CAUTIs are one of the most common preventable adverse events in hospitalized patients. Prior to the start of this intervention, CAUTI rates in our ICU’s throughout our multicenter acute care system were significantly above the national average. Our hypothesis was that we could decrease CAUTI’s by daily review of the urine culture orders for patients with a Foley catheter
We implemented guidelines for appropriate ordering of urine culture for patients with Foley catheters in 2014. The culture was deemed appropriate if the patient had a fever >100.4°F within 48 hours or leukocytosis with no other identifiable source of infection and has one or more of the following: costovertebral angle/flank pain, suprapubic pain, increase in urinary frequency; urgency, frequency or dysuria after catheter removal, acute mental status change, worsening of clinical status. The ordering prescriber was called to cancel the order that did not meet the urine culture ordering guideline. If the ordering prescriber questioned the guidelines, Epidemiologists intervened to explain the rationale. This was a prospective, observational study. Chi-Squared analysis was used to compare the reduction of CAUTIs
The data showed sustained improvement. Compared to the 2012 baseline rate of 4.28 cases per 1000 device days, the 2013 rate was 2.70 (p=0.085), the 2014 rate was 1.38 (p=0.00046), the 2015 rate was 0.73 (p<0.0001), and the 2016 rate was 0.63 (p<0.0001).
We found that using guidelines combined with an Infection Preventionist review to determine the appropriateness of urine cultures was associated with a significant reduction in the rate of ICU CAUTI’s. Real-time culture order review is a sustainable process that has continued the success of our CAUTI reduction program
M. O. Vernon, None
K. Singh, None
L. Peterson, None