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. 2022 Sep 26;6(5):488-495.
doi: 10.1016/j.mayocpiqo.2022.08.004. eCollection 2022 Oct.

Reducing Catheter-Associated Urinary Tract Infections Across a Hospital System Through Urine Culture Stewardship

Carmin M Kalorin  1 , Jessica M Dixon  1 , Lucy V Fike  2 , J West Paul  1   3 , Neal K Chawla  1 , David Kirk  1 , Patricia C Woltz  1 , Nimalie D Stone  2
Affiliations

Reducing Catheter-Associated Urinary Tract Infections Across a Hospital System Through Urine Culture Stewardship

Carmin M Kalorin et al. Mayo Clin Proc Innov Qual Outcomes. .

Abstract

Objective: To evaluate the effectiveness and safety of an evidence-based urine culture stewardship program in reducing hospital catheter-associated urinary tract infections (CAUTIs) and the rate of CAUTIs across a 3-hospital system.

Patients and methods: This is a prospective, 2-year quality improvement program conducted from October 1, 2018, to September 30, 2020. An evidence-based urine culture stewardship program was designed, which consisted of the following: criteria for allowing or restricting urine cultures from catheterized patients, a best practice advisory integrated into the ordering system of an electronic medical record, and a systematic provider education and feedback program to ensure compliance. The system-wide rates of CAUTIs (total CAUTIs/catheter days×1000), changes in intercepts, trends, mortality, length of stay, rates of device utilization, and rates of hospital-onset sepsis were compared for 3 years before and 2 years after the launch of the program.

Results: Catheter-associated urinary tract infections progressively decreased after the initiation of the program (B=-0.21, P=.001). When the trends before and after the initiation of the program were compared, there were no statistically significant increases in the ratio of actual to predicted hospital length of stay, intensive care unit length of stay, system-wide mortality, and intensive care unit mortality. Although the rates of hospital-acquired sepsis remained consistent after the implementation of the stewardship program through the first quarter of 2020, the rates showed an increase in the second and third quarters of 2020. However, hospital-onset sepsis events associated with the diagnosis of a urinary tract infection did not increase after the intervention.

Conclusion: Urine culture stewardship is a safe and effective way to reduce CAUTIs among patients in a large multihospital health care system. Patient safety indicators appeared unchanged after the implementation of the program, and ongoing follow-up will improve confidence in the long-term sustainability of this strategy.

Keywords: BPA, best practice advisory; CAUTI, catheter associated urinary tract infection; CDC, Centers for Disease Control and Prevention; EMR, electronic medical record; LOS, length of stay; WMUCSP, WakeMed Urine Culture Stewardship Program.

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Figures

Figure 1
Figure 1
Screenshot of the best practice advisory alert implemented within the order-entry system of the WakeMed Healthcare electronic medical record. lac, lactate; pn, pain; qSOFA, quick sequential organ failure assessment; sx, symptoms; unexp, unexplained; US, ultrasound; WBC, white blood cell.
Figure 2
Figure 2
Impact of the stewardship program on the rates of catheter-associated urinary tract infections per 1000 catheter days.
Figure 3
Figure 3
Rates of hospital-onset sepsis per 1000 discharges.
See this image and copyright information in PMC

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