A multifaceted nursing process to reduce catheter-associated urinary tract infections in a medical intensive care unit in the era of COVID-19

Abstract

Background

The catheter-associated urinary tract infection (CAUTI) rate started to rise in October 2020 in our medical intensive care unit during the early months of coronavirus disease 2019 (COVID-19) pandemic. A multidisciplinary taskforce, therefore, took the initiative in developing the CAUTI reduction process.

Methods

In this quality improvement initiative, the effectiveness of the CAUTI reduction process was examined retrospectively during the 25-month period from October 2020 to October 2022 in the medical intensive care unit. The processes utilized a multifaceted approach, incorporating nurse-driven protocol for the removal of indwelling urinary catheters. The urinary catheter device utilization ratios (DURs) and CAUTI rates from preintervention and postintervention were monitored and compared.

Results

The DUR decreased significantly from 0.59 in the preintervention period to 0.39 in the postintervention phase 1 (33.9% reduction, P = .002). The significant reduction continued through the postintervention phase 2. In association with decline in DUR, the CAUTI rates reduced significantly from 3.14 in the preintervention period to 0.57 CAUTI per 1,000 catheter days in the postintervention phase 2 (81.8% reduction, P = .029).

Conclusions

The CAUTI reduction process effectively decreased the DURs, and in turn, the CAUTI rates. Our effort highlights the success achieved through sustained multidisciplinary team participation.