CAUTION: A Program to Decrease Hospital Acquired Catheter Associated Urinary Tract Infections

In late 2007/early 2008 we recognized that the catheter associated urinary tract infection (CAUTI) rates for our hospital were elevated (mean of 2.89/1000 patient days) compared with those of the CDC National Nosocomial Infection Surveillance (NNIS) of 0.53/1000 patient days.  A point prevalence study revealed a high percentage of catheterized patients and the need for improvement in catheter management practices.
A multidisciplinary process improvement program was initiated with involvement of physicians (Infectious Disease and Hospitalist), Infection Control, and Nursing.  

·         A catheter management knowledge assessment tool was distributed to all inpatient nursing staff (except perinatal and the acute rehabilitation center) revealing knowledge gaps. 

·         The indwelling catheter kits were standardized to include the silver /hydrogel coated catheters and a securing device.

·         Education was initiated with the development of the CAUTI intervention bundle using the letters CAUTION.   Educational newsletters were created.  Presentations were done at nursing, physical therapy, and other ancillary staff meetings.  Physician education was also provided.

C = Closed system, catheter selection

A = Aseptic management

U = Universal/Standard precautions

T = Tie/Secure catheter to body, tubing to bed

I = Indications

O = Obstruction free

N = No dependent loops.

·         An LVN assigned to the project provided routine follow up on indication and continued need for an indwelling catheter. 

·         The presence of an indwelling catheter and catheter management were added to the observation and data collection done during the quarterly pressure ulcer prevalence surveys.

The success of the program so far has been demonstrated by:

·       A decrease in the CAUTI rate from 2.89 to 0.41/1000 patient days.

·       The prevalence of all catheters fell from 36% to 28% with catheters in 48 hour or longer falling from 24% to 14%. 

·       The percentage of catheters secured has risen from 68% to 92%.