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An In Vitro Bladder Model of Catheter-Associated Urinary Tract Infection
Published on: June 24, 2025
A Multifaceted Approach to Reduction of Catheter-Associated Urinary Tract Infections in the Intensive Care Unit With
Katherine M Mullin1, Christopher S Kovacs1, Cynthia Fatica2
11Department of Infectious Diseases,Medicine Institute,Cleveland Clinic Foundation,Cleveland,Ohio.
Insights
A multifaceted intervention successfully reduced catheter-associated urinary tract infections (CAUTIs) in ICUs by emphasizing appropriate urine culture indications. This collaborative approach improved patient safety and reduced infection rates.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Hospital Epidemiology
Background:
- Catheter-associated urinary tract infections (CAUTIs) are prevalent hospital-acquired infections (HAIs).
- Reducing CAUTI rates is critical due to public health and financial implications.
- Intensive care units (ICUs) are particularly vulnerable to CAUTIs.
Purpose of the Study:
- To implement and evaluate a multifaceted intervention aimed at decreasing CAUTIs in ICUs.
- To emphasize appropriate indications for urine culture in critically ill patients.
- To align clinical practice with established guidelines for catheter management and fever evaluation.
Main Methods:
- Assembled a multidisciplinary project team to address CAUTI reduction.
- Implemented CDC-recommended protocols for urinary catheter insertion, maintenance, and removal.
- Aligned urine culturing practices with ACCCM and IDSA guidelines for fever evaluation.
- Prospectively collected surveillance data for CAUTI and hospital-acquired bloodstream infections (HABSI) per NHSN protocols.
- Calculated and compared device utilization ratios (DURs), CAUTI rates, HABSI rates, and urine culture rates.
Main Results:
- The CAUTI rate significantly decreased from 3.0 to 1.9 per 1,000 catheter days between 2013 and 2014.
- The device utilization ratio (DUR) remained low and stable (0.7 in 2013, 0.68 in 2014).
- Hospital-acquired bloodstream infection (HABSI) rates decreased from 2.8 to 2.4 per 1,000 patient days.
Conclusions:
- A collaborative, multifaceted approach is essential for effectively reducing CAUTI rates in ICUs.
- Stewardship of urine culturing practices was a key, safe component of the successful CAUTI reduction strategy.
- The intervention demonstrated success in improving patient safety and reducing healthcare-associated infections.
Abstract:
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 2017;38:186-188.
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