Title : Enhancing patient safety: CAUTI prevention through targeted ICU interventions
Abstract:
Purpose: The ICU has observed an increase in catheter-associated urinary tract infections (CAUTIs), which pose a significant risk to patient safety and increase healthcare costs. The purpose of this action plan is to implement evidence-based strategies across all phases of catheter management to reduce CAUTI incidence, improve patient outcomes, and sustain a culture of safety within the ICU.
Description: To achieve this goal, a comprehensive, collaborative approach was implemented:
Insertion Phase: Proper catheter insertion is critical for reducing infection risks. To ensure proficiency, all staff performing insertions will undergo a competency assessment focusing on sterile techniques and evidence-based practices. Additionally, a two-person insertion model will be adopted. This approach involves one person performing the procedure while another verifies the sterile field and technique, minimizing contamination during placement.
Maintenance Phase: Ongoing catheter care plays a pivotal role in preventing infections. Collaborating with nursing assistants (NAs) and student nurses (SNs), the ICU will reinforce daily peri-care to ensure catheter cleanliness. To promote consistency, standardized peri-care packets will be introduced, providing clear instructions and tools. Routine best practices—such as emptying urine bags at half full, avoiding dependent loops in tubing, using securement devices, and maintaining cleanliness in high-touch areas—will be re-emphasized through education and audits.
Removal Phase: Prolonged catheter use is a major risk factor for infection. The ICU will strictly adhere to the HOUDINI protocol, an evidence-based approach that evaluates the need for catheter retention. This ensures that catheters are removed promptly when no longer clinically necessary, reducing the risk of CAUTIs associated with extended use.
Sample Collection Phase: Accurate urine sampling is critical to diagnosing CAUTI. To ensure reliable results, any catheter that has been in place for more than 48 hours will be replaced before urine culture collection. This measure minimizes contamination from biofilm on older catheters. Staff will also receive education on aseptic techniques for sample collection, focusing on obtaining specimens from newly inserted catheters or drainage bags. An observer role will be introduced during sampling to ensure compliance with these protocols.
Results and Next Steps: Implementation of these interventions has significantly reduced CAUTI incidence in the ICU. The average CAUTI rate decreased from 1.67 cases per month (January–June) to 0.75 cases per month (July–October), representing a 55% reduction. These results highlight the efficacy of structured, evidence-based strategies in infection prevention. To sustain these improvements, the ICU will continue routine monitoring of adherence to insertion, maintenance, removal, and sampling protocols. Regular staff education, audits, and transparent data sharing will support ongoing compliance and foster a culture of continuous quality improvement.
