Reduction in Health Care Facility Onset Catheter-Associated Urinary Tract Infections: A Resident-Led Quality Improvement Initiative

ABSTRACT

Background. Hospital-acquired catheter-associated urinary tract infection (CAUTI) was estimated to cause 19,700 cases in 2020 across the United States per the Centers for Disease Control and Prevention (CDC). While this is a 25% decrease in reported incidence rates since 2015, ad-hoc changes in care practices and limitations of surveillance definitions brought on by the giant burden of COVID-19 on the healthcare system possibly resulted in underreporting of CAUTIs. In a 290-bed tertiary, community hospital in the Detroit metropolitan area, there was a 200% increase CAUTIs from 2020 (5 CAUTIs) to 2021(16 CAUTIs). A multidisciplinary, resident-led team was assembled to reduce hospital-acquired CAUTIs. Methods. A multi-pronged quality improvement initiative was conducted from January 1, 2021, through March 31, 2022. CAUTIs were identified and reviewed via electronic health records using predefined criteria related to CDC surveillance definitions, urinary catheter insertion indications, laboratory data, and antibiotic use. Plan-Do-Study-Act (PDSA) Cycle model was used to guide the initiative. Thus far one PDSA cycle has been completed. The initial intervention bundle was designed by the multidisciplinary team and led by internal medicine and transitional year residents. The intervention bundle included 1. Provider (including physician and RN) education, 2. Design and implementation of an appropriate urinary catheter practice algorithm, and 3. Expert review of positive urine cultures and CAUTI cases. Results. Baseline data collected from January to December 2021 showed 16 CAUTIs. Post-implementation of the intervention bundle from January to March 2022 resulted in a 75% reduction in CAUTI incidence (1 CAUTI flagged). Conclusion. A targeted intervention bundle improved CAUTI incidence by reducing inappropriate urinary catheter insertion and prolonged removal. Ongoing local initiatives focused on hospital-acquired infections, such as this one, are paramount to the persistent optimization of infection prevention despite national trends.