A Multifaceted Approach to Reduction of Catheter-Associated Urinary Tract Infections in the Intensive Care Unit With an Emphasis on "Stewardship of Culturing"

BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are among the most common hospital-acquired infections (HAIs). Reducing CAUTI rates has become a major focus of attention due to increasing public health concerns and reimbursement implications. OBJECTIVE To implement and describe a multifaceted intervention to decrease CAUTIs in our ICUs with an emphasis on indications for obtaining a urine culture. METHODS A project team composed of all critical care disciplines was assembled to address an institutional goal of decreasing CAUTIs. Interventions implemented between year 1 and year 2 included protocols recommended by the Centers for Disease Control and Prevention for placement, maintenance, and removal of catheters. Leaders from all critical care disciplines agreed to align routine culturing practice with American College of Critical Care Medicine (ACCCM) and Infectious Disease Society of America (IDSA) guidelines for evaluating a fever in a critically ill patient. Surveillance data for CAUTI and hospital-acquired bloodstream infection (HABSI) were recorded prospectively according to National Healthcare Safety Network (NHSN) protocols. Device utilization ratios (DURs), rates of CAUTI, HABSI, and urine cultures were calculated and compared. RESULTS The CAUTI rate decreased from 3.0 per 1,000 catheter days in 2013 to 1.9 in 2014. The DUR was 0.7 in 2013 and 0.68 in 2014. The HABSI rates per 1,000 patient days decreased from 2.8 in 2013 to 2.4 in 2014. CONCLUSIONS Effectively reducing ICU CAUTI rates requires a multifaceted and collaborative approach; stewardship of culturing was a key and safe component of our successful reduction efforts. Infect Control Hosp Epidemiol 2016;1-3.

Infection control and hospital epidemiology. 2016 Nov 17 [Epub ahead of print]

Katherine M Mullin, Christopher S Kovacs, Cynthia Fatica, Colette Einloth, Elizabeth A Neuner, Jorge A Guzman, Eric Kaiser, Venu Menon, Leticia Castillo, Marc J Popovich, Edward M Manno, Steven M Gordon, Thomas G Fraser

1Department of Infectious Diseases,Medicine Institute,Cleveland Clinic Foundation,Cleveland,Ohio., 2Department of Infection Prevention,Quality and Patient Safety Institute,Cleveland Clinic Foundation,Cleveland,Ohio., 3Pharmacy Institute,Cleveland Clinic Foundation,Cleveland,Ohio., 4Respiratory Institute,Cleveland Clinic Foundation,Cleveland,Ohio., 5Anesthesiology Institute,Cleveland Clinic Foundation,Cleveland,Ohio., 6Heart and Vascular Institute,Cleveland Clinic Foundation,Cleveland,Ohio., 7Children's Hospital and Pediatric Institute,Cleveland Clinic Foundation,Cleveland,Ohio., 8Department of Anesthesiology,Emory University School of Medicine,Atlanta,Georgia., 9Department of Neurology,Feinberg School of Medicine,Northwestern University,Chicago,Illinois.

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