Background

 A CAUTI, or Catheter-Associated Urinary Tract Infection, is a serious infection that occurs when bacteria or other pathogens enter the urinary tract when a catheter (a tube) is used to drain urine from a patient's bladder. Catheters are tubes inserted into the bladder through the urethra to help drain urine. They are often used for patients who cannot urinate on their own, due to mobility issues, surgery, illness, or other medical conditions.

Risk factors for CAUTIs

Any patient with an in-dwelling urinary catheter is at risk for a CAUTI. However, the risk of developing a CAUTI increases if:

• it was not placed using a sterile technique,

• the catheter is not well maintained,

• the patient’s immune system is compromised, or

• the catheter is left in place for too long.

Symptoms of a CLABSI

Symptoms of CAUTI can include fever, chills, lower abdominal pain, cloudy or bloody urine, and a strong urge to urinate.

Treatment and Impact

CAUTIs are treated with antibiotics, in some cases the catheter may need to be removed or replaced. CAUTIs are a significant concern in hospitals because they can lead to serious complications and even death in vulnerable patients, and they increase the patients hospital stay and care costs.

Based on six studies reporting cost data for CAUTIs, the Agency for Healthcare Research & Quality (US) has estimated the additional cost for hospital-acquired CAUTIs to be $13,793 (95% CI: $5,019 to $22,568). Based on four studies, excess mortality was estimated at 0.036 (95% CI: 0.004 to 0.079) per hospital-acquired condition: this means that for every 1,000 in-hospital CAUTI cases, there are 36 excess deaths¹.

Prevention

CAUTIs can be reduced with proper sterile catheter insertion and maintenance, including rigorous hand hygiene, regular monitoring and removal as soon as possible to reduce the chance of infection.

How are CAUTIs proactively managed in an Accountable Care Unit with SIBR rounds?

A key step in CAUTI prevention is to ensure that catheters are only used when necessary, that proper sterile technique is used during insertion and that the unit staff are proactively removing catheters as soon as possible.

During SIBR, the bedside nurse is required as part of step 4 of the SIBR communication protocol, i.e. during the SIBR quality-safety checklist, to report on the presence, necessity and insertion date of any catheters to the rest of the team. Ideally each unit will have a nurse-driven CAUTI/catheter prevention protocol that nurses can use to prompt their critical thinking on the best catheter management strategy for each patient. The ACU leadership dyad, nurse & physician co-leads, should be monitoring CAUTI events on the unit and working with the frontline staff to optimize the treatment process.

Improvement Outcomes Reported by ACUs

A medical-telemetry unit at Presbyterian St Luke's hospital utilizing the ACU care model found that their rate of catheter days reduced by 31.9% after implementing SIBR rounds. This is important are it shows that the unit staff were proactively managing the use of catheters in their patients and removing the opportunity for CAUTIs to occur.

A 26-bed acute medical unit at Orange Hospital in New South Wales reported an average of 50% fewer catheters in-situ in the year following ACU & SIBR implementation.

References

1. https://www.ahrq.gov/hai/pfp/haccost2017-results.html#:~:text=Based%20on%20six%20studies%20reporting,CAUTI%20cases%2C%20there%20are%2036