296. The Power of a System: Addressing Catheter-Associated Urinary Tract Infections (CAUTI) in Intensive Care units
Session: Poster Abstract Session: HAI: Device Associated Infections
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • CAUTI Poster-final.pdf (230.6 kB)
  • Background: Improving outcomes related to CAUTI should address multiple elements critical to success. These include ensuring knowledge, competencies, and evaluating and providing feedback on processes and outcomes.

    Methods: We implemented a multilayered approach to reduce CAUTI in the largest non-profit U.S. health system, supported by the "Partnership for Patients" efforts. This included updating policies to reflect the appropriate indications for catheter use and maintenance, standardizing the catheter insertion kits, incorporating regular nursing competency evaluation for insertion and maintenance, and directly engaging teams in hospitals with high CAUTI standardized infection ratios (SIR) through regular coaching and site visits.

    Results: Hospitals with policies for placement and maintenance of urinary catheters with appropriate indications based on CDC guidelines increased from 55/71 (77.5%) in 2012 to 69/77 (89.6%) in 2014 (p=0.045). Moreover, nursing annual competencies for insertion and maintenance of urinary catheters improved from 19/71 (26.8%) in 2012 to 69/77 (89.6%) in 2014 (p<0.001). Evaluating CAUTI events with root cause analysis increased from 28/71 (39.4%) in 2012 to 62/77 (80.5%) in 2014 (p<0.001). Of 67 hospitals with intensive care units (ICU) evaluated, the system ICU CAUTI SIR dropped by 16% from 1.22 in 2013 to 1.03 in 2014, reflecting a reduction of 124 events. Four large hospitals led the reduction in events by 48% resulting in 87 events prevented. Large hospitals had the dominant effect on the system SIR improvements (Table).

    Conclusion: A system approach addressing both processes and outcomes has led to a reduction in system CAUTI SIR. This approach may be mirrored by other large health systems, state hospital associations or other entities working on infection prevention regionally and nationally.

    CAUTI SIR for ICU and Hospital Size

    Mean SIR

    Median SIR

    Range SIR

    % of all events

    <100 beds

    2013 (n=14)

    1.11

    0.24

    0-13.6

    1.6%

    2014 (n=15)

    0.45

    0

    0-1.89

    0.7%

    100-300 beds

    2013 (n=24)

    0.81

    0.59

    0-2.9

    12.4%

    2014 (n=23)

    0.82

    1.08

    0-4.2

    14.8%

    >300 beds

    2013 (n=28)

    1.32

    1.4

    0-3.02

    86%

    2014 (n=29)

    1.09

    1.2

    0-2.2

    84.5%

    Mohamad G. Fakih, MD, MPH, FIDSA, FSHEA1,2, Michelle Heavens, BSN, MHA2, Julie Grotemeyer, BS2 and Ann Hendrich, RN, PhD2, (1)Infection Prevention and Control, St. John Hospital & Medical Center, Grosse Pointe Woods, MI, (2)Care Excellence, Ascension Health, St Louis, MO

    Disclosures:

    M. G. Fakih, None

    M. Heavens, None

    J. Grotemeyer, None

    A. Hendrich, 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.