Reduction of Catheter Associated Urinary Tract Infections (CAUTIs) Through Interdisciplinary Collaboration

Session Description: An increase in the catheter-associated urinary tract infection (CAUTI) standardized infection ratio (SIR) from 0.00 in 2022 quarter 4 to 1.191 in 2023 quarter 3 was identified within the neurology service line at a level-1 trauma teaching hospital. A gap analysis revealed wide variation in practice, a lack of education regarding appropriate patient selection for ordering urine cultures, and poor compliance with daily chlorohexidine (CHG) bathing for patients with indwelling urinary catheters (IUC). An interdisciplinary team was assembled to assess diagnostic stewardship and CHG bathing. Through the analysis, it was found that daily CHG bathing compliance for patients with IUCs was less than 50% in 2023 quarter 3. Review of the events determined that 67% of patients cultured did not meet appropriate criteria for culturing and those patients subsequently were not treated. Demonstrating a commitment to the high reliability values of the organization, a “stop the line” campaign was implemented for all urine cultures ordered on neurology patients. Supportive steps included: engaging the ordering providers and Chief of Epidemiology, educating new medical residents, reinforcing the need for daily CHG bathing with nursing colleagues, daily CHG bathing compliance monitoring in real-time, training for nursing colleagues on how to culture urine as well as appropriate indications to report to the providers, empowering nursing colleagues to “stop the line” and escalate potentially inappropriate cultures to the unit manager and the Infection Preventionist.
Through this interdisciplinary collaboration, daily CHG bathing compliance increased to greater than 90% by 2024 quarter 2, from less than 50% prior to implementation. Inappropriate culturing and treatment of asymptomatic bacteriuria was reduced to only one event in 2024 quarter 2. Since implementation, a decrease has been realized in SIR through 2024 quarter 2 to 0.240 (p=0.127).