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At Portneuf Medical Center, we do more than talk about quality, we are active in quality improvement initiatives and ongoing quality patient care. Here is one example of our recent initiative to significantly reduce CAUTIs in our facility:
Portneuf Medical Center
Catheter Associated Urinary Tract Infection Reduction Initiative
Project start date: 05/12/2021
Background: Catheter-associated urinary tract infections (CAUTIs) are among the most common health care-associated infections in the United States. "CAUTIs represent approximately 9% of all hospital acquired infections, and approximately 65%–70% of CAUTIs are believed to be preventable." https://www.ncbi.nlm.nih.gov/.
What is a CAUTI?
“A urinary tract infection (UTI) is an infection involving any part of the urinary system, including urethra, bladder, ureters, and kidney. UTIs are the most common type of healthcare-associated infection reported to the National Healthcare Safety Network (NHSN). Among UTIs acquired in the hospital, approximately 75% are associated with a urinary catheter, which is a tube inserted into the bladder through the urethra to drain urine. Between 15-25% of hospitalized patients receive urinary catheters during their hospital stay. The most important risk factor for developing a catheter-associated UTI (CAUTI) is prolonged use of the urinary catheter. Therefore, catheters should only be used for appropriate indications and should be removed as soon as they are no longer needed.” https://www.cdc.gov.
Impact of catheter associated urinary tract infections include:
- CAUTI makes up 13% of Healthcare-Associated Infections (HAIs) reported, comprising an estimated 93,300 infections annually.
- CAUTIs lead to longer length of hospital stay.
- CAUTI is the leading cause of secondary bloodstream infection.
- Studies have found a strong correlation between catheter use greater than six days and the development of a CAUTI.
- An estimated 13,000 deaths (mortality rate 2.3%) are attributed to UTIs annually in the United States.
- The mortality rate increases to approximately 10% when the patient also has a secondary bacteremia (bloodstream infection as a result of the UTI). https://www.vdh.virginia.gov.
As baseline data for this improvement project, Portneuf Medical Center identified four (4) Catheter Associated Urinary Tract Infections (CAUTI) reported in 2020, the first year of the COVID-19 pandemic. In Q1 and Q2 2021, Portneuf Medical Center noted a rise in reported incidences of CAUTI infections related to high volumes of COVID-19 positive patients (some intubated and in a prone position, making foley and peritoneal care difficult) and an increased use of indwelling foley catheters.
Data from the National Healthcare Safety Network (NHSN) show significantly higher incidence in catheter-associated urinary tract infections (CAUTIs) in 2021 compared to 2019. These increases coincided with periods of high COVID-19 hospitalizations and were especially elevated during the first and third quarters of 2021. https://www.cdc.gov.
The goal was to reduce the number of CAUTI’s in 2021 by 75% and maintain less than two (2) during the calendar year of 2022.
A multidisciplinary team was assembled in May of 2021 to review performance data, review specific cases, identify process opportunities, and develop a plan of action for sustained improvement. The team, comprised of nurses, nursing educators, pharmacists, department leaders, physicians, quality team members, as well as infection preventionists, used the hospital’s Plan Do Study Act (PDSA) improvement model to evaluate and to drive necessary changes to the care/maintenance of patients with indwelling foley catheters.
The improvement actions included reducing the number of indwelling urinary catheters and increasing the use of external devices, i.e.: PureWick and condom catheters, as a less invasive means of urinary management. This was complimented by the standardization for frequency of cleaning/care and products used. Together, these actions have proved to be very effective with no observed CAUTI infections in Q4 2021 or 2022 year to date.
On 09/15/2022, Portneuf Medical Center will reach a milestone as having gone one (1) year without a CAUTI infection. Baseline and performance data may be observed in the following graph:
Portneuf Medical Center is committed to the safety of our patients and takes pride in the united sense of teamwork that makes improvement initiatives successful.