Eliminating catheter-associated urinary tract infections in the intensive care unit: is it an attainable goal?

Abstract

Background: Purpose of this study is to determine strategies to decrease catheter-associated urinary tract infection (CAUTI) in intensive care unit (ICU) patients.

Methods: ICU patients with an indwelling urinary catheter (UC) in one tertiary hospital were monitored for CAUTI. Interventions were implemented sequentially with quarterly data collection. Outcome measures were infection ratio (IR = number of infections/catheter days [CD] × 1000) and device utilization rate (DUR = catheter days/patient days).

Results: CDs and DUR decreased (fiscal year 2008: CD, 11,414; DUR, .85 vs fiscal year 2013: CD, 8,144; DUR, .70). IR increased with suspension of prepackaged baths (IR, 3.2 to 3.5 to 4.9 to 5.0), twice daily UC care (IR, 4.8 to 6.7), emptying UC bags at 400 mL (IR, 6.7 to 9.2). Two-person UC placement (IR, 5.6 to 4.8), physician notification of CAUTI (IR, 6.1 to 4.8), and reinstitution of prepackaged baths and daily UC care (IR, 4.8 to 3.7) decreased CAUTI rates.

Conclusions: Decreasing CAUTI in the ICU requires diligent monitoring and constant practice re-evaluation. Elimination of CAUTI in the ICU may not be possible.

Keywords: Catheter-associated urinary tract infection (CAUTI); Indwelling urinary catheter; Intensive care unit; Urinary catheter utilization.