292. Changing the Culture of Culturing: A Multifaceted Approach to Reduction of Catheter-Associated Urinary Tract Infections in the ICU with an Emphasis on Appropriate Indications for Obtaining a Urine Culture
Session: Poster Abstract Session: HAI: Device Associated Infections
Thursday, October 8, 2015
Room: Poster Hall
  • CAUTI.png (103.6 kB)
  • Background: Catheter-Associated Urinary Tract Infections (CAUTIs) are the most common type of hospital-acquired infection (HAI).  Reduction in CAUTI rates has become a major focus of attention due to increasing public health concerns and reimbursement implications.  We describe a multifaceted intervention to decrease CAUTIs in our ICUs with an emphasis on indications for obtaining a urine culture.                                                        

    Methods: A project team composed of critical care disciplines including Pediatric, Medical, Surgical, Neurologic, Cardiac, Heart Failure, and Cardiothoracic Surgery was assembled to address an institutional goal of decreasing CAUTIs.  Interventions  implemented between year 1 and year 2 included:  a nursing driven protocol for catheter removal,  improved fidelity of electronic documentation of catheters, implementation of preservative tubes for specimen collection, periodic maintenance audits, and assessment of competency on placement and maintenance. Consensus was obtained from all critical care disciplines to consider culturing practice as per IDSA guidelines for evaluation of a fever in the critically ill.  Surveillance for CAUTI and hospital acquired bloodstream infection (HABSI) were recorded prospectively as per National Healthcare Safety Network (NHSN) protocols.  Device utilization ratios (DUR), rates of CAUTI, HABSI, and urine cultures per 1,000 patient days were calculated and compared.  ICU admissions and meropenem and piperacillin-tazobactam initiations in those settings were also compared.

    Results:  The CAUTI rate decreased from 3.0 per 1,000 catheter days in 2013 to 1.9 in 2014 (p= 0.0003, rate ratio 0.6291 [0.49-0.81]) (Fig 1).  The DUR was 0.7 in 2013 and 0.68 in 2014. The HABSI rate per 1,000 patient days was 2.8 in 2013 and 2.4 in 2014 (p=0.15). The rate of piperacillin-tazobactam and meropenem initiation per ICU admission was 0.35 and 0.13 in 2013 and 0.36 and 0.12 in 2014 (p=0.98 and 1.03 respectively).

    Figure 1:

    Conclusion:  Effectively reducing ICU CAUTI rates requires a multifaceted approach involving all critical care disciplines. Stewardship of culturing was a key component of our successful reduction efforts and did not lead to increased HABSIs or empiric antibiotic usage.


    Katherine Mullin, MD1, Christopher Kovacs Jr., MD1, Cynthia Fatica, RN, BSN, CIC2, Colette Einloth, BA2, Elizabeth Neuner, PharmD3, Edward Manno, MD4, Jorge Guzman, MD5, Eric Kaiser, MD6, Venugopal Menon, MD7, Marc Popovich, MD6, Leticia Castillo, MD8 and Thomas G. Fraser, MD, FSHEA2,9, (1)Infectious Disease; Medicine Institute, Cleveland Clinic, Cleveland, OH, (2)Quality and Patient Safety Institute, Cleveland Clinic, Cleveland, OH, (3)Pharmacy, Cleveland Clinic, Cleveland, OH, (4)Neurological Institute, Cleveland Clinic, Cleveland, OH, (5)Respiratory Institute, Cleveland Clinic, Cleveland, OH, (6)Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, (7)Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, (8)Children's Hospital and Pediatric Institute, Cleveland Clinic, Cleveland, OH, (9)Infectious Disease, Cleveland Clinic, Cleveland, OH


    K. Mullin, None

    C. Kovacs Jr., None

    C. Fatica, None

    C. Einloth, None

    E. Neuner, None

    E. Manno, None

    J. Guzman, None

    E. Kaiser, None

    V. Menon, None

    M. Popovich, None

    L. Castillo, None

    T. G. Fraser, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.