Reduction of catheter-associated urinary tract infections among patients in a neurological intensive care unit: a single institution's success.
OBJECTIVE
To date, there has been a shortage of evidence-based quality improvement initiatives that have shown positive outcomes in the neurosurgical patient population. A single-institution prospective intervention trial with continuous feedback was conducted to investigate the implementation of a urinary tract infection (UTI) prevention bundle to decrease the catheter-associated UTI rate.


METHODS
All patients admitted to the adult neurological intensive care unit (neuro ICU) during a 30-month period were included. The study consisted of two 1-month preintervention observation periods (approximately 1200 catheter days) followed by a 30-month intervention phase (20,394 catheter days). A comprehensive evidence-based UTI bundle encompassing avoidance of catheter insertion, maintenance of sterility, product standardization, and early catheter removal was enacted.


RESULTS
The urinary catheter utilization rate dropped from 100% to 73.3% during the intervention phase (p < 0.0001) without any increase in the rate of sacral decubitus ulcers or other skin breakdown. The rate of catheter-associated UTI was also significantly reduced from 13.3 to 4.0 infections per 1000 catheter days (p < 0.001). There was a linear relationship between the decreased quarterly catheter utilization rate and the decreased catheter-associated UTI rate (r(2) = 0.79, p < 0.0001).


CONCLUSIONS
This single-center prospective study demonstrated that a comprehensive UTI prevention bundle along with a continuous quality improvement program can significantly reduce the duration of urinary catheterization and rate of catheter-associated UTI in a neuro ICU.
Department of Neurosurgery, University of Florida, Gainesville, FL, USA.
W Lee
WL
Titsworth
Jeannette
J
Hester
Tom
T
Correia
Richard
R
Reed
Miranda
M
Williams
Peggy
P
Guin
A Joseph
AJ
Layon
Lennox K
LK
Archibald
J
J
Mocco
D000046:Academic Medical Centers; D002408:Catheters, Indwelling / Q000382:microbiology*; D003299:Cooperative Behavior; D003428:Cross Infection / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D005431:Florida; D006801:Humans; D007362:Intensive Care Units; D033183:Interdisciplinary Communication; D009422:Nervous System Diseases / Q000628:therapy*; D003668:Pressure Ulcer / Q000517:prevention & control; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000592:standards; D013242:Sterilization; D014546:Urinary Catheterization / Q000009:adverse effects* / Q000592:standards; D014552:Urinary Tract Infections / Q000517:prevention & control*