Prevention of Catheter Associated Urinary Tract Infections (CAUTIs): results and challenges
CAUTIs are one of the most common hospital acquired infections. Basic and specific practices to prevent CAUTIs have been applied in different institutions but reducing rates of CAUTIs and Foley catheter days remains challenging.
Implementation of specific practices to reduce CAUTIs including Nurse Driven Foley Catheter removal protocol, monthly Infection control team unit rounds for education and assessment of catheter indications and a Foley Catheter Bundle that have guidelines for Foley insertion best practice competency and urinary catheter best practice algorithm.
This study was conducted in a 941 bed tertiary center which includes 100 ICU beds. In addition to basic CAUTI prevention practices, the above mentioned specific practices were implemented in 10/2012. Prior to specific practices interventions, we had per month mean patient days of 19,313, Foley days of 3662 (3426-4031) and 10.08 CAUTIs (7-13) in compare to post interventions where we had mean patient days of 19,916, Foley days of 3211 (2866-3556) and CAUTI number of 6.69 (2-10). CAUTI rate per 1000 catheter days was reduced by 30% from 2.94 to 2.08. CAUTI rate per 10,000 patient days decreased from 5.59 to 3.35 with 41% reduction despite the fact that Foley days was reduced by 14% only. We faced many challenges including healthcare professional commitment to engage in the application of these specific measures, definitions of CAUTIs by CDC/NHSN lack complete validation and CAUTI rates can vary depending on the reporting method used. In addition, we noticed more than 50% of urine cultures grew yeast which can be a colonizer or a contaminant rather than an infectious agent. Also, patients transferred from long term facility or other centers are more likely to develop CAUTIs.
Conclusion: CAUTIs can be reduced by implementing specific measures which included nurses driven protocol, infection control team Foley catheter rounds, and Foley catheter bundles. Further studies are needed to evaluate these measures. In addition, further work is needed to validate and modify CDC/NHSN definitions and criteria for CAUTI to help better understand the effectiveness of these prevention methods. Education programs for healthcare professionals concerning CAUTIs and its complication will be helpful to implement prevention methods.
R. Jett-Mitchell, None