ISR 13 - Multi-modal Strategies for Implementation of CAUTI Prevention Guidelines in an Inpatient Rehabilitation Hospital to Improve Patient Outcomes

Background: Reducing catheter-associated urinary tract infection (CAUTIs) rate among hospitalized patients is a major focus for prevention. Consistent implementation of evidence-based practice (EPB) guidelines can be challenging in inpatient rehabilitation facilities (IRFs) where delivery of care is a partnership between physicians, nurses and allied health professionals. The following study evaluates reduction of CAUTI rate at an IRF using multi-modal interventions strategies.

Methods: The study was conducted at a free-standing IRF over a 3 year period between September 2019 through August 2022. A gap analysis of EBP guidelines was conducted to develop intervention strategies. Surveillance was conducted for positive urine cultures. A standardized algorithm of symptoms was used for chart review of infections and the presence of an indwelling urinary catheter. CAUTI rate was calculated per 1,000 device days; device utilization ratio (DUR) was calculated per patient days. National Health and Safety Network statistics calculator was used for comparison of two incidence density rates.

Results: Gap analysis identified opportunities for improvement in adapting guidelines to the IRF setting. Several interventions were designed, including: targeted education with practice-specific messaging, establishing unit-based device rounds, revising documentation in the electronic medical record and engaging leadership with unit-based data dashboards. DUR did not decrease substantially over the study period (DUR = 0.08, 0.073 and 0.069 during years 1, 2 and 3, respectively). CAUTI rate was reduced from 7.01 x 1,000 device days to 5.90 x 1,000 device days over the first two years of the study, and further reduced to 3.71 x 1000 device days during the third year (p = 0.0164).

Conclusions: Effective CAUTI prevention in IRFs requires diverse intervention strategies to engage staff in all healthcare disciplines. By engaging physicians, nurses and allied health partners, we were able to establish a sustainable program for CAUTI prevention following expert guidelines.