9-215 - The implementation of a new perineal care protocol to reduce catheter-associated urinary tract infections in the intensive care unit


Aurora BayCare Medical Center


BACKGROUND: Urinary tract infections associated with the use of an indwelling urinary catheter (CAUTI) are one of the most common hospital-acquired infections, accounting for more than 12% of the infections reported by acute care hospitals. CAUTI's are associated with numerous complications, including prolonged hospital stay, bloodstream infections, and even death. Between 15-25% of hospitalized patients receive urinary catheters at some point during their hospital stay, putting them at risk for CAUTI. CAUTI rates by hospital are now publically available and the Centers for Medicare and Medicaid Services (CMS) will no longer reimburse hospitals for the additional costs of caring for patients who develop CAUTI. The use of the catheter for the shortest duration of time is the most important modifiable risk factor, but additional methods of prevention are needed for those patients who require prolonged catheter use.

METHODS: We established our baseline by measuring the CAUTI rates in our 24-bed intensive care unit (ICU) by quarter for all 12-months in 2014. In February, 2015, we implemented a new standard for perineal care. This standard requires the completion of perineal care three times a day using a cleansing cloth designed specifically for perineal and meatal cleansing. We continued to track our ICU CAUTI rates (quarterly and rolling 12-month along with ICU patient days, total urinary catheter days, and compliance to the protocol). These data allow us to monitor our CAUTI rates as a standardized infection rate (SIR).

RESULTS: Our overall CAUTI rate data to date are shown in Table 1. The CAUTI rates are highlighted to indicate values above our upper threshold (red), within our middle range (yellow), and below our target threshold (green).

CONCLUSIONS: The implementation of our new perineal care protocol has resulted in a decrease in our CAUTI SIR to below threshold, which continues to be maintained.

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