Reducing Catheter-Associated Urinary Tract Infections Across a Hospital System Through Urine Culture Stewardship

Area of Science:

• Healthcare Quality Improvement
• Infectious Disease Prevention
• Antimicrobial Stewardship

Background:

• Catheter-associated urinary tract infections (CAUTIs) are a significant healthcare-associated infection.
• Effective strategies are needed to reduce CAUTI rates and associated morbidity.
• Urine culture stewardship programs aim to optimize the use of urine cultures and antibiotic therapy.

Purpose of the Study:

• To evaluate the effectiveness and safety of an evidence-based urine culture stewardship program.
• To reduce hospital catheter-associated urinary tract infections (CAUTIs) across a 3-hospital system.
• To assess the impact on patient safety indicators, including mortality and length of stay.

Main Methods:

• Prospective, 2-year quality improvement program (October 2018 - September 2020).
• Implementation of an evidence-based urine culture stewardship program with specific criteria, electronic medical record best practice advisories, and provider education.
• Comparison of CAUTI rates, sepsis rates, mortality, and length of stay for 3 years pre-program and 2 years post-program.

Main Results:

• Progressive decrease in CAUTI rates observed after program initiation (B=-0.21, P=.001).
• No statistically significant increases in hospital length of stay, ICU length of stay, or mortality.
• Hospital-onset sepsis rates remained consistent, with no increase in sepsis events linked to urinary tract infections.

Conclusions:

• Urine culture stewardship is a safe and effective strategy for reducing CAUTIs in large healthcare systems.
• Patient safety indicators remained stable post-implementation.
• Ongoing monitoring is recommended to ensure the long-term sustainability of the program.