A Bundle-Based Approach to Prevent Catheter-Associated Urinary Tract Infections in the Intensive Care Unit.

Journal Article (Journal Article)

Background

Catheter-associated urinary tract infections are the second most common health care-associated infections, occurring most frequently in intensive care units. These infections negatively affect patient outcomes and health care costs.

Local problem

The targeted institution for this improvement project reported 13 catheter-associated urinary tract infections in 2018, exceeding the hospital's benchmark of 4 or fewer such events annually. Six of the events occurred in the intensive care unit. Project objectives included a 30% reduction in reported catheter-associated urinary tract infections, 20% reduction in urinary catheter days, and 75% compliance rating in catheter-related documentation in the intensive care unit during the intervention phase.

Methods

This project used a pre-post design over 2 consecutive 4-month periods. The targeted population was critically ill patients aged 18 and older who were admitted to the intensive care unit. A set of bundled interventions was implemented, including staff education, an electronic daily checklist, and a nurse-driven removal protocol for indwelling urinary catheters. Data were analyzed using mixed statistics, including independent samples t tests and Fisher exact tests.

Results

No catheter-associated urinary tract infections were reported during the intervention period, reducing the rate by 1.33 per 1000 catheter days. There was a 10.5% increase in catheter days, which was not statistically significant (P = .12). Documentation compliance increased significantly from 50.0% before to 83.3% during the intervention (P = .01).

Conclusions

This bundled approach shows promise for reducing catheter-associated urinary tract infections in critical care settings. The concept could be adapted for other health care-associated infections.

Full Text

Duke Authors

Cited Authors

  • Shadle, HN; Sabol, V; Smith, A; Stafford, H; Thompson, JA; Bowers, M

Published Date

  • April 2021

Published In

Volume / Issue

  • 41 / 2

Start / End Page

  • 62 - 71

PubMed ID

  • 33791761

Electronic International Standard Serial Number (EISSN)

  • 1940-8250

International Standard Serial Number (ISSN)

  • 0279-5442

Digital Object Identifier (DOI)

  • 10.4037/ccn2021934

Language

  • eng