From the Tucson Medical Center, Tucson, AZ.
Abstract
- Objective: To describe a quality improvement project to reduce catheter-associated urinary tract infections (CAUTIs) in an intensive care unit (ICU).
- Methods: Descriptive report.
- Results: CAUTIs are a common health care–associated infection that results in increased length of stay, patient discomfort, excess health care costs, and sometime mortality. However, many cases of CAUTIs are preventable. To address this problem at our institution, we enrolled in the Hospital Engagement Network (HEN) collaborative for the reduction of CAUTIs, utilizing the Comprehensive Unit-based Safety Program (CUSP) as the platform for our project. This article describes our project implementation, challenges encountered, and the lasting improvement we have achieved at our facility.
- Conclusion: By challenging the ICU culture, providing nursing with alternatives to urinary catheters, and promoting physician engagement, we were able to reduce catheter utilization and CAUTI rates in the ICU.
Hospital-acquired infections (HAIs) are important causes of morbidity and mortality in the United States [1]. Among HAIs, urinary tract infections are the 4th most common, with almost all cases caused by urethral instrumentation [2]. Catheter-associated urinary tract infections (CAUTIs) are associated with an increased hospital length of stay of 2 to 4 days and a cost of $400 million to $500 million annually [3]. As of 2015, the Centers for Medicare and Medicaid Services no longer reimburses hospitals for treating CAUTIs.
CAUTIs are a particular challenge in the intensive care unit (ICU) due to the high urinary catheter utilization rates. In our mixed medical/surgical ICU, the catheter utilization rate was 84% in 2012 and was the setting for the majority of CAUTIs in our hospital. The risk of CAUTI can be reduced by ensuring that catheters are used only when needed and removed as soon as possible; that catheters are placed using proper aseptic technique; and that the closed sterile drainage system is maintained. In 2013 we launched a project to improve our CAUTI rates and enrolled in the Hospital Engagement Network (HEN) collaborative for the reduction of CAUTIs, utilizing the Comprehensive Unit-based Safety Program (CUSP) [4] as the platform for our project. This article describes our project implementation, the challenges we encountered, and the lasting improvement we have achieved.
Setting
Tucson Medical Center is a 600-bed tertiary care hospital, the largest in southern Arizona, with over 1000 independent medical providers. The medical center is a locally governed, nonprofit teaching hospital that has been providing care to the city of Tucson, southern Arizona, southwest New Mexico, and northern Mexico for the past 70 years. There are 2 adult critical care units: a cardiovascular ICU and a mixed medical/surgical ICU. We focused our efforts and interventions on the mixed ICU, a 16-bed unit that includes medical, surgical (neuro, general and vascular), and neurological patient populations that had 19 CAUTIs in 2012, versus 2 CAUTIs in the cardiovascular ICU.
Project
Initial Phase
The first steps in our project were to develop our unit-based team, identify project goals, and review our current nursing practice and processes. First, using the template from the CUSP platform, we assembled a team that consisted of the chief nursing officer (executive sponsor), ICU medical director, nurse manager, infection control manager, infection control nurse, 4 nurse champions (2 two night shift 2 day shift), and a patient care technician.