Increased attention to rising Healthcare Associated Infection (HAI) rates has shed light on facilities that, even amidst the COVID-19 surge, have achieved a reduction in infection rates. One example of success is the Alaska Native Medical Center (ANMC)’s reduced Catheter-Associated Urinary Tract Infection (CAUTI) rates.
CAUTIs are uncomfortable for patients and can result in prolonged hospital stay, increased
cost, and mortality. CDC's National Healthcare Safety Network (NHSN) reports complications associated with Non-Catheter-Associated Urinary Tract Infections (UTI) may result in more than an estimated 13,000 deaths each year. The CDC 2020 Executive Progress Report noted a 19% overall national increase in CAUTI Standardized Infection Ratios (SIRs) observed in 2020-Q4 compared to 2019-Q4. In comparison, ANMC’s 2020-Q4 CAUTI SIR rate decreased by 9% from the 2019 average SIR rate of 1.38.
In addition, further declines show ANMC achieving an SIR rate of 0 in quarters 2 through 4 of 2021. ANMC’s physician champion helped increase the visibility of effort and enhance training regarding appropriate and inappropriate indications for catheter placement, proper technique for catheter placement, appropriate use of urine cultures, and nontreatment of asymptomatic bacteriuria, along with increased surveillance efforts.
Real-time data surveillance systems allow tracking of every patient with indwelling catheters and provides staff the information needed to monitor them. Daily rounding, along with the completion of an audit tool by clinical staff supervisors, has helped hardwire the process. Shared daily communication has contributed to a sense of team and accomplishment.
Cumulatively, these efforts and the great patient advocacy from bedside nurses have contributed to the reduction of CAUTI facility-wide. Continuing their efforts, the team is exploring alternatives to indwelling urinary catheters, providing reiterative trainings, reinforcing RNs as patient safety advocates, and showcasing results with up-to-date data. Bedside nursing’s commitment to improving care at ANMC, team engagement with bi-weekly CAUTI team review, bi-directional communication (resulting from the daily audit tool), and the use of real-time data (allowing teams to see the results of their efforts by unit and location) have been key to the success. Great work ANMC!