ISR 14 - Implementing Initiatives to Reduce Catheter Usage and Catheter-Associated Urinary Tract Infections in Acute Care Hospitals

Background: Catheter-associated urinary tract infection (CAUTI) reduction is a priority. The purpose of this project was to increase awareness of best practices for CAUTI prevention and implement initiatives to decrease indwelling urinary catheter (IUC) utilization and CAUTI.

Methods: A healthcare system with 13 acute care facilities implemented three initiatives to decrease CAUTI between July 2022 and January 2023. The first was the “Low or No Foley Initiative” led by critical care physicians in intensive care units (ICU) to restrict placement of IUC and remove as soon as possible. Use of intermittent catheterization or external catheters was encouraged. The second was the removal of urinalysis (UA) with reflex to culture testing protocol; instead, providers were educated to order a urine culture only when UA with reflex microscopy indicated infection and urinary tract infection (UTI) symptoms (i.e., flank pain, suprapubic pain, etc.) were present. Lastly, the CAUTI team collaborated with nurse leaders and provider specialty councils to implement three evidence-based nurse driven urine management protocols to decrease IUC utilization: revision of the Indwelling Urinary Catheter Removal Protocol, development of an Intermittent Catheterization Protocol, and expansion of use of a Present on Admission Catheter Protocol to facilitate removal or exchange of urinary catheters based on assessment/symptoms. To evaluate the impact of these changes, the CAUTI SIR (standardized infection ratio) and IUC SUR (standardized utilization ratio) were compared for one year prior to implementation (July 2021-June 2022) and one year post (July 2022-June 2023) using EpiInfo (CDC, Atlanta GA).

Results: There was a statistically significant decrease in the SIR (36%, from 0.845 to 0.543, p=0.01) and the SUR (22%, from 0.882 to 0.69, p= < 0.05).

Conclusions: Intense focus on the three CAUTI reduction initiatives resulted in a statistically significant decrease in device utilization and CAUTI across the health system during a one-year timeframe.