The Impact of Clinical Decision Support (CDS) Tools on Catheter Associated Urinary Tract Infections (CAUTI

Purpose:
In a community hospital, a two year upward trend in catheter associated urinary tract infections (CAUTI) was identified by the Infection Control Department. A multidisciplinary task force was formed to identify various interventions with the ultimate goal of reducing CAUTI.

Significance:
Urinary tract infections account for more than 40% of healthcare-associated infections with approximately 80% associated with insertion of indwelling urinary catheters with risk of infection linked to duration of catheter dwell time. CAUTIs are one of the HACs no longer reimbursed by CMS

Strategy and Implementation:
The task force analyzed data, reviewed the literature and recommended procedural and policy changes to reduce the number of CAUTIs. They found CAUTIs were more likely to occur when catheters were in place greater than four days also, silver-coated catheters showed positive results in reducing the risk of CAUTIs. As a result, a review of proper catheter technique was implemented for the clinical staff, silver–coated catheters were implemented hospital-wide, and electronic CDS tools were developed to decrease the number of catheter dwell time and CAUTIs. The first CDS tool developed was a daily catheter list which automatically notified the clinician of patients who had indwelling catheters in place for three or more days. The second CDS tool was a daily reminder to reassess catheter necessity. The daily reminder automatically triggers 3 days after a catheter is inserted. As long as the catheter is in place, the daily automatic reminder will be sent to the nurse caring for the patient

Evaluation:
As a result of these interventions there was a sustained reduction in catheter use over a 12 month period. During this time period CAUTI rate decreased by 41 per cent (7.1/1000 catheter days to 4/1/1000 catheter days) and catheter device days decreased from an average of 1,560 to 1,470 per month.

Implications for Practice:
An interdisciplinary team is an effective approach to changing current practice. By identifying and implementing new processes such as CDS tools which support evidence based practice, there will be a positive impact on patient care outcomes, regulatory agency compliance and pay for performance.