A team approach to preventing Healthcare Acquired Catheter Associated Urinary Tract Infections (CAUTIs) in an urban acute care facility

Background: CAUTIs account for 26% of (Hospital Acquired Infections) HAIs which represents 93,300 infections annually. CMS collects and publicly reports hospitals’ quality-of-care data including CAUTI and other HAI rates. Through the Affordable Care Act, Congress authorized Value Based Purchasing (VBP).  Through VBP CMS links healthcare quality to the Medicare payment system by rewarding high performance and penalizing low performance.  Hospitals must implement strategies to reduce CAUTI rates and other HAIs and improve healthcare quality to avoid financial penalties.

 Harlem Hospital Center, a 282 bed urban acute care facility, had a CAUTI rate of 5.8 per 1000 urinary catheter days compared  to National Health Care Safety Network (NHSN) and New York State Rate is 2.2 /1,000 and 2.3 /1,000 urinary catheter days respectively.  A risk assessment was done and goals set to reduce CAUTI rate in the Adult ICU by 25%, achieve a Standardize Infection Ratio (SIR) < 1, and CAUTI Prevention Bundle compliance ≥ 95%.  

 Method: A multidisciplinary team convened and implemented the following strategies: a) educate clinicians on the CAUTI Prevention bundle, b0  conduct daily compliance audits; c) provide real time feedback; and d) collect and report on the number of patients with urinary catheters in daily nursing rounds. Also, cases meeting CDC/NHSN definition for CAUTI were reviewed daily and feedback provided to Units and leadership.

Results: In six months, the institution achieved a rate of 1.9 per 1000 urinary catheter days which resulted in a 68% reduction; far exceeding our 25% goal and the NHSN and New York State benchmark.  A SIR of 0.98 and 95% bundle compliance was also realized. 

 Summary: Evidence-based interventions are effective in preventing healthcare related infections, promoting high quality patient care, and reducing healthcare costs. CAUTI Prevention interventionsin the ICU reduced our CAUTI rates from 5.8 to 1.9 per 1000 device days.