Abstract

Catheter-associated urinary tract infections (CAUTIs) from indwelling urinary catheter (IUC) account for 25% of all hospital-acquired infections. Neuro-critically ill patients are at 2–5 times greater risk of developing CAUTI because of increased use of indwelling urinary catheters due to neurogenic urinary retention. The CAUTI rate for the Neurocritical Care Unit was 7.814 per 1000 patient days with an average quarterly utilization rate of 84%. A robust quality improvement project that included rapid impleentation of evidence, removal or replacement of the IUC by day 5, weekly patient centered rounds, urine culturing best practices, order set changes, and supporting evidence to improve straight catheterization best-practices was implemented. Data was collected over an 11-month period. In 19,000 patient days, patient device utilization rate decreased 63%, SIR and SUR decreased below the mean for majority of the previous 8 quarters. The CAUTI rate decreased to 1.57. A paired samples t-test was performed to assess strength of intervention. Statistically significant improvement in device utilization reduction and infection count were seen. The SIR intervention group was significantly lower than the pre-intervention group, (t(6)= 1162.699, p= <0.001). Additionally, the SUR intervention group (M=73.86, SD=8.630) was lower than the preintervention group (M=84.33, SD=7.356), (t(6)=-22.385, p= <0.001). The project found the upper limit of 5 days of an indwelling urinary catheter for desired outcomes of improved CAUTI rates. This quality improvement project utilized best evidence of removing or replacing IUC by day 5.

Notes

References:

Firoozeh N, Agah E, Bauer ZA, Olusanya A, Seifi A. Catheter-Associated Urinary Tract Infection in Neurological Intensive Care Units: A Narrative Review. Neurohospitalist. 2022 Jul;12(3):484-497. doi: 10.1177/19418744221075888. Epub 2022 Feb 25. PMID: 35755214; PMCID: PMC9214946.

Gunardi WD, Karuniawati A, Umbas R, Bardosono S, Lydia A, Soebandrio A, Safari D. Biofilm-Producing Bacteria and Risk Factors (Gender and Duration of Catheterization) Characterized as Catheter-Associated Biofilm Formation. Int J Microbiol. 2021 Feb 22;2021:8869275. doi: 10.1155/2021/8869275. PMID: 33688348; PMCID: PMC7920707.

Ouyang, M., Billot, L., Song, L., Wang, X., Roffe, C., Arima, H., Lavados, P. M., Hackett, M. L., Olavarría, V. V., Muñoz-Venturelli, P., Middleton, S., Pontes-Neto, O. M., Lee, T. H., Watkins, C. L., Robinson, T. G., & Anderson, C. S. (2021). Prognostic significance of early urinary catheterization after acute stroke: Secondary analyses of the international HeadPoST trial. International journal of stroke : official journal of the International Stroke Society, 16(2), 200–206. https://doi.org/10.1177/1747493020908140.

Perrin, K., Vats, A., Qureshi, A., Hester, J., Larson, A., Felipe, A., Sleiman, A., Baron-Lee, J., & Busl, K. (2021). Catheter-Associated Urinary Tract Infection (CAUTI) in the NeuroICU: Identification of Risk Factors and Time-to-CAUTI Using a Case-Control Design. Neurocritical care, 34(1), 271–278. https://doi.org/10.1007/s12028-020-01020-3

Description

Learn about one unit's efforts to reduce CAUTI rate, SIR and SUR. Several evidence-based implementations were used to guide the unit including a day 5 limit of removal or replacement of an indwelling urinary catheter. SUR reduced 63%, SIR was below the mean for 8 quarters and CAUTI rate improved from 7.814 per 1,000 patient days to 1.57 per 1,000 patient days.

Author Details

Nicole E. Sunderland, DNP, RN, SCRN, CCRN

Sigma Membership

Xi

Type

Presentation

Format Type

Text-based Document

Study Design/Type

Quality Improvement

Research Approach

Other

Keywords:

Acute Care, Implementation Science, Catheter-associated urinary tract infections, CAUTIs

Conference Name

36th International Nursing Research Congress

Conference Host

Sigma Theta Tau International

Conference Location

Seattle, Washington, USA

Conference Year

2025

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.

Review Type

Abstract Review Only: Reviewed by Event Host

Acquisition

Proxy-submission

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Reducing CAUTI in the Neurocritical Care Unit Through Rapid Implementation of the Evidence

Seattle, Washington, USA

Catheter-associated urinary tract infections (CAUTIs) from indwelling urinary catheter (IUC) account for 25% of all hospital-acquired infections. Neuro-critically ill patients are at 2–5 times greater risk of developing CAUTI because of increased use of indwelling urinary catheters due to neurogenic urinary retention. The CAUTI rate for the Neurocritical Care Unit was 7.814 per 1000 patient days with an average quarterly utilization rate of 84%. A robust quality improvement project that included rapid impleentation of evidence, removal or replacement of the IUC by day 5, weekly patient centered rounds, urine culturing best practices, order set changes, and supporting evidence to improve straight catheterization best-practices was implemented. Data was collected over an 11-month period. In 19,000 patient days, patient device utilization rate decreased 63%, SIR and SUR decreased below the mean for majority of the previous 8 quarters. The CAUTI rate decreased to 1.57. A paired samples t-test was performed to assess strength of intervention. Statistically significant improvement in device utilization reduction and infection count were seen. The SIR intervention group was significantly lower than the pre-intervention group, (t(6)= 1162.699, p= <0.001). Additionally, the SUR intervention group (M=73.86, SD=8.630) was lower than the preintervention group (M=84.33, SD=7.356), (t(6)=-22.385, p= <0.001). The project found the upper limit of 5 days of an indwelling urinary catheter for desired outcomes of improved CAUTI rates. This quality improvement project utilized best evidence of removing or replacing IUC by day 5.