Reduction in catheter-associated urinary tract infections by bundling interventions

Abstract

Objective: Urinary tract infections (UTIs) are the most common type of hospital-acquired infection, and most are associated with indwelling urinary catheters, that is, catheter-associated UTIs (CAUTIs). Our goal was to reduce the CAUTI rate.

Interventions: We retrospectively examined the feasibility and cost-effectiveness of a bundle of four evidence-based interventions upon the incidence rate (IR) of CAUTIs in a community hospital. The first intervention was the exclusive use of silver alloy catheters in the hospital's acute care areas. The second intervention was a securing device to limit the movement of the catheter after insertion. The third intervention was repositioning of the catheter tubing if it was found to be touching the floor. The fourth intervention was removal of the indwelling urinary catheter on postoperative Day 1 or 2, for most surgical patients.

Main outcome measure: Rates of CAUTI per 1000 catheter days were estimated and compared using the generalized estimating equations Poisson regression analysis.

Results: During the study period, 33 of the 2228 patients were diagnosed with a CAUTI. The CAUTI IR for the pre-intervention period was 5.2/1000. For the 7 months following the implementation of the fourth intervention, the IR was 1.5/1000 catheter days, a significant reduction relative to the pre-intervention period (P = 0.03). The annualized projection for the cost of implementing this bundle of four interventions is $23 924.

Conclusion: A bundle of four evidence-based interventions reduced the incidence of CAUTIs in a community hospital. It is relatively simple, appears to be cost-effective and might be sustainable and adaptable by other hospitals.