Ascension EDs created new catheter protocols—and slashed infection rates by 30%

CAUTIs are the most common hospital acquired infection

Ascension Health in 2012 reduced the rate of catheter-associated urinary tract infections (CAUTIs) in its EDs through an initiative that redefined when catheters are appropriate, Maureen McKinney writes in Modern Healthcare.

According to CDC, CAUTIs account for the most—about 30%—of all hospital acquired infections and lead to more than 8,000 deaths annually. Initiatives to bring down CAUTI rates generally focus on removing catheters as early as possible.

CDC: One in 25 hospital patients acquires an infection

After Ascension's St. Louis-based hospitals were selected to become a hospital engagement network through the Partnership for Patients, the system identified CAUTIs as a key area for quality improvement.

Mohamad Fakih, Ascension's infectious disease physician leader, headed up the initial 18-hospital CAUTI pilot, which focused on appropriate catheter use in the ED. "Others say, 'Let's get rid of it quickly.' We say, 'Let's stop before we even put it in,'" Fakih says.

He and his team drafted clear guidelines on appropriate urinary-catheter use and customized the recommendations for ED patients. For example, Fakih's team determined that catheters were appropriate for patients with urinary obstruction or those scheduled for certain surgical procedures, but inappropriate for patients with dementia.

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Beginning in June 2012, a physician and nurse champion at each of the 18 hospitals oversaw the implementation of the project and educated staff about its benefits. 

"Before, it was just the norm to put a catheter in, and now it's definitely not," says Arlene Boestler, St. John Hospital's nurse champion for the project. She adds that the guidelines have been embedded into the electronic health records (EHR) system, so indications automatically pop up when nurses chart a catheter.

In just six months, Fakih and his team found that:

  • New catheter placements in the participating EDs decreased by more than 30%, from 9.1% at the baseline to 6.1%; and
  • Appropriate catheter placements based on the guidelines increased from 74% to 91%.

The Agency for Healthcare Research and Quality has integrated Ascension's approach into the agency's national effort to prevent catheter-associated UTIs, called "On the CUSP: STOP CAUTI," which is used at more than 200 U.S. EDs, Fakih says (McKinney, Modern Healthcare, 8/2 [subscription required]).

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