Catheter-associated urinary tract infections

Urinary tract infections (UTIs) account for 40 percent of all healthcare-associated infections (HAIs), according to the Centers for Disease Control and Prevention (CDC). Urinary catheters are associated with the vast majority of those healthcare-acquired UTIs.(1) Floyd Medical Center is utilizing the ERASE CAUTI Foley catheter management system along with facility-wide physician and nurse education on the appropriate use of catheters and the importance of avoiding catheters when not medically necessary, to reduce its CAUTI rates. Floyd earned first place in VHA Georgia’s 2010 Clinical Excellence award category.

A comprehensive catheterization process improvement initiative has led Georgia-based Floyd Medical Center to an 83 percent reduction in catheter-associated urinary tract infections (CAUTIs) and a 23 percent decline in the number of catheterizations performed at the hospital. In recognition of its accomplishments.

“We forged a hospital-wide initiative focused on reducing catheter use and related urinary tract infections,” said Darrell Dean, DO, MPH, medical director for clinical and operational performance improvement at Floyd Medical Center. “The ERASE CAUTI Foley catheter management system and tray has many design elements and product enhancements that were integral in our program to reduce variation in practice and achieve our goal of reducing CAUTI.”

Dr. Dean cited the kit’s larger sterile barrier drape and one-layer tray design versus the industry standard two-layer tray as important factors to helping the nursing staff maintain aseptic technique. He also pointed to the tray’s checklists as vital tools to CAUTI prevention—one that helps document a valid clinical reason for inserting a catheter and another that reviews the proper steps to catheter insertion. Upon completion, the checklists are then adhered to the patient’s chart for proper documentation of insertion.

In 2008, Floyd had 14 documented CAUTIs or 2.74 per 1,000 catheter days, which falls between the National Health Safety Network’s (NHSN) 50th and 75th percentile for all hospitals. The hospital began its initiative to reduce HAIs in March 2009 with the goal of reducing CAUTIs by 25 percent. For all of 2009, the hospital had only six CAUTIs or 1.17 CAUTIs per 1,000 catheter days, which represented a 53.7 percent reduction, exceeding the initial goal. This placed the hospital between the NHSN’s 10th and 25th percentile. For the first quarter of 2010, the hospital has experienced zero CAUTIs.  In addition to CAUTI reduction, the number of days a catheter was used went from 1,209 to 925, or a 23 percent drop, from March 2009 to March 2010.

Dr. Dean led the hospital’s CAUTI prevention team. He performed a chart analysis of 30 random patients with urinary catheters hospitalized during 2008 with a principal or secondary diagnosis of urinary tract infection. He identified several issues that guided his team through the improvement process, including the practice of inserting urinary catheters in the emergency department in order to collect a urine sample and then failing to remove the catheter once the sample was obtained. He also discovered that 73 percent of all catheters were inserted in the emergency department.

“We started using Medline’s Foley InserTag, a yellow sticker that wraps around the drain tubing with the date and time of the Foley insertion clearly visible to the caregivers, said Dr. Dean. “We also used a checklist sticker placed on the patient’s chart as a daily reminder for our nurses and physicians about the reason for catheter insertion, when it was inserted and whether the need for the catheter still exists or can be removed.”

References

1. Catheter-related UTIs: a disconnect in preventive strategies. Physician’s Weekly. 2008; 24(6).

Floyd Medical Center, based in Rome, Ga., is a 304-bed non-profit teaching community hospital serving Northwest Georgia and Northeast Alabama. Floyd Medical Center has a state-designated Level II Trauma Center, a behavioral health center, primary care and urgent care network of providers. Floyd Medical Center also hosts a realm of outpatient services, including operation of the Floyd County Clinic and an associated pharmacy for uninsured patients who cannot otherwise afford healthcare.