An Interdisciplinary Approach to Decreasing CAUTI in Persons with Spinal Cord Injury in Acute Rehabilitation
Topic of Interest
Quality Initiatives
Patient Populations
Interprofessional Collaboration
Abstract
Title: An Interdisciplinary Approach to Decreasing CAUTI in Persons with Spinal Cord Injury in Acute Rehabilitation
Author(s): Shelly Amato PhD, APRN-CNS, CRRN, CNRN, Bridget Blayney BSN, RN, CRRN and Christina V. Oleson MD
Significance/Background: Urinary tract infections (CAUTI) are the fifth most common healthcare associated infection (CDC, 2020). Reducing CAUTI is even more challenging in persons with spinal cord injury (SCI) due to neurogenic bladder, resulting in retention of urine and the inability to empty the bladder (Taweel & Seyam, 2015). Historically, indwelling catheters were used to manage neurogenic bladder but have been found to increase the likelihood of developing a CAUTI (Barboglio Romo et al., 2018).
Project Description: An interdisciplinary quality improvement project was initiated to decrease CAUTI rates and indwelling urinary catheter (IUC) use on a SCI rehabilitation unit. The project involved implementation of a catheter removal algorithm, urine culture stewardship, and staff education. The algorithm outlined a step by step approach to IUC removal. Day 1 & 2 included physician assessment of contraindications to the intermittent catheterization program (ICP), monitoring intake and output, and limiting fluids to a maximum of 2 liters per day. In addition, family were identified for education about the ICP. Days 3 & 4 included discontinuing the IUC and initiating the ICP with bladder scanning to determine timing of the ICP.
Evaluation Methods: CAUTI rates were calculated based on CDC National Healthcare Safety Network (NHSN) definitions. Urinary catheter days were calculated based documentation in Quadramed.
Results: CAUTI rates decreased from 7 (3.85/1,000 catheter days) in 2017 to 1 (3.09/1000 catheter days) in 2018 to 0 in 2019 and 0 through July 2020. Catheter days decreased from 1817 in 2017 to 510 in 2018 to 331 in 2019 and 109 through July 2020.
Conclusion: The implementation of a urinary catheter removal algorithm, urine culture stewardship, and staff education has shown to be a sustainable practice change that has decreased the rate of indwelling urinary catheter use and nosocomial CAUTI rates for patients with SCI in the inpatient rehabilitation setting.
Barboglio, P.G., Smith, C.P., Cox, A., Averbeck, M.A., Dowling, C., Beckford, C., Manohar, P., Duran, S., & Cameron, A.P. (2018). Non-surgical urologic management of neurogenic bladder after spinal cord injury, World Journal of Urology, 36, 1555-1568.
Centers for Disease Control. (2020). Urinary tract infection (catheter-associated urinary tract infection [CAUTI] and non-catheter-associated urinary tract infection [UTI] and other urinary system infection [USI] events. Retrieved from https://www.cdc.gov/nhsn/PDFs/pscManual/7pscCAUTIcurrent.pdf
Taweel, W., Seyam, R. (2015). Neurogenic bladder in spinal cord injury patients. Res Rep Urol, 7, 85-99.