QAPI 108 - Impact of Indwelling Urinary Catheter Necessity Review on Urinary Catheter Utilization and Catheter-associated Urinary Tract Infections

Background: Catheter-associated urinary tract infections (CAUTI) are one of the leading causes of healthcare-associated infections and a burden to patients and health care organizations. Reducing the use of indwelling urinary catheters (IUC) is an effective method in reducing CAUTIs. The objective of this study is to determine the effectiveness of line necessity review and outreach on urinary catheter utilization (UCU) and CAUTIs.

Methods: From February 2022 – October 2022 all inpatients at a midwestern acute care hospital with an IUC were reviewed for necessity via chart review by an infection preventionist (IP). The IP sent a message to the assigned nurse of any patients with IUCs that potentially were no longer indicated with recommendation to discuss removal with attending physician or update the indication. To evaluate the effectiveness the UCU rates and CAUTI population rates were compared between the intervention and pre-intervention (May 2021 – January 2022) timeframes.

Results: A total of 142 messages were sent by the IP, and 99 IUCs (69.7%) were removed the same day as the outreach. UCU rates were 12.4% (4223/33977) during the 9-month period prior to the study compared to 11.6% (3593/31091) during the 9-month study period which was a reduction of 6.5% (P value = 0.0006). The CAUTI population rate decrease from 0.88 cases per 10,000 patient days to 0.32 cases per 10,000 patient days but was not statistically significant (P value = 0.3617).

Conclusions: This study shows that implementing a workflow involving the review of IUCs for necessity can lead to reduction in UCU. A study with a longer timeframe and adjustment for potential confounding factors due to other interventions is needed to determine if the decrease in IUC utilization was based on the clinical necessity reviews, and if it leads to a significant decrease in CAUTIs.