QAPI 107 - Evaluation of Cauti-reduction Strategies and Associated Reduction in CAUTI Rate and Catheter Utilization at a Large Academic Medical Center

Background: Urinary tract infections (UTI) are the leading cause of hospital-associated infection (HAI), with 80% attributable to indwelling urinary catheters. Despite implementation of a urinary catheter management protocol (UCMP), catheter-associated urinary tract infection (CAUTI) rates continued to increase.

Methods: After UCMP implementation in 2015, CAUTI prevention measures between 2016 and 2017 focused on improvement of reporting infrastructure to support quality-improvement (QI) efforts. This encompassed a revised electronic drilldown tool, establishment of daily leadership rounding for continuous process monitoring, and development of a standardized CAUTI prevention bundle, utilizing a lean tool for support. A database enabled tracking of bundle failures, supporting data-driven action plans for improvement. Initial action planning targeted catheter utilization, with the introduction of an external female urinary catheter in March 2017. Subsequent efforts focused on evidence-based standardization of care. This included adoption of a peri-care system for adult inpatients with urinary catheters in April 2019, development of culturing stewardship guidelines in October 2019, and revisions to the UCMP with acute urinary retention (AUR) order set development in October 2020.

Results: The hospital CAUTI rate decreased from 1.66 (per 1,000 device days) in 2017 to 1.42 in 2018. In the first quarter of 2019 (2019Q1), the CAUTI rate was 1.73, falling to 1.42 in 2019Q2, during peri-care system implementation, and 0.76 in 2019Q3 and 0.52 in 2019Q4, after implementation. Addition of AUR section to the UCMP in 2019Q4 led to a further decrease of CAUTI rate to 0.19 in 2020Q1. The CAUTI rate for 2020 was 0.48, increasing to 0.84 in 2021. Catheter utilization rate averaged 0.21 in 2015, decreasing to 0.135 during 2019.

Conclusions: A multifaceted, interdisciplinary approach to CAUTI prevention led to reduction of CAUTI rates and catheter utilization. These QI efforts were key to mitigating the increased CAUTI rates attributable to the COVID pandemic in 2021.