Catheter-associated Urinary

Tract Infection (CAUTI)

Kristen Nii-Jensen
Asherly Silva
Sandy Van
Natalie Wong
Sun Young Helmer
N362: QI Project

UTI are the most common type of

healthcare-associated infection

Approximately 1 in 5 patients in acute

care receiving an indwelling catheter
The risk of developing CAUTI increase 5
% for each day

Catheter-associated UTI have been

associated with increased morbidity
and mortality rate

2.3 % mortality rate of patients with

CAUTI

The Centers for Medicare & Medicaid

Services no longer pays for
reasonably preventable hospitalacquired complications

-Each episode of CAUTI costs at least

$600
-Each episode of urinary tract-related
bacteremia costs at least $2800
-$0.4-0.5 billion per year nationally

CAUTI: Root Cause Analysis

Plan:

Goal: Decrease facilities

incidence of CAUTI

Analysis: A run chart that plots

incidence of CAUTI prior to and
after interventions are enacted

Interventions: Identify causes and

effects, perform a literary review
of evidence based research on
best interventions to eliminate or
reduce the causes of CAUTI

Based on plans, teachings, and interventions

implemented in several facility wide CAUTI
prevention studies, and the QI as described by
Cherry & Jacobs (2011).

Do: Implement appropriate

interventions after an education
period, taking care to assess baseline
data of CAUTI prior to intervention,
and collect data throughout trial
period.

Check: Assess data to observe if

interventions have affected CAUTI
incidence. Assess adherence to
protocol and adjust interventions or
provide teaching reinforcement.

Act: Implement the interventions on a

facility wide scale if results warrant
this action.

Cause & Effect Diagram

Inappropriately placed
indwelling catheters

Improperly inserted
catheters (not using
aseptic technique)
Based on HICPAC (2009) indicators
that contribute to CAUTI incidence.

Prolonged indwelling
catheter placement

Improper handling after

insertion (Ineffective
drainage, handling tubing
without clean gloves,
improper cleansing)

C
A
U
T
I

CDC Recommended Core

Strategies for CAUTI Prevention
In accordance with Healthcare Infection Control Practices Advisory
Committee (HICPAC)

Insert catheters only for appropriate indications

Leave catheters in place only as long as needed

Ensure that only properly trained persons insert and maintain catheters

Insert catheters using aseptic technique and sterile equipment

Following aseptic insertion, maintain a closed drainage system

Maintain unobstructed urine flow

Practice hand hygiene and standard (or appropriate isolation) precautions

according to CDC HICPAC guidelines

Supporting Literature
CDC Recommendations

Insert catheters only for appropriate indications

Leave catheters in place only as long as

needed

Ensure that only properly trained persons insert and

maintain catheters

Insert catheters using aseptic technique and sterile

equipment

Following aseptic insertion, maintain a closed drainage

system

Maintain unobstructed urine flow

Practice hand hygiene and standard (or appropriate

isolation) precautions according to CDC HICPAC
guidelines

Elpern, E. & colleagues (2009) published their study in

American Journal of Critical Care that concluded
implementation of an intervention to judge appropriateness of
indwelling urinary catheters may result in significant reduction in
duration of catheterization and occurrences of CAUTIs

Yin-Yin, C. & colleagues (2013) published their study, also in

American Journal of Critical Care, that studied the
implementation of a criteria-based reminder to reduce use of
urinary catheters and CAUTI infections. They found the
reminder system reduced incidence of CAUTIs by 48% when
comparing the intervention and control group

Antibiotic prophylaxis is not one of CDCs core

recommended core strategies and Infectious Disease
Society of America guidelines state benefit of antibiotics at
time of catheter removal is unresolved issue

Marschall, J. and colleagues (2013) did a metaanalysis that found antibiotic prophylaxis for 3 days
or less when removing urinary catheters reduced the
rate of CAUTIs. Rate of CAUTIs were 4.7% in the
treated group and 10.5% in the control group.

Solution

Establish criteria

Limits use of indwelling

catheters

Daily evaluations

Recommend removal

Indicate reason for

continuation

Elpern, E., Killeen, K., Ketchem, A., Wiley, A., Patel, G., & Lateef, O. (2009). Reducing use of indwelling urinary catheters and associated urinary tract infections. American Journal Of Critical Care, 18(6), 535-542. doi:10.4037/ajcc2009938

Solution

Evidence-Based

6 month period in MICU

With intervention

(Criteria & Reminder)

Use of catheters decreased by 22%

No CAUTIs during study

Total elimination of CAUTIs not

reasonable goal

Elpern, E., Killeen, K., Ketchem, A., Wiley, A., Patel, G., & Lateef, O. (2009). Reducing use of indwelling urinary catheters and associated urinary tract infections. American Journal Of Critical Care, 18(6), 535-542. doi:10.4037/ajcc2009938

Evaluation of Solution

Nurses adherence to protocols

-

Implementing appropriate indications for insertion or

continuation of indwelling catheter
Using the reminder system everyday
Removing the catheter when not deemed appropriate

Data collection
-

Durations of catheterization

Rates of CAUTI

Quality Improvement

Prior to any intervention, one should analyze the root causes

of the issue
Find evidence-based research for appropriate interventions to
prevent adverse outcomes
QI tools can be an essential part of assessments of
interventions, analyses of root causes, and be a helpful tool in
guiding appropriate improvement actions or assist in the
implementation of better protocol, thus improving quality of
healthcare.