Impact of Implementing a Multi-Model Set of Interventions on the Surveillance Rates of Catheter-Associated Urinary Tract Infection

BACKGROUND: Catheter-associated urinary tract infection (CAUTI) is associated with increased healthcare cost, morbidity, and mortality. A multi-model set of interventions to decrease CAUTI rates (CAUTI Prevention Bundle) was initiated in our hospital in 2014–2015. The CAUTI Prevention Bundle consists of educational and behavioral interventions to improve placement, maintenance, and removal of catheters. METHODS: CAUTI events for 2014 and 2016 were identified according to the National Healthcare Safety Network (NHSN) 2016 definition. CAUTI rates and device utilization ratios (DURs) for 2014 and 2016 were compared. In February 2015, urinalysis with reflex to culture (UArC) criteria were changed. Prior to February 2015, UA with positive nitrate, positive leukocyte esterase, microscopic exam indicating ≥6 WBC/hpf, microscopic exam indicating The presence of any bacteria, or appearance other than clear was reflexed to culture. Based on the new UArC criteria, UA with positive leukocyte esterase or microscopic exam indicating ≥6 WBC/hpf is reflexed to culture. We performed chart review of CAUTI events prior to changing criteria and identified triggering criteria. We also identified CAUTI events with no UA or UArC. RESULTS: A total of 71 and 28 CAUTI events were identified in 2014 and 2016, respectively. The CAUTI rate decreased from 2.29 per 1,000 catheter days in 2014 (95% CI = 2.20,2.39) to 1.23 per 1,000 catheter days in 2016 (95% CI = 1.16,1.30). Rate difference 1.06 (95% CI = 0.94,1.18; P < 0.001). Rate ratio 0.573 (95% CI = 0.527,0.622). Catheter days were 31,064 and 23,016 in 2014 and 2016, respectively. Device utilization ratio (DUR) decreased from 0.14 in 2014 to 0.11 in 2016. Using the new UArC criteria, seven CAUTI events in 2014 would have been prevented. This would have translated into 9.86% reduction in CAUTI events for 2014. In 2014, 19.72% of CAUTI events had no UA or UArC order. In 2016, 12.5% of CAUTI events had no UA or UArC order. CONCLUSION: Implementing a CAUTI Prevention Bundle significantly reduces CAUTI events. Appropriate use of urine culture provides an opportunity to further reduce inflated CAUTI surveillance rates. DISCLOSURES: All authors: No reported disclosures.