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Objective: To determine if SICU CAUTI incidence can be decreased using a targeted, low-cost educational initiative
Design: Intervention study: before-after trial
Setting: Academic tertiary care SICU
Patients: SICU patients with a Foley catheter
Interventions: A multidisciplinary group (hospital epidemiology, SICU nursing, SICU physicians) assessed the baseline SICU CAUTI rate during an 11-month period and reviewed patient data. The CAUTI rate was compared to the National Healthcare Safety Network (NHSN) target CAUTI threshold and urinary catheter utilization ratio (UCUR). Retrospective analysis noted that most CAUTI (20/27) were in trauma patients, (23/27) occurred after > 5 Foley days, and (17/27) in those with fecal incontinence. Therefore, the following interventions were applied, and data was reassessed during the following 3-month period: 1) system integrity was assessed and ensured, 2) catheters were firmly secured to the thigh, 3) drainage bags remained unobstructed, and 4) bags were emptied at 50% capacity. Concomitantly, SICU staff education was provided regarding these practices. Daily removal prompts were provided for all patients with Foley catheters.
Main Outcome Measures: CAUTI rate, UCUR
Results: Mean SICU patient days per month were similar before (269+98) and after intervention (232+94; p = 0.42), as were catheter days/month (230+83 vs 173+77; p=0.15). CAUTI rate decreased after intervention (5.1+4.4 vs 1.4+2.2 CAUTI/month; p=0.013), and the UCUR decreased to equal the NHSN mean of 0.76 (0.86+0.06 vs. 0.73+0.06; p=0.021 pre vs post). No trauma patient developed a CAUTI following the deployed interventions.
Conclusions: The CAUTI rate decreased after a focused, multidisciplinary, and low-cost educational intervention that targeted Foley care and timely removal.