QAPI 99 - Assessing the Effect of Removing and Reintroducing Perineal Care Products on Catheter Associated Urinary Tract Infections

Background: Proper perineal (pericare) and Foley care are important steps in Foley maintenance to reduce the incidence of catheter-associated urinary tract infections (CAUTI). At a quaternary academic medical center, there was an increase in CAUTI during a time where cleansing products were altered. Prior to October 2019, intensive care units (ICUs) utilized a cleansing foam for incontinence care. From October 2019 to January 2022, the cleansing foam was removed to promote the use of barrier cream wipes to address an increase in pressure injuries. Beginning February 2022, the cleansing foam was returned to the ICUs, in addition to barrier cream wipes. During these transitions, products in general care did not change. To determine whether the removal of cleansing foam contributed to a rise in CAUTI, the incidence rate before foam removal, foam removal, and foam introduction was calculated and compared.

Methods: We conducted a retrospective analysis of CAUTI before product change (Foam 1: July 2017-September 2019), product change (No Foam: October 2019-January 2022), and product reintroduction (Foam 2: February 2022-December 2022). We pulled a report of all CAUTIs, categorized them by ICU or general care, and calculated the incidence rates (IR) per 100-catheter days as defined by the National Healthcare and Safety Network (NHSN).

Results: The IR of CAUTI for the ICUs during Foam 1, No Foam, and Foam 2 were 8.2, 10.6, and 9.2 per 100-catheter days respectively. The IR of CAUTI for general care for Foam 1, No Foam, and Foam 2 were 6.6, 8.7, and 7.7 per 100-catheter days, respectively.

Conclusions: There was a similar rise and fall in the incidence of CAUTI in ICU as in general care where the cleansing practices were not altered. The increase in CAUTI is more likely due to the pandemic and missed pericare opportunities rather than the withdrawal of the cleansing foam.