title: Toward eliminating catheter-associated urinary tract infections in an academic health center.
abstract: BACKGROUND
  Eliminating catheter-associated urinary tract infections (CAUTI) is at the forefront of quality improvement and cost reduction for payers and hospitals alike. Herein we describe a double-focused strategy to eliminate CAUTI's on a surgical oncology unit over the course of 24 mo.
  
  
  METHODS
  CAUTI's were tracked on a 30-bed surgical oncology unit 12 mo before and 12 mo after implementation of specific measures aimed at (1) decreasing utilization and (2) increasing catheter bundle and hand hygiene compliance. A policy of early Foley catheter removal was implemented. Univariate analyses were performed comparing nominal and numerical variables between the pre- and post-intervention groups.
  
  
  RESULTS
  The pre- and post-intervention groups comprised of 1376 and 1467 patients, respectively. Postintervention, there was a significant decrease in both total Foley (P = 0.02) and patient (P = 0.03) days. This resulted in a significant reduction in utilization rate from 0.28 to 0.24, (P < 0.0001) and median CAUTI rate from 4.6 to 0.0 (P = 0.03). Reduced CAUTIs were associated with significant improvements in monthly bundle compliance at ≥95% (75% versus 17%, P = 0.003) and hand hygiene compliance at ≥95% (92% versus 58%, P = 0.05). Among our thoracic epidural cohort (n = 11), three patients (27%) required reinsertion for urinary retention. None of these epidural patients were diagnosed with a CAUTI.
  
  
  CONCLUSIONS
  Although not eliminated entirely, CAUTIs on our unit were significantly reduced through decreased utilization and improved compliance to institutional patient safety measures. Adoption of these strategies to other inpatient units would not only improve patient safety but also result in significant cost savings.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, The Brody School of Medicine, East Carolina University, Greenville, North Carolina; Surgical Services, Vidant Medical Center, Greenville, North Carolina.
authors.forename: Swapnil D
authors.initials: SD
authors.lastname: Kachare
authors.affiliation: Surgical Services, Vidant Medical Center, Greenville, North Carolina.
authors.forename: Cheri
authors.initials: C
authors.lastname: Sanders
authors.affiliation: Surgical Services, Vidant Medical Center, Greenville, North Carolina.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Myatt
authors.affiliation: Division of Surgical Oncology, Department of Surgery, The Brody School of Medicine, East Carolina University, Greenville, North Carolina; Surgical Services, Vidant Medical Center, Greenville, North Carolina.
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Fitzgerald
authors.affiliation: Division of Surgical Oncology, Department of Surgery, The Brody School of Medicine, East Carolina University, Greenville, North Carolina; Surgical Services, Vidant Medical Center, Greenville, North Carolina. Electronic address: zervose@ecu.edu.
authors.forename: Emmanuel E
authors.initials: EE
authors.lastname: Zervos
mesh_terms: D000046:Academic Medical Centers / Q000592:standards; D005770:Gastrointestinal Neoplasms / Q000601:surgery*; D063373:Hand Hygiene / Q000379:methods / Q000592:standards; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000592:standards; D017410:Practice Guidelines as Topic; D058996:Quality Improvement; D062606:Tertiary Care Centers / Q000592:standards; D014546:Urinary Catheterization / Q000009:adverse effects*; D014552:Urinary Tract Infections / Q000209:etiology / Q000517:prevention & control*; D014565:Urogenital Neoplasms / Q000601:surgery*
keywords: CAUTI; Foley catheter; Reinsertion; Thoracic epidural