Targeting Catheter-Associated Urinary Tract Infections in a Trauma Population: A 5-S Bundle Preventive Approach

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Abstract

Complications from catheter-associated urinary tract infections (CAUTIs) can cause morbidity and mortality. Our institution's Trauma Quality and Improvement Program analysis identified CAUTIs as an outlier complication in our trauma population. This study aimed to determine whether implemented measures would reduce CAUTI rates in trauma population. A 5-S CAUTI bundle was implemented. Its effects were measured on a prospectively collected dataset of adult trauma patients using our Trauma Registry during the 4-year study period. Implemented measures included (1) staff education, (2) bladder catheter stabilization, (3) patient and caregiver education, (4) keeping the collection bag below the bladder and above the floor, and (5) daily evaluations for discontinuation. Chi-squared and t-test analyses were used with significance defined as p < .05. Twelve thousand nine hundred and sixty-two trauma patients were admitted to trauma service during the 4-year study period. Of these, 94 developed CAUTIs, with an average age of 67 years and 56% were females. The average injury severity score was 16 in patients with CAUTIs compared with 9 in non-CAUTI patients (p < .0002). In the index year, CAUTIs occurred in 41 out of 3,054 (1.34%), the following year there were 34 out of 3,455 (0.98%), in 2016 there were 11 out of 3,246 (0.33%), and 8 out of 3,207 (0.25%) in 2017 (p < .001). Results demonstrated an 80% reduction in CAUTI rate. Execution of the 5-S CAUTI bundle resulted in a significant 80% reduction in CAUTI rate in our trauma population.

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