Intentional Leadership Rounds: A Proactive Approach to CAUTI Reduction

Reduction in catheter-associated urinary tract infections (CAUTIs) using a silver-coated 100% silicone Foley catheter verses a silver-coated latex Foley catheter in a Northeastern U.S. acute care hospital

Introduction: Catheter-associated urinary tract infections (CAUTIs) are a significant source of morbidity in intensive care units (ICUs). This study evaluates the impact of bathing compliance utilizing a 4% chlorhexidine gluconate (CHG) product on CAUTI incidence across two 16-bed ICUs with differing Foley catheter utilization and infection outcomes. The Standardized Utilization Ratio (SUR) measures the ratio of observed to predicted device use, while the Standardized Infection Ratio (SIR) reflects the ratio of observed to predicted healthcare-associated infections (CAUTI). Methods: A retrospective comparative analysis was performed on two ICUs within the same institution. Each unit had 16 beds and evaluated 1,000 patients during calendar year 2024. CHG bathing compliance, Foley catheter utilization (SUR), and CAUTI incidence (SIR) were collected and analyzed. ICU 1 and ICU 2 were compared using descriptive statistics and p-values for statistical significance (threshold: p < 0.05). Our Foley utilization protocol is as follows: Remove the Foley catheter and place a Foley removal order on all patients except those who are (1) post-GU procedure, (2) prone position, (3) have chronic Foley use (changed regularly), or (4) require replacement only if intermittent straight catheterization is needed more than 3 times in 24 hours. Daily CHG application was performed using a foaming pump dispensed onto a damp washcloth or directly onto the patient’s skin, followed by rinsing with a second damp washcloth after appropriate contact time. Perineal cleansing was conducted using the same technique, and Foley catheters along with other tubes and drains were wiped with CHG foam. Results: ICU 1 had a lower Foley catheter utilization (SUR: 0.48 vs 0.8, p = 0.001) and CHG bathing compliance rate (85% vs 92 %, p = 0.001) compared to ICU 2. Despite increased catheter use, ICU 2 achieved a SIR of 0, indicating no CAUTIs, while ICU 1 had a SIR of 0.55 (p = 0.0001). Conclusions: Higher CHG bathing compliance was significantly associated with lower CAUTIs, even in the context of greater Foley catheter utilization. These results emphasize the importance of high CHG bathing adherence and Foley care protocols in reducing infection rates in patients who require a Foley in the ICU.

Reducing the Number One Health Care Acquired Infection Utilizing a Silver-Impregnated Foley with Bacteriostatic Tubing/Bag System

Reducing Catheter - Associated Urinary Tract Infection in a Major Academic Facility Using a Novel Comprehensive Tool

Reducing Central Line Bloodstream and Catheter-Associated Urinary Tract Infections in the Neuro Critical Care Unit Using a Bundled Approach

The passage of the Affordable Care Act has ignited a shift from the pay-for-performance model to value-based care with a particular relevance in critical care settings. Provider incentive programs are widely considered as a means to reward providers based on the achievement of preset quality metrics. This article aims to demonstrate the effects of a provider incentive program in the critical care delivery system in a large academic center in the Northeastern United States. This article describes the results of a retrospective analysis of a performance-driven quality improvement initiative at a critical care facility of an academic medical center using a quasi-experimental pre-/posttest design. A set of quality measures was selected as outcome metrics. Selection criteria for the process measures are as follows: (i) the metric goals should be influenced by the physician's input to a large degree; (ii) the measure must be transparent and accessible within the hospital-wide data reporting system; (iii) the metric that required group effort and interdisciplinary collaboration to achieve; and (iv) the measure must directly affect patient outcome. The outcome metrics are central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs), standardized infection ratio (SIR), Foley catheter and central line utilization standardized utilization ratio (SUR), hand hygiene compliance, and adherence to respiratory recovery pathway goals. These metrics were tracked from for 3 years with success defined as achieving set benchmarks for each metric. The average CLABSI SIR and CAUTI SIR across all intensive care units (ICUs) decreased by 44% (P = .05) and 87% (P = .02) over 3 years as well as the central line and Foley catheter utilization falling by 41% and 30%, respectively. Hand hygiene compliance in the ICUs improved for the same period by 27 percentage points, as did compliance with the respiratory recovery pathway program by 4 percentage points. The use of a physician-driven financial incentive model in a critical care setting measured by outcome metrics dependent on physician input is successful with rigorous implementation and careful evaluation.

Catheter-associated urinary tract infection (UTI) in nursing home residents is a common cause of sepsis, hospital admission, and antimicrobial use leading to colonization with multidrug-resistant organisms. To develop, implement, and evaluate an intervention to reduce catheter-associated UTI. A large-scale prospective implementation project was conducted in community-based nursing homes participating in the Agency for Healthcare Research and Quality Safety Program for Long-Term Care. Nursing homes across 48 states, Washington DC, and Puerto Rico participated. Implementation of the project was conducted between March 1, 2014, and August 31, 2016. The project was implemented over 12-month cohorts and included a technical bundle: catheter removal, aseptic insertion, using regular assessments, training for catheter care, and incontinence care planning, as well as a socioadaptive bundle emphasizing leadership, resident and family engagement, and effective communication. Urinary catheter use and catheter-associated UTI rates using National Healthcare Safety Network definitions were collected. Facility-level urine culture order rates were also obtained. Random-effects negative binomial regression models were used to examine changes in catheter-associated UTI, catheter utilization, and urine cultures and adjusted for covariates including ownership, bed size, provision of subacute care, 5-star rating, presence of an infection control committee, and an infection preventionist. In 4 cohorts over 30 months, 568 community-based nursing homes were recruited; 404 met inclusion criteria for analysis. The unadjusted catheter-associated UTI rates decreased from 6.78 to 2.63 infections per 1000 catheter-days. With use of the regression model and adjustment for facility characteristics, the rates decreased from 6.42 to 3.33 (incidence rate ratio [IRR], 0.46; 95% CI, 0.36-0.58; P < .001). Catheter utilization was 4.5% at baseline and 4.9% at the end of the project. Catheter utilization remained unchanged (4.50 at baseline, 4.45 at conclusion of project; IRR, 0.95; 95% CI, 0.88-1.03; P = .26) in adjusted analyses. The number of urine cultures ordered for all residents decreased from 3.49 per 1000 resident-days to 3.08 per 1000 resident-days. Similarly, after adjustment, the rates were shown to decrease from 3.52 to 3.09 (IRR, 0.85; 95% CI, 0.77-0.94; P = .001). In a large-scale, national implementation project involving community-based nursing homes, combined technical and socioadaptive catheter-associated UTI prevention interventions successfully reduced the incidence of catheter-associated UTIs.

Central-line bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) negatively impact clinical outcomes and hospital reimbursement. In this report, 4 year trends involving 11 hospitals in New York City were examined. Data from the National Healthcare Safety Network (NHSN) were extracted for 11 acute-care hospitals belonging to the NYC Health + Hospital system from 2016 through 2019. Trends in device infections per 1,000 patient days, device utilization ratios, and standardized infection ratios (SIRs) were examined for the 11 hospitals and for the entire system. Over the 4-year period, there were progressive declines in central-line days, infections per 1,000 central-line days, and device utilization ratios for the system. The average annual SIRs for the system also declined: 1.40 in 2016, 1.09 in 2017, 1.04 in 2018, and 0.82 in 2019. Case-mix indices correlated with SIRs for CLABSIs. Level 1 trauma centers had higher SIRs and a disproportionately greater number of CLABSIs in patients located in NHSN-defined surgical intensive care units. Similar trends with CAUTIs were noted, with progressive declines in catheter days, infections per 1,000 patient days, device utilization ratios, and SIRs (1.42 in 2016, 0.93 in 2017, 1.18 in 2018, and 0.78 in 2019) over the 4-year period. Across an 11-hospital system, continuing efforts to reduce device utilization and infection rates resulted in declining SIRs for CLABSIs and CAUTIs. Hospitals with higher case-mix indices, and particularly level 1 trauma centers, had significantly higher central-line infection rates and SIRs.

Catheter-associated urinary tract infections (CAUTIs) represent approximately 9% of all hospital acquired infections, and approximately 65%–70% of CAUTIs are believed to be preventable. In the spring of 2013, Boston Medical...

Nurse-led implementation of evidence-based bundles to reduce CAUTIs in an academic acute care hospital: A four-year longitudinal quasi-experimental study.

Effect of Non-Infection Prevention Champions on Catheter-Associated Urinary Tract Infection Rates

Extra Mortality of Nosocomial Infections in Adult ICUs of 9 Hospitals of Argentina. Findings of the International Nosocomial Infection Control Consortium (INICC)

A multifaceted quality improvement strategy reduces the risk of catheter-associated urinary tract infection.

Using Data to Drive and Sustain Practice Changes in Conquering Catheter-Associated Urinary Tract Infections

Background: Infection preventionists (IPs) are the backbone of the quality and safety matrix of their organizations. Tools to help locate potential gaps can provide unique viewpoints from frontline staff. The CDC provides a Targeted Assessment for Prevention (TAP) strategy that identifies vulnerabilities in the prevention of healthcare-associated infection (HAIs). Methods: A statewide quality improvement organization, partnering with the CDC TAP team, administered TAP facility assessments for catheter-associated urinary tract infection (CAUTI), central-line–associated bloodstream infection (CLABSI), and Clostridioides difficile infection (CDI) to a collaborative of 15 acute-care and 2 long-term acute hospitals. More than 800 respondents filled out surveys based on their individualized perceptions of infection prevention practices. Results: The survey results yielded the following lagging indicators: lack of awareness of nursing and physician champions, need for competency-based training of clinical equipment, and feedback on device utilization. At the hospital system level, one improvement team focused on CDI, uncovered leading and lagging areas in general infrastructure, antibiotic stewardship, early detection and appropriate testing, contact precautions, and environmental cleaning. To culminate the TAP collaborative, the cohort of organizations, supported by interdisciplinary teams, participated in a full-day TAP workshop in which they reviewed detailed analyses of their HAI data and assessment results, shared best practices for infection prevention and planned for specific improvement projects using the plan-do-study-act model. Conclusions: Results of a statewide analysis of HAI prevention data and opportunities at a local level were reviewed. The TAP strategy can be used to target opportunities for improvement, to assess gaps in practice, and to develop and implement interventions for improving outcomes. Healthcare facilities and quality improvement organizations can drive infection prevention actions.Funding: NoneDisclosures: None