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Successful strategy to decrease indwelling catheter utilization rates in an academic medical intensive care unit.

Sushilkumar Satish Gupta1, Pavan Kumar Irukulla1, Mangalore Amith Shenoy1

  • 1Department of Pulmonary Medicine and Critical Care, Maimonides Medical Center, Brooklyn, NY.

American Journal of Infection Control
|August 29, 2017
PubMed
Summary
This summary is machine-generated.

Implementing an indwelling urinary catheter (IUC) restriction protocol significantly reduced IUC use and catheter-associated urinary tract infections (CAUTIs) in an intensive care unit (ICU). This strategy proved effective in a complex academic medical setting.

Keywords:
Catheter-associated urinary tract infections (CAUTI)Hospital-acquired infectionsIncontinence associated dermatitis (IAD)Indwelling urinary catheter (IUC) utilization ratioIntensive care unitQuality improvement

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Area of Science:

  • Critical Care Medicine
  • Infectious Disease Prevention
  • Healthcare Quality Improvement

Background:

  • Indwelling urinary catheter (IUC) use is a primary risk factor for healthcare-associated urinary tract infections (UTIs).
  • Managing critically ill patients without IUCs presents unique challenges.
  • Developing strategies to reduce IUC utilization is crucial for patient safety.

Purpose of the Study:

  • To devise and implement a strategy to decrease indwelling urinary catheter (IUC) utilization.
  • To assess the impact of this strategy on catheter-associated urinary tract infection (CAUTI) rates.
  • To identify and address challenges associated with reduced IUC use in critically ill patients.

Main Methods:

  • A retrospective observational study was conducted in an adult medical intensive care unit (ICU) from January 2012 to December 2016.
  • The study period incorporated a baseline phase and subsequent intervals for strategy implementation.
  • IUC utilization ratios and CAUTI rates were calculated and compared.

Main Results:

  • A statistically significant decrease in IUC utilization ratio was observed, from 0.92 at baseline to 0.28 after three interventions (P < .0001).
  • CAUTI rates significantly decreased from 5.47 to 1.08 (P = .0134), with sustained differences over a 2-year follow-up.
  • Incontinence-associated dermatitis (IAD) was noted as a potential complication; however, IAD rates did not change significantly.

Conclusions:

  • Aggressive IUC restriction protocols and provider training effectively reduced IUC use and CAUTI rates in a large academic ICU.
  • The study demonstrates the feasibility of managing critically ill patients with fewer IUCs.
  • Comprehensive strategies are vital for successful implementation and sustained outcomes in complex healthcare settings.