title: A Multifaceted Approach to Reduction of Catheter-Associated Urinary Tract Infections in the Intensive Care Unit With an Emphasis on "Stewardship of Culturing".
abstract: BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are among the most common hospital-acquired infections (HAIs). Reducing CAUTI rates has become a major focus of attention due to increasing public health concerns and reimbursement implications. OBJECTIVE To implement and describe a multifaceted intervention to decrease CAUTIs in our ICUs with an emphasis on indications for obtaining a urine culture. METHODS A project team composed of all critical care disciplines was assembled to address an institutional goal of decreasing CAUTIs. Interventions implemented between year 1 and year 2 included protocols recommended by the Centers for Disease Control and Prevention for placement, maintenance, and removal of catheters. Leaders from all critical care disciplines agreed to align routine culturing practice with American College of Critical Care Medicine (ACCCM) and Infectious Disease Society of America (IDSA) guidelines for evaluating a fever in a critically ill patient. Surveillance data for CAUTI and hospital-acquired bloodstream infection (HABSI) were recorded prospectively according to National Healthcare Safety Network (NHSN) protocols. Device utilization ratios (DURs), rates of CAUTI, HABSI, and urine cultures were calculated and compared. RESULTS The CAUTI rate decreased from 3.0 per 1,000 catheter days in 2013 to 1.9 in 2014. The DUR was 0.7 in 2013 and 0.68 in 2014. The HABSI rates per 1,000 patient days decreased from 2.8 in 2013 to 2.4 in 2014. CONCLUSIONS Effectively reducing ICU CAUTI rates requires a multifaceted and collaborative approach; stewardship of culturing was a key and safe component of our successful reduction efforts. Infect Control Hosp Epidemiol 2017;38:186-188.
authors.affiliation: 1Department of Infectious Diseases,Medicine Institute,Cleveland Clinic Foundation,Cleveland,Ohio.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Mullin
authors.affiliation: 1Department of Infectious Diseases,Medicine Institute,Cleveland Clinic Foundation,Cleveland,Ohio.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Kovacs
authors.affiliation: 2Department of Infection Prevention,Quality and Patient Safety Institute,Cleveland Clinic Foundation,Cleveland,Ohio.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Fatica
authors.affiliation: 2Department of Infection Prevention,Quality and Patient Safety Institute,Cleveland Clinic Foundation,Cleveland,Ohio.
authors.forename: Colette
authors.initials: C
authors.lastname: Einloth
authors.affiliation: 3Pharmacy Institute,Cleveland Clinic Foundation,Cleveland,Ohio.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Neuner
authors.affiliation: 4Respiratory Institute,Cleveland Clinic Foundation,Cleveland,Ohio.
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Guzman
authors.affiliation: 5Anesthesiology Institute,Cleveland Clinic Foundation,Cleveland,Ohio.
authors.forename: Eric
authors.initials: E
authors.lastname: Kaiser
authors.affiliation: 6Heart and Vascular Institute,Cleveland Clinic Foundation,Cleveland,Ohio.
authors.forename: Venu
authors.initials: V
authors.lastname: Menon
authors.affiliation: 7Children's Hospital and Pediatric Institute,Cleveland Clinic Foundation,Cleveland,Ohio.
authors.forename: Leticia
authors.initials: L
authors.lastname: Castillo
authors.affiliation: 8Department of Anesthesiology,Emory University School of Medicine,Atlanta,Georgia.
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Popovich
authors.affiliation: 9Department of Neurology,Feinberg School of Medicine,Northwestern University,Chicago,Illinois.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Manno
authors.affiliation: 1Department of Infectious Diseases,Medicine Institute,Cleveland Clinic Foundation,Cleveland,Ohio.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Gordon
authors.affiliation: 1Department of Infectious Diseases,Medicine Institute,Cleveland Clinic Foundation,Cleveland,Ohio.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Fraser
mesh_terms: D000073602:Antimicrobial Stewardship / Q000706:statistics & numerical data; D055499:Catheter-Related Infections / Q000453:epidemiology*; D003428:Cross Infection / Q000517:prevention & control*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D009820:Ohio / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology*; D014556:Urine / Q000382:microbiology