QAPI 122 - Standardization of Perineal Care Practice to Reduce Catheter-associated Urinary Tract Infections

Background: Despite implementation of best practice measures such as daily urinary catheter (UC) needs assessment, two-person UC insertion, and nurse-driven protocol for catheter removal and bladder management, catheter-associated urinary tract infection (CAUTI) rates remained unchanged throughout our facility. After conducting a gap analysis, one factor that was noted to have significant variability in practice was cleansing of the perineal area, or peri care. To standardize the approach to performing peri care, our facility implemented a multi-pronged approach to CAUTI reduction to reduce variability in practice.

Methods: In 2021, our clinical teams took measures to reduce CAUTI that included providing materials and supplies to standardize the practice of performing peri care, promoting accountability to ensure that peri care was provided per policy, and engaging hospital leadership. Starting in February 2021, we initiated a report of peri care compliance by unit at daily leadership safety huddle. Unit leaders were able to provide education and just in time coaching for overdue peri care. In April 2021, we implemented the use of pre-packaged meatal and perineal cleansing cloths, moving away from multi-use bath basins to perform peri care. CAUTI criteria from the National Healthcare Safety Network (NHSN) were used to identify infections over a 24-month period.

Results: During the 12-month pre-intervention phase, our facility identified 25 CAUTIs resulting in an incidence rate of 1.19 CAUTIs per 1,000 catheter days. During the 12-month post-intervention study phase, the facility identified 11 CAUTIs, with an incidence rate of 0.56 CAUTIs per 1,000 catheter days, a 56% reduction. The post-intervention reduction in CAUTI was statistically significant with a p-value of 0.034.

Conclusions: Utilizing a multifaceted approach to peri care including standardizing practice, promoting accountability, and engaging hospital leadership reduced CAUTIs at our facility.