Background: Catheter-associated urinary tract infections (CAUTIs) are among the most common hospital-acquired infections. CAUTIs have gained attention due to public reporting and reimbursement implications. Urine cultures are often obtained for inappropriate indications, which can falsely elevate CAUTI rates. Our objective was to determine the impact of a new evidence-based urine culture algorithm on our CAUTI rates.
Methods: This quality improvement project was implemented at a 1541 bed academic medical center in New Haven, CT. Our CAUTI Performance Improvement (PI) Team, a collaboration between nurses, infectious disease physicians and urologists developed a urine culture algorithm for catheterized patients in 10/2017. This algorithm recommends directed evaluation of fever in a catheterized patient based on Infectious Disease Society of America guidelines (Figure 1). Education about appropriate culturing and catheter utilization was initiated 11/2017, the algorithm was approved on 12/27/2017, and included in the electronic medical record 02/2018. The incidence rates (IR) of CAUTI per 1000 catheter days (CD), urine cultures ordered, urinary catheter days and central line-associated bloodstream infection (CLABSI) rates were compared for the quarter pre and post algorithm implementation.
Results: Our CAUTI IR decreased by >40% from 1.4 to 0.8 per 1000 CD for the quarters pre and post algorithm implementation, respectively (Figure 2). Average monthly urine cultures ordered in catheterized patients decreased by 28% from 120 (4th quarter, 2017) to 84 post algorithm implementation (1st quarter, 2018, Figure 3). The average monthly catheter days decreased by 1.5% (4409 days in 4th quarter, 2017 to 4342 in 1st quarter, 2018). Despite the decrease in urine cultures ordered, we did not see a compensatory increase in CLABSI rates during the post implementation period.
Conclusion: Thoughtful culturing through algorithm-directed evaluation of fever based on signs and symptoms combined with staff education about culturing and catheter utilization led to reduction in unnecessary urine culture orders and CAUTIs. Our next steps are to evaluate the impact of this algorithm on antibiotic utilization and C. difficile rates, and examine the sustainability of these interventions over time.
A. L. Fisher, None
L. Sullivan, None
A. Hittelman, None
M. Leapman, None
M. Juthani-Mehta, Iterum Therapeutics: Scientific Advisor , Consulting fee .
R. Martinello, None