Reduction of catheter-associated urinary tract infections among patients in a neurological intensive care unit: a single institution's success

J Neurosurg. 2012 Apr;116(4):911-20. doi: 10.3171/2011.11.JNS11974. Epub 2012 Jan 6.


Object: To date, there has been a shortage of evidence-based quality improvement initiatives that have shown positive outcomes in the neurosurgical patient population. A single-institution prospective intervention trial with continuous feedback was conducted to investigate the implementation of a urinary tract infection (UTI) prevention bundle to decrease the catheter-associated UTI rate.

Methods: All patients admitted to the adult neurological intensive care unit (neuro ICU) during a 30-month period were included. The study consisted of two 1-month preintervention observation periods (approximately 1200 catheter days) followed by a 30-month intervention phase (20,394 catheter days). A comprehensive evidence-based UTI bundle encompassing avoidance of catheter insertion, maintenance of sterility, product standardization, and early catheter removal was enacted.

Results: The urinary catheter utilization rate dropped from 100% to 73.3% during the intervention phase (p < 0.0001) without any increase in the rate of sacral decubitus ulcers or other skin breakdown. The rate of catheter-associated UTI was also significantly reduced from 13.3 to 4.0 infections per 1000 catheter days (p < 0.001). There was a linear relationship between the decreased quarterly catheter utilization rate and the decreased catheter-associated UTI rate (r(2) = 0.79, p < 0.0001).

Conclusions: This single-center prospective study demonstrated that a comprehensive UTI prevention bundle along with a continuous quality improvement program can significantly reduce the duration of urinary catheterization and rate of catheter-associated UTI in a neuro ICU.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Academic Medical Centers
  • Catheters, Indwelling / microbiology*
  • Cooperative Behavior
  • Cross Infection / prevention & control*
  • Evidence-Based Medicine
  • Florida
  • Humans
  • Intensive Care Units*
  • Interdisciplinary Communication
  • Nervous System Diseases / therapy*
  • Pressure Ulcer / prevention & control
  • Prospective Studies
  • Quality Assurance, Health Care / standards
  • Sterilization
  • Urinary Catheterization / adverse effects*
  • Urinary Catheterization / standards
  • Urinary Tract Infections / prevention & control*