• Am J Infect Control · Dec 2017

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

    • Sushilkumar Satish Gupta, Pavan Kumar Irukulla, Mangalore Amith Shenoy, Vimbai Nyemba, Diana Yacoub, and Yizhak Kupfer.
    • Department of Pulmonary Medicine and Critical Care, Maimonides Medical Center, Brooklyn, NY. Electronic address: sugupta@maimonidesmed.org.
    • Am J Infect Control. 2017 Dec 1; 45 (12): 1349-1355.

    BackgroundDuration 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.MethodsA 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.ResultsOur 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.ConclusionsOur 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.Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

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