Decreasing Catheter-Associated Urinary Tract Infections: Our Journey

Purpose: As of October 1, 2008, Centers for Medicare and Medicaid no longer reimburse for the treatment of hospital acquired conditions (HAC) related to catheter-associated urinary tract infections (CAUTIs) ².  The cost of treatment for a hospital acquired CAUTI ranges from $1200-$4700³.  At a 642 bed academic level one trauma hospital located in the South-Central US, there were 95 CAUTIs in 2013 with an estimated financial burden of $114,000 to $446,500.

Objective: The CAUTI Best Practice Team’s goal was to decrease CAUTIs to zero by implementing proven evidence-based reduction practices¹. The CAUTI Best Practice Team consisted of bedside nurses, nursing leadership, an Infection Prevention Practitioner, a Wound Ostomy Continence Nurse, and a physician.

Outcomes: With the implementation of Rapid Cycle Methodology, the hospital decreased hospital acquired CAUTIs and catheter utilization. The CAUTI Best Practice Team formalized and implemented a nurse-driven protocol for indwelling urinary catheter (IUC) management and removal. Initially physicians had patient safety concerns related to the protocol, but with team collaboration and clarification of the indicators, they supported the protocol. An algorithm was implemented with specific guidelines and recommendations regarding post-removal of IUCs for retention. The hospital reduced CAUTIs from 95 in 2013 to 78 in 2014. Continued interventions have brought CAUTIs down to 13 in 2016 and sustained decreases in 2017. During this same time period, catheter utilization dropped from an average of 23% to 11% in our medical-surgical units. With these practices in place, the hospital has had a reduction of 82 HACs from IUC which is an 86% decrease in CAUTIs representing a savings of approximately $98,400 - $385,400.