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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