QAPI 110 - Implementation of a Catheter-associated Urinary Tract Prevention Bundle in a Medical-neurological Intensive Care Unit

Background: Catheter-associated urinary tract infections (CAUTI) are among the most common healthcare-associated infections, increasing morbidity and mortality rates, especially among critically ill patients. In 2018, the medical-neurological intensive care unit (MNICU) in a 402-bed community hospital had a utilization rate of 52.6 percent and a CAUTI rate of 1.53 per 1,000 catheter days. This quality improvement project seeks to determine if implementing a CAUTI bundle will decrease indwelling catheter utilization and CAUTI rates compared to current practice.

Methods: This quality improvement project aimed to reduce indwelling catheter utilization and CAUTI rates among adult patients in a 20-bed MNICU by implementing a CAUTI bundle guided by the Agency for Healthcare Research and Quality Toolkit for Reducing CAUTI in Hospitals over 46 months. The CAUTI bundle consisted of a checklist for insertion, daily documentation of necessity, a nurse-driven protocol for catheter removal, a urinary retention protocol, external urine collection devices, and rounding. Data were extrapolated from the electronic medical record for indwelling catheter utilization and CAUTI rates. Percent reduction calculations and Mann-Whitney U -tests were conducted to compare indwelling catheter utilization and CAUTI rates per 1000 catheter days at pre (2018) and post-implementation (2019- October 2022).

Results: Pre-implementation, indwelling catheter utilization was 52.6%, with a CAUTI rate of 1.53 across 12 months. The post-implementation utilization rate averaged 35.9% across 46 months, with an overall CAUTI rate of 0.77, resulting in a 31.8% reduction in average utilization and a 49.7% reduction in CAUTI rates. Mann-Whitney U tests showed a statistically significant decline in catheter utilization (Z = -4.32, p < .001); however, the decline in CAUTI rates was not significant (Z = 1.65, p = .100).

Conclusions: This quality improvement project found that a CAUTI Prevention bundle can decrease
indwelling catheter utilization and CAUTI rates. MNICU has remained CAUTI-free for 21 months.