ISR 88 - Two Years of Zero Harm: A Multi-faceted Approach for Achieving Two Years Without a Catheter-associated Urinary Tract Infection (CAUTI)

Background: After experiencing five catheter-associated urinary tract infections (CAUTI) in 2019 (standardized infection ratio [SIR] 0.69) and six in 2020 (SIR 0.6), a 191-bed acute care hospital was determined to find a sustainable way to reduce the number of infections.

Methods: Many interventions were introduced to reduce the number of CAUTIs, consisting of education, alternative device implementation, and electronic medical record (EMR) tools. Registered nurses (RN) and nurse assistants (NA) were reeducated on the importance of aseptic urine specimen collection and indwelling urinary catheter (IUC) maintenance bundles at annual skills fairs. The infection prevention (IP) and nursing team explored alternative external male urine collection devices such as condom catheters and moisture-wicking urinary pouches. The IP team performed audits with nursing unit leaders on IUC maintenance bundle compliance and reported the data monthly to unit staff and leadership. Additionally, inappropriate urine cultures decreased through the implementation of a urine culture hard stop in the EMR to ensure urine specimens were ordered and sent only if truly indicated.

Results: After implementation of these interventions, the hospital had one reportable CAUTI in 2021. In 2022 and 2023, zero were reported. The standardized infection ratio (SIR) declined from 0.69 in 2019 to 0 in 2022 and 2023.

Conclusions: The IP and nursing department credits the sustenance of zero harm to the culture of high reliability created by the above interventions. Team members providing direct patient care are aware of the expectations related to CAUTI prevention. The facility plans to continue diligent daily review of IUCs, prevent placement of IUCs if another viable option exists, educate team members on IUC maintenance expectations, and ensure all urine cultures ordered when the IUC has been in place for three or more days are reviewed by an infectious disease physician for appropriateness.