206 - Targeted Assessment for Prevention Facility Assessments: The Most Common CAUTI and CLABSI Infection Prevention Gaps

Background: The Targeted Assessment for Prevention (TAP) Strategy is a quality improvement framework created by the Centers for Disease Control and Prevention (CDC) to facilitate reduction of healthcare-associated infections (HAIs). TAP Facility Assessments are a component of the TAP Strategy and are completed by staff across the facility to help identify perceptions of and target infection prevention gaps. We aim to describe the gaps most commonly reported by facilities completing TAP Facility Assessments for catheter-associated urinary tract infections (CAUTI) and central line-associated bloodstream infections (CLABSI).

Methods: TAP CAUTI and CLABSI Assessments were completed by acute care facilities across the nation with CDC technical assistance from December 2014 to August 2019. Similar questions across two versions of CAUTI Assessments and three versions of CLABSI Assessments were combined. Analysis was limited to facilities with ≥10 Assessments. Infection prevention gaps were defined as >33% respondents answering Unknown, >33% respondents answering No, or >50% of respondents answering No+Unknown or Never+Rarely+Sometimes+Unknown. Analysis was completed at the facility-level and the most common gaps reported across facilities were identified.

Results: A total of 1,942 CAUTI Assessments from 42 facilities in 12 states and 1,623 CLABSI Assessments from 29 facilities in 11 states were included for analysis. The mean number of assessments per facility was 46.2 for CAUTI and 56.0 for CLABSI. Across both CAUTI and CLABSI, commonly reported perceptions about infection prevention gaps included lack of physician and nurse champions for prevention activities, failure to conduct competency assessments, and inconsistency in select device insertion practices (Figure 1). For CAUTI, lack of practices to facilitate timely removal of urinary catheters were also commonly reported, with one third of facilities reporting inconsistency in use of alerts for catheter removal, 78.6% reporting lack of physician response to these alerts, and 90.5% reporting deficiencies in removing unnecessary catheters in the post-anesthesia care unit. For CLABSI, 79.3% of facilities reported failure to replace central lines within 48 hours after emergent insertion and 62.1% reported that feedback was not provided to staff on central line device utilization ratios.

Conclusion: For both Assessments, absence of CAUTI and CLABSI prevention champions, failure to conduct competency assessments, and inconsistency in performing device insertion practices were commonly reported across facilities. These common gaps have and will continue to inform the development of tools and resources to improve infection prevention practices as well as help to better target the implementation of interventions.