QAPI 161 - Urine Control: Interdisciplinary Collaboration for Catheter Associated Urinary Tract Infection Reduction at an Inpatient Rehabilitation Institute

Tuesday, June 4, 2024

12:46 PM – 1:15 PM CST

Location: Kiosk 6 - APIC Central, Hall 1

Presenter(s)

Taylor Keck, MPH, CIC (she/her/hers)

Infection Preventionist
UPMC Mercy

Co-Author(s)

Edward Hetherington, MSN RN

Clinical Director U.P. M.C. Rehabilition Institue Mercy Hospital
U.P.M.C. Mercy Hospital
Heather Dixon, MSN, RN, CIC

Director of Infection Prevention
UPMC Mercy
Mohamed Yassin, MD, PhD

Physician
UPMC Mercy
Gary Noel Floro Galang, MD

Medical Director TBI Unit , UPMC Rehabilitation INstitute
UPMC / University of Pittsburgh
AH

Amanda Harrington, MD

Medical Director, Spinal Cord Injury Services
UPMC
JB

Jessica Berry, MD

Physician
UPMC

Disclosure(s):

Taylor Keck, MPH, CIC: No financial relationships to disclose

Edward Hetherington, MSN RN: No financial relationships to disclose

Heather Dixon, MSN, RN, CIC: No financial relationships to disclose

Mohamed Yassin, MD, PhD: No financial relationships to disclose

Gary Noel Floro Galang, MD: No financial relationships to disclose

Amanda Harrington, MD: No financial relationships to disclose

Jessica Berry, MD: No financial relationships to disclose

Background: Acute inpatient rehabilitation (IPR) patients may have prolonged indwelling urinary catheters (IUC) to manage complications from their injuries or conditions. This can increase the risk of catheter associated urinary tract infections (CAUTI). These populations can also have an increased incidence of asymptomatic bacteriuria. An increase in CAUTI was observed between January 2021 and April 2022 at a hospital associated IPR Institute with 76 dedicated beds specializing in stroke, spinal cord injury, brain injury, and general rehabilitation. An interdisciplinary team including infection prevention (IP), clinical teams, and IPR leadership was created to review opportunities for interventions.

Methods: Daily rounding with IP, clinical staff, and IPR leadership for IUC necessity, device maintenance, and urine culture stewardship was initiated. Unit champions completed monthly surveillance of IUC maintenance with peer coaching. Unit protocols were developed to exchange chronic IUC on admission to IPR. Clean intermittent catheter practices were highly encouraged. Following any CAUTI, a root cause analysis (RCA) was completed with stakeholders to identify causal factors and action items to prevent recurrence. Foley utilization and CAUTI rates were obtained from the National Healthcare Safety Network and urine culture rates were obtained from medical record abstraction.

Results: Between pre- and post-intervention, the CAUTI standardization ratio, foley utilization rate, and urine culture rate decreased by 30%, 60%, and 31%, respectively. Two RCAs occurred early in the post-intervention period with findings of improper urine culture stewardship which was corrected. The IPR Institute achieved zero CAUTIs for a continuous 16 months (July 2022-November 2023) and counting.

Conclusions: IPR patients can be at increased risk for CAUTI due to their conditions and prolonged hospital stays. Education on device maintenance, necessity, and diagnostic stewardship is continuously provided to the medical, nursing, and therapy teams. Full engagement of IPR stakeholders in this collaboration provided sustainable interventions to significantly decrease CAUTI rates in IPR.

Learning Objectives:

Upon completion, participants will be able to describe indwelling catheter maintenance best-practices that can decrease the risk for a catheter associated urinary tract infection (CAUTI).
Upon completion, participants will be able to describe how findings from a root-cause analysis can be to further infection prevention quality improvement projects.
Upon completion, participants will be able to describe how creating a multidisciplinary collaborative group with key stakeholders can advance infection prevention initiatives to improve patient outcomes.