Background: In 2012, the Scottsdale Osborn Medical Center intensive care unit (ICU) had a rate of catheter-associated urinary tract infection (CAUTI) among the highest in Arizona hospitals, with 54 infections reported. To address the high rate of CAUTI in the Osborn campus ICU, the project team participating in the Alliance of Independent Academic Medical Centers (AIAMC) National Initiative IV joined the CAUTI systemwide oversight team in the ambitious goal to eliminate CAUTI from Scottsdale Healthcare.
Methods: The quality improvement project to eliminate CAUTI took place throughout calendar year 2014 at the Osborn campus and involved the AIAMC project team, the CAUTI systemwide oversight team, and support from the Scottsdale Healthcare information technology team. A CAUTI bundle based on current best-practice guidelines for prevention of CAUTI was finalized in January 2014. In addition, the AIAMC project team spearheaded and coordinated 6 initiatives based on current guidelines to attempt to reduce unnecessary urinary catheter use in the hospital system. The initiatives included education, mandatory prompts and reminders in the electronic medical record, daily patient tracking, a resident quality champion, and a urine retention protocol.
Results: Catheter days in the ICU dropped by approximately one-third during the first 2 quarters of 2014 and then appeared to level off. The CAUTI numbers and rate fluctuated in the ICU without much change during 2013 and 2014 but then dropped in 2015. However, the national definition of CAUTI changed in the first quarter of 2015, and the change in definition was estimated to reduce the number of reported CAUTIs in our hospital by 25%-30%. Urinary catheter days in the non-ICU units declined relatively steadily from the last quarter of 2013 through midyear 2015. CAUTI rates were fairly low in this setting during the observed quarters. In the emergency department (ED), both urinary catheter insertions and the insertion rate dropped during 2014. The insertion rate dropped from approximately 4% of all ED patients prior to the initiative to just 1%.
Conclusion: The greatest success of this AIAMC National Initiative IV project was the dramatic and sustained decrease in urinary catheter insertions in the ED. The project also helped achieve an important reduction in urinary catheter days in the target hospital ICU and non-ICU floors and likely helped to reduce CAUTI rates as well. Intensive education efforts involving nurses, residents, attending physicians, and quality improvement staff were crucial elements in the initiative. Tracking patients with urinary catheters and electronic order entry and stop reminders played an important role. Despite progress, much work remains to eliminate CAUTI from the hospital.
Keywords: Catheter-related infections; cross infection; patient safety; quality improvement; urinary catheterization.