alternative devices was tracked from January-September, 2023.

Results: After initiating the implementation of the two external urinary devices, utilization of male urinary alternative devices increased from 512 in January-March, 2023 to 1,352 July-September, 2023. Female external urinary devices increased from 16,935 January-March, 2023 to 20,743 July-September, 2023. In 2021 prior to this initiative, the CAUTI standard infection ratio was 0.59 and an infection rate of 1.050/1,000 line days. Following implementation to expand alternatives, 2023 had a CAUTI standard infection ratio of 0.41 and an infection rate of 0.73/1,000 line days.

Conclusions: Providing staff with better alternatives to urinary catheters can increase utilization of these devices, decrease urinary catheters, as well as reduce the risk of patient’s developing a catheter associated urinary tract infection.