Catheter Associated Urinary Tract Infections (CAUTI) – A hospital's program to make it a "Never” event

Hospital-acquired urinary tract infections account for approximately 40% of all hospital-acquired infections, resulting in over 900,000 incidences per year and the loss of millions of dollars to the health care industry.  In addition, hospital-acquired catheter-associated urinary tract infections (CAUTI) results in incidences of bacteremia, septicemia, death, and frequently serve as a source for antibiotic resistant organisms such as VRE, MRSA, and multi-drug resistant gram-negative rods.  In 1992, Classen et al., in a well-designed case control study, demonstrated a cost difference of $3,803 between patients who acquired catheter associated UTI vs. patients who did not.  Due to health care cost inflation since that time, current costs may approach $5,000- $7,000.  On April 13, 2007, CMS issued a proposed rule change that would disallow payment for hospital acquired urinary tract infection.

Education on universal precautions, avoiding unnecessary catheterizations, training on proper technique for placement of catheters, removal of the catheters as soon as possible, maintaining a closed system and minimizing manipulations of the catheter system have shown to prevent CAUTIs. The CDC (1981) strongly recommended educating personnel in correct techniques of catheter insertion and care.

A group of nurses including the WOCN nurses at a university hospital in the southwest set out to reduce the incidence of CAUTI in their inpatient population. At the same time the hospital implemented the use of silver and hydrogel coated catheters, the advanced practice nurses began an educational intervention for the staff. The education was offered to staff on the hospital’s intranet site.  The information included the following: indications for Foley, pathways of infection, Foley catheter and proper aseptic technique, Foley catheter protocol, male catheterization, female catheterization, monitoring, urine sampling, and a    self-learning module. Quarterly rounds have been conducted and the incidence of CAUTI’s are being followed with the assistance of the Infection Control Department.