Reduction of catheter-associated urinary tract infections among patients in a neurological intensive care unit: a single institution's success

Clinical article

W. Lee Titsworth M.D., Ph.D. 1 , Jeannette Hester M.S.N., R.N. 4 , Tom Correia B.S.N., R.N. 4 , Richard Reed B.S.N., R.N. 4 , Miranda Williams M.P.H., R.N. 5 , Peggy Guin Ph.D., A.R.N.P. 4 , A. Joseph Layon M.D. 2 , Lennox K. Archibald M.D. 3 and J Mocco M.D., M.S. 1
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  • 1 Department of Neurosurgery;
  • 2 Division of Critical Care Medicine, Department of Anesthesiology; and
  • 3 Division of Infectious Disease, Department of Internal Medicine, University of Florida;
  • 4 Department of Nursing and Patient Services; and
  • 5 Department of Infection Prevention and Control, Shands Hospital at the University of Florida, Gainesville, Florida
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Object

To date, there has been a shortage of evidence-based quality improvement initiatives that have shown positive outcomes in the neurosurgical patient population. A single-institution prospective intervention trial with continuous feedback was conducted to investigate the implementation of a urinary tract infection (UTI) prevention bundle to decrease the catheter-associated UTI rate.

Methods

All patients admitted to the adult neurological intensive care unit (neuro ICU) during a 30-month period were included. The study consisted of two 1-month preintervention observation periods (approximately 1200 catheter days) followed by a 30-month intervention phase (20,394 catheter days). A comprehensive evidence-based UTI bundle encompassing avoidance of catheter insertion, maintenance of sterility, product standardization, and early catheter removal was enacted.

Results

The urinary catheter utilization rate dropped from 100% to 73.3% during the intervention phase (p < 0.0001) without any increase in the rate of sacral decubitus ulcers or other skin breakdown. The rate of catheter-associated UTI was also significantly reduced from 13.3 to 4.0 infections per 1000 catheter days (p < 0.001). There was a linear relationship between the decreased quarterly catheter utilization rate and the decreased catheter-associated UTI rate (r2 = 0.79, p < 0.0001).

Conclusions

This single-center prospective study demonstrated that a comprehensive UTI prevention bundle along with a continuous quality improvement program can significantly reduce the duration of urinary catheterization and rate of catheter-associated UTI in a neuro ICU.

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Contributor Notes

Address correspondence to: J Mocco, M.D., M.S., Department of Neurosurgery, University of Florida, P.O. Box 100265, Gainesville, Florida 32610. email: jmocco@neurosurgery.ufl.edu.

Please include this information when citing this paper: published online January 6, 2012; DOI: 10.3171/2011.11.JNS11974.

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