397. Impact of Catheter-day Reductions on CAUTI Intervention Evaluation
Session: Poster Abstract Session: HAI: Preventing Device-Associated Infections
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • Poster CAUTI CR_vers3.pdf (683.5 kB)
  • Background:Prevention of Catheter Associated Urinary Tract Infection (CAUTI) begins with reduction of catheter-days (CDs). Because the number of CDs is the denominator of the CAUTI rate, reductions in CDs can confound evaluation of CAUTI interventions. The purpose of this study was to demonstrate reductions in catheter days and CAUTI events from interventions performed in the Central Region (CR) of Intermountain Healthcare (IHC), and the impact on CAUTI rates.

    Interventions:The CR consists of 5 hospitals, one of which is a 476 bed tertiary care facility. A CAUTI task force convened to review best practices. In 2012, a daily email was initiated alerting managers of patients with a catheter in place more than 48 hours. Nurse leaders designed education targeting insertion practice, maintenance, perineal care (2013-2014). IPs audited bedside compliance with these practices. Monthly catheter “tips”reminded staff about important aspects of catheter care and maintenance.

    Methods: CAUTI data is reported to NHSN per 1000 catheter-days by all study hospitals. Hospital days (HDs) were collected as part of routine reporting. Because the definition of CAUTI changed in 2015 to exclude Candida spp., we increased 2015 CAUTI rates by 15.1% (rate of Candiduria 2012-2014). Rates were compared with a z-score for person-time data.

    Results: In 2012, 148 CAUTIs were attributable to CR hospitals, CAUTI rate 3.86 per 1000 catheter days, and CAUTI rate 6.92 per 10,000 hospital days. Catheter-days decreased from 38318 in 2012 to 31743 in 2015 (a 17.2% reduction). Hospital days increased from 213785 to 222985 (a 4.3% increase). Total CAUTIs reduced in CR to 109 (with definition change adjustment, a 26.3% reduction). CR improvements did not result in a significant CAUTI rate reduction: CAUTI rate per 1000 catheter days 3.4; rate ratio 0.93 (0.72, 1.20, p=0.9); however, significant reductions were noted per HDs: CAUTI rate per 10,000 hospital days 4.88, rate ratio adjusted 2015 vs 2012: 0.71 (0.55, 0.9), p=0.005.

    Conclusion: IHC’s Central Region CAUTI task force initiated several interventions resulting in significant reductions in both CDs and CAUTI events, not reflected in CAUTI rates. Program evaluation should include CAUTIs per HD to assess intervention effectiveness.

    Kristin Dascomb, MD, PhD1, Carrie W. Taylor, RN, CIC2, Sharon Sumner, RN3, Annan Fetzer, RN1, Janette Orton, MS1, Nathan Barton, BS1, Sean D Firth, PhD, MPH1 and John P. Burke, MD, FIDSA, FSHEA4, (1)Intermountain Healthcare, Murray, UT, (2)Clinical Epidemiology and Infectious Diseases, Intermountain Medical Center, Murray, UT, (3)Intermountain Medical Center, Murray, UT, (4)LDS Hospital, Salt Lake City, UT

    Disclosures:

    K. Dascomb, Medicines Company: Investigator , Research grant

    C. W. Taylor, None

    S. Sumner, None

    A. Fetzer, None

    J. Orton, None

    N. Barton, None

    S. D. Firth, Medicines Company: Investigator , Research grant

    J. P. Burke, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.