Bart UTI Research Award: Preventing Catheter-Related Urinary Tract Infections: Back to the Basics

BACKGROUND: Urinary tract infections (UTIs) account for up to 40% of all hospital-acquired infections. Evaluation of a 10-bed post intensive care rehabilitation Unit (PICRU) in June 2003 revealed a catheter-associated urinary tract infection (CA-UTI) rate of 27.0 per 1000 urinary catheter days. Routine surveillance was initiated to establish a baseline CA-UTI rate and identify interventions to decrease rates. METHODS: CA-UTI rates were calculated using current CDC definition. A 12-month retrospective chart review was performed. Discussions with staff were held to determine current practices. Silver-impregnated urinary catheters were used for all patients. RESULTS: Record review revealed rates from 11.6 to 46.5 per 1000 urinary catheter days (mean rate of 22.7). Average length of catheterization to first positive urine culture was 36.6 days. Discussion with staff revealed routine perineal and catheter care (PCC)—cleansing the meatus and perineal area and the catheter to 4 inches from insertion site—was performed with daily bathing and incontinence. Current literature recommends PCC twice daily in addition to bathing and incontinence. Twice-daily PCC in addition to current practice was instituted in July 2003. This intervention was discussed at staff meetings. Monthly graphs of the CA-UTI rates were posted on the unit. The 6-month post-intervention mean CA-UTI rate was 7.3, a 68% decrease (p<0.001). CONCLUSIONS: Patient-care provider education was effective at reducing rates of CA-UTI. Monitoring of the intervention as well as continuing patient-care provider education continues.