The team used the study’s outcomes to springboard elsewhere in the organization and to find opportunities for impactful change. For instance, they found the diaper wipes did not have antimicrobial agents so nurses now start with a diaper wipe and then do a peri wipe. They also realized through their pilot that more than 50% of catheters were placed in the operating room, so the operating room staff applied the bundles appropriately.
Akron Children’s Hospital joined the Ohio Children’s Hospitals’ Solutions for Patient Safety Collaborative, which includes more than 80 children’s hospitals and is focused on reducing harm by preventing readmissions, serious safety events, and 10 specific hospital-acquired conditions, including CAUTI. Between 2015 and 2016, the collaborative aims to reduce hospital-acquired conditions such as CAUTI by 40%.
Christ-Libertin says it is a hospital’s responsibility to be a good steward of antibiotics and, therefore, avoid infections that could require their usage. “We don’t want to contribute to antibiotic resistance,” she says.
In addition to implementing prevention techniques similar to North Shore University Hospital, Akron Children’s Hospital has online modules that address each of these areas, and peer practice groups that help improve clinicians’ catheter skills. To ensure that everyone who deals with catheters is up to date on best practices, catheter care is built into the hospital’s graduate resident education program and taught to parents, who sometimes have to catheterize their children. “We’ve also integrated catheter reviews into the team rounding process so each day the risk/benefit of a patient’s catheter can be weighed,” Christ-Libertin says.
The hospital, having now achieved a 70% reduction in catheter days in the ICU, is turning its attention to general units and is currently gathering data for a baseline.
The right windmill?
As many hospitals target resources toward CAUTI to ensure patient safety and CMS payment, Michael Edmond, MD, MPH, MPA, the chief quality officer and associate chief medical officer at the University of Iowa Hospitals and Clinics, a 730-bed facility that annually admits 32,000 patients for in-patient hospital care, calls CAUTI “a distraction” that is diverting resources away from other higher-impact prevention activities.
CAUTIs, he says, “have low preventability, high levels of misclassification, low impact because significant morbidity is uncommon and death is rare, and a high opportunity cost.”
He cites a 2013 JAMA Internal Medicine study that although CAUTI was more common than CLABSI, another HAI, the cost per infection was significantly lower, accounting for only $0.03 billion annually for CAUTI vs. $1.85 billion for CLABSI. And hospitals spent $110 on SSIs for every $1 spent on CAUTI.
Edmond says that while the mortality rate of secondary bloodstream infections from CAUTIs is notable at 11%, the actual risk of getting a secondary bloodstream infection from CAUTI is relatively low, with Baylor University finding that 1.6% of patients with CAUTIs acquire a secondary bloodstream infection and the University of Wisconsin reporting 0.4%.
Edmond uses the Stop CAUTI Project’s Comprehensive Unit-based Safety Program model to determine that a 900-bed hospital with 49,000 catheter days per year would avoid only one additional secondary bloodstream infection every five years and one additional death every 50 years.
Removing catheters too soon can lead to other issues, he says, such as patient falls as they walk to the bathroom, and the need for more nursing resources on the patient floors. “You can’t look at CAUTIs in isolation; prevention can have adverse unintended consequences.”