Successful strategy to decrease indwelling catheter utilization rates in an academic medical intensive care unit


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Abstract

HighlightsMultidisciplinary team approach reduces indwelling urinary catheter utilization ratio in a complex intensive care unit environment.Education of the health care providers and strict criteria to define appropriate indications for the use of indwelling urinary catheters in the intensive care unit are necessary to decrease the catheter-associated urinary tract infection rate.Decreasing the indwelling urinary catheter utilization ratio is one of the most important determining factors to decrease the catheter-associated urinary tract infection rate.Implementation of this kind of approach can decrease the incidence of catheter-associated urinary tract infection.Background:Duration of indwelling urinary catheterization is an important risk factor for urinary tract infections. We devised a strategy to decrease the utilization of indwelling urinary catheters (IUCs). We also highlight the challenges of managing critically ill patients without IUCs and demonstrate some of the initiatives that we undertook to overcome these challenges.Methods:A retrospective observational outcomes review was performed in an adult medical intensive care unit (ICU) between January 2012 and December 2016. This period included a baseline and series of intervals, whereby different aspects of the strategies were implemented. IUC utilization ratio and catheter-associated urinary tract infection (CAUTI) rates were calculated.Results:Our IUC utilization ratio had a statistically significant decrease from 0.92 (baseline) to 0.28 (after 3 interventions) (P < .0001). Similarly, CAUTI rates had a statistically significant decrease from 5.47 (baseline) to 1.08 (after 3 intervention) (P = .0134). These rates sustained a statistically significant difference over the 2-year follow-up period from the last intervention. Incontinence-associated dermatitis (IAD) was identified as a potential complication of not using an IUC. There was no statistically significant change in the IAD rates during 2013-2016.Conclusions:Our interventions demonstrated that aggressive and comprehensive IUC restriction protocol and provider training can lead to a successful decrease in IUC use, leading to a lower IUC utilization ratio and CAUTI rate in a large complex academic ICU setting.

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