Dropping the urine culture: sustained CAUTI reduction using a UTI order panel

Area of Science:

• Infectious Diseases
• Healthcare Quality Improvement
• Epidemiology

Background:

• Catheter-associated urinary tract infections (CAUTIs) represent a significant healthcare-associated infection burden.
• Effective strategies are needed to optimize diagnostic approaches and reduce CAUTI incidence, particularly in tertiary care settings.
• The COVID-19 pandemic introduced challenges to infection control practices and patient management.

Purpose of the Study:

• To introduce and evaluate the impact of a novel urinary tract infection (UTI) panel on CAUTI rates.
• To assess the effectiveness of the UTI panel in reducing urine cultures (UC) and CAUTI incidence.
• To determine if the UTI panel's impact on CAUTI was sustained during the COVID-19 pandemic.

Main Methods:

• A quasi-experimental design was employed, comparing three periods: pre-panel, post-panel implementation, and post-panel during the COVID-19 pandemic.
• Data from tertiary care inpatients were analyzed using Poisson regression and interrupted time series (ITS) analysis.
• Key metrics included catheter days (CD), urine cultures (UC), CAUTI rates per 1,000 CD and patient days (PD), and National Health Safety Network standardized infection ratios (SIRs).

Main Results:

• Implementation of the UTI panel led to a significant decrease in UC per 1,000 PD (36.9 to 16.6).
• CAUTI rates per 1,000 CD decreased by 40% post-panel implementation (P < .001).
• Despite a nonsignificant 13% increase during the COVID-19 period, CAUTI rates remained 32% lower than pre-panel levels (P = .02).

Conclusions:

• The introduction of the UTI panel was associated with substantial reductions in both UC and CAUTI.
• The positive impact of the UTI panel on CAUTI reduction was maintained throughout the challenging period of the COVID-19 pandemic.
• This strategy demonstrates a successful approach to improving UTI diagnostics and infection control in a hospital setting.