After the CAUTI Bundle….What Then?

Catheter-related urinary tract infection (CAUTI) is one of the most frequent hospital-acquired infections.  It is known that following the bundle of best practices an lead to a reduction in CAUTI.  Our critical care unit had already aggressively implemented this bundle of care and participated in a LEAN Rapid Improvement Event, reducing CAUTI by over 40%, and were still experiencing patients with CAUTI.  We wanted to do more. 

After consultation with an antibiotic stewardship expert and collaborating with our Infection Prevention Committee colleagues we implemented a novel prophylaxis regimen using Clorpactin bladder irrigations, starting Foley Catheter day four, repeating every three days until the catheter was removed.  Clorpactin (Oxychlorosene in 0.9% Sodium Chloride, final concentration 0.05%) is a topical irrigant antiseptic and works via oxidation and chlorinization of cell proteins and enzymes.  This product has been available since the 1950’s, costs little to use and is well-tolerated in the literature. 

After implementing the Clorpactin bladder irrigation prophylaxis protocol in January of 2014 our 16-bed ICU/PCU went from six CAUTI in 2013 to one CAUTI in 2014, an 83% reduction.  Our CAUTI rate per 1000 Foley days reduced form 3.4 in 2013 to 1.31 in 2014.  We are currently at zero in our ICU for the first nine months of 2015.  It appears that this practice is making a difference for our patients.  We will present two complete years of data from our ICU. 

The financial impact at our small hospital of going from 6 to zero CAUTI annually is approximately a $6,000 savings.  However, the estimated total cost of CAUTI annually in the U.S. is $450 million. If further research supports this inexpensive (less than $1.00 for the irrigation solution) intervention the financial impact would be substantial.