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Reducing catheter-associated urinary tract infection in high dependency unit: an eighteen-month quality improvement
Waleed Abdulmotalib Mazi1, Mylene Bondad2, Maryam Althumali3
1Infection Prevention and Control, Taif Health Cluster, Taif, Kingdom of Saudi Arabia.
Insights
Catheter-associated urinary tract infection (CAUTI) rates in Saudi Arabian high-dependency units were significantly reduced by implementing behavior change models and evidence-based prevention strategies. This approach successfully lowered CAUTI incidence by nearly 50% over 18 months.
Area of Science:
- Healthcare epidemiology
- Infectious disease prevention
- Patient safety
Background:
- Catheter-associated urinary tract infections (CAUTI) increase patient morbidity and mortality.
- Saudi Arabian high-dependency units (HDUs) had a CAUTI incidence six times higher than US benchmarks in 2021.
- Limited data exists on CAUTI rates in Saudi Arabian HDUs.
Purpose of the Study:
- To decrease the CAUTI incidence rate by 50% by the end of 2022.
- To evaluate the effectiveness of combined behavior change and prevention models in reducing CAUTI.
Main Methods:
- Prospective study in a tertiary HDU (January 2022 - June 2023).
- Gap analysis against Society of Healthcare Epidemiology of America/Infectious Diseases Society of America (SHEA/IDSA) guidelines.
- Implementation of Kotter and Rathgeber's behavior change model and National Strategy Model for CAUTI prevention.
- Surveillance and data analysis adhering to US National Healthcare Safety Network (US-NHSN) guidelines.
Main Results:
- CAUTI incidence decreased from 7.07 to 3.57 per 1000 urinary catheter days (P < 0.0001).
- Urinary catheter utilization increased significantly from 0.79 to 0.94.
- Compliance with CAUTI prevention bundles remained consistently above 90%.
Conclusions:
- Combining behavior change strategies with evidence-based CAUTI prevention models effectively reduced infection rates.
- Sustained implementation over 18 months demonstrated significant CAUTI reduction.
- This combined approach may be applicable to reducing other healthcare-associated infections.
Background:
The urinary catheter usually leads to a catheter-associated urinary tract infection (CAUTI) contributing to further morbidity and mortality. There is very limited data on the CAUTI incidence rate in high-dependency units (HDUs) in the Kingdom of Saudi Arabia. The institutional CAUTI incidence rate in HDU was six times higher compared to the United States National Healthcare Safety Network (US-NHSN) in 2021.
Objective:
To reduce 50% CAUTI incidence rate by the end of 2022.
Method:
A prospective study was conducted in tertiary HDU from January 2022 to June 2023. A gap analysis was assessed between the hospital practices and the Society Healthcare Epidemiology of America/Infectious Diseases Society of America (SHEA/IDSA) basic recommendations. The Kotter and Rathgebers' changing behavior model was applied at the beginning of the project. Formal education and prevention of CAUTI were applied using the National Strategy Model. Surveillance and statistical data analysis were carried out using US-NHSN guidelines.
Results:
The overall CAUTI incidence rate declined from 7.07- to 3.57/1000 urinary catheter days despite of significant increase in the utilization ratio from 0.79 to 0.94 (P value 0.0001). The compliance rate of the bundle CAUTI prevention was improved and sustained above 90%. A CAUTI incidence rate reduction was observed following the combination of the changing behavior and SHEA/IDSA of CAUTI prevention models over 18 months.
Conclusion:
We assumed the combination of the changing behavior and the prevention models for a long period is useful in reducing the CAUTI incidence rate and possibly applied to reduce other healthcare-associated infections.
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