Title : Improving CAUTI metrics, morale, and mainly patient outcomes
Abstract:
Despite implementing several CAUTI prevention initiatives throughout 2024, JSUMC reported 44 CAUTIs for the year, exceeding the 75th percentile national benchmark. This high rate surpassed NHSN's predictive model, which estimated 12-22 CAUTIs for JSUMC in 2024.To achieve our 2025 goal of a 10% reduction in CAUTIs hospital-wide, we enhanced our existing CAUTI Reduction Plan. Enhancements included a dedicated Quality Initiative IP Coordinator, risk reduction strategies, interdisciplinary team collaboration, improved diagnostic stewardship, targeted unit-based interventions, expanded role-specific education, and enhanced IP surveillance for outcome measurement. Our outcome measures are easily identified as CAUTI incidence, showing a decrease in infections, improved patient outcomes and experience, and lower costs of patient care. This project is ongoing, and we will continue with the interventions we have already put in place: increased staff education, resident education, partnering with the lab and physicians to improve specimen quality and diagnostic stewardship, and focusing on the units in greatest need of improvement.
Quality Initiative IP Coordinator: A new Infection Preventionist (IP) role was created to lead the CAUTI Reduction Plan in partnership with the IP department, utilizing a PDCA (Plan-Do-Check-Act) cycle for continuous improvement.
Risk Reduction Strategies: We promoted alternatives to indwelling urinary catheters (IUCs), such as external catheters and intermittent catheterization, emphasizing appropriate IUC insertion technique, and focusing on limiting IUC duration.
Interdisciplinary Collaboration: We created an interdisciplinary team including IP, nursing staff, physicians, residents, leadership, nursing education, laboratory, IT, urology, and the hospitalist group. This team continuously works to identify and implement methods to decrease the incidence of CAUTI.
Diagnostic Stewardship: We collaborated with physicians and the lab to ensure appropriate urine specimen ordering and collection, reducing unnecessary urine cultures and improving CAUTI metric accuracy.
Targeted Unit-Based Interventions: This targeted plan focuses on 5 units with specific CAUTI reduction goals, using NHSN's Targeted Assessment for Prevention (TAP) report to guide interventions and track progress.2 A communication strategy was implemented to promote IUC removal and track progress. IP and nursing leadership partnered with the hospitalist group to facilitate IUC removal using a nurse-driven protocol.
Role-Specific Education and Competency: We provided and continue to provide CAUTI prevention education at nursing orientation, annual nurse and PCT competencies, and resident education sessions.
Surveillance, Analysis, and Reporting: IP conducts daily proactive communication, concurrent and retrospective surveillance of IUCs and urine cultures. If a CAUTI is detected, we perform an Apparent Cause Analysis (ACA) to identify gaps and develop preventative interventions. IP reports CAUTI data weekly to senior leadership, monthly at the JSUMC IP meeting, and to the HMH IP Committee.
Outcomes: Since we have refocused our efforts on CAUTI prevention, we have seen a sustained decrease in the CAUTI rate at JSUMC. In 2025, JSUMC had 19 CAUTI (a 56.82% decrease from 44 CAUTI the previous year).
