Midwest Health System Successfully Reduces CAUTI Incidences with ECRI and the ISMP PSO

Problem

Throughout 2021, the health system recorded five CAUTIs, resulting in a standardized infection ratio (SIR) of 0.563 for the entire year. By the end of Q1 2022, however, the system had logged six CAUTIs for an SIR of 2.410—an alarming increase compared to the prior year.

While three of the Q1 2022 cases were attributed to the intensive care unit (ICU), internal analysis revealed opportunities for improvement across departments. In fact, the team surfaced variation in how personnel understood perineal care, indwelling urinary catheter care, and site preparation for insertion of these catheters.

Entering 2022, the health system aimed for a 20% reduction in CAUTIs compared to 2021. However, they later ending up adjusting their goals. For the remainder of 2022, the system strived for zero CAUTIs. Furthermore, they set a target of achieving 95% compliance in executing indwelling urinary catheter care by June 30, 2022, with plans to maintain this 
level through the end of the year.

Solution

The Infection Prevention team shared their concerns with experts from ECRI and the ISMP PSO, who provided feedback, research, and recommendations and reviewed policies related to CAUTI prevention.

ECRI and the ISMP PSO were important in ensuring that conversations were kept confidential. This meant that people could converse openly without worrying that what they said might be used against them later. These protections are unique to PSOs, which allow healthcare providers to have honest conversations about how to improve patient safety and quality of care.

ECRI and the ISMP PSO consistently offered help and follow-up. This support was particularly essential after finding out that several issues were causing more CAUTI cases.

The Infection Prevention team had to address multiple issues simultaneously to ensure patient safety, rather than focusing on just one or two main areas. Their key challenge was to enhance safety across various aspects without overwhelming the staff and leadership.

The Infection Prevention team developed an innovative solution by introducing a fun and engaging approach for delivering educational content and managing changes within the organization. This strategy aimed to make the process enjoyable and memorable for staff, integrating a friendly competition between departments to further increase motivation and engagement.

The initiative bolstered CAUTI prevention from every angle:

• Reducing utilization of catheters: A surefire way to prevent CAUTIs is to reduce usage of indwelling urinary catheters. To that end, the Infection Prevention team reviewed indications with inpatient hospitalists and nurses. They also encouraged Emergency Department providers to use external urinary collection management systems instead of defaulting to indwelling urinary catheters.
• Increasing quality and consistency: The Infection Prevention team made more reports about CAUTI prevention available. This gave directors, managers, and other staff a clearer view, helping them to enhance how they manage the care of urinary catheters, ultimately improving practices.
• Reshaping behaviors: People are the key to lasting change. The health system proactively recognized and rewarded high performers while increasing accountability for other staff as needed.

Result

The health system’s efforts paid off in the form of higher awareness and compliance with its CAUTI prevention bundle. In fact, the system identified zero CAUTIs in Q2 2022. In addition, the team:

• Decreased indwelling urinary catheter utilization by 50% over a five-month period.
• Achieved and sustained 97% compliance in indwelling urinary catheter care across nursing departments.
• Achieved and sustained 98% compliance in indwelling urinary catheter care in the ICU.