CAUTIs are “Catheter Associated Urinary Tract Infections.” Urinary catheters are tubes placed in some patients’ bladders to help them void urine and to monitor urine output. They are often referred to as “Foley catheters”. While such catheters are extremely valuable, the catheters can introduce germs into the urinary tract and lead to urinary tract infections, which can spread further into the bloodstream. Bloodstream infections can be very serious and even lead to death. Medical researchers developed a “bundle” of best practices and checklist for use during the insertion and maintenance of urinary tract catheters that can reduce CAUTIs. Tracking such infections in hospitals is beneficial to encourage the adoption of best practices for urinary catheter care, and to evaluate its effect.

The Standardized Infection Ratio (SIR) is the primary measure used to track healthcare associated infections by the Connecticut Department of Public Health. The ratio is the number of actual infections that occur in a given time (called the baseline period) divided by the number predicted. The baseline is 1.0, which means that the number of infections observed is the same as the number predicted. If the SIR is greater than 1.0, it indicates that more HAIs were observed than predicted; conversely, an SIR less than 1.0 indicates that fewer HAIs were observed than predicted. As the aim is to reduce CAUTIs, we aim to reduce the SIR below 1 (the lower, the better).

The SIR for CAUTIs started high, but the curve decreased from 2012 to 2013, suggesting that prevention programs in hospitals are having an effect. In 2014, Connecticut and the nation expanded tracking of CAUTIs to include patients housed on acute care hospital, not just those in ICUs. There are many patients in ward settings who need urinary catheters for longer term treatment, and who may be at risk for infections, such as cancer patients. Keeping urinary catheters free of germs in the ward setting, where patient can walk around, is challenging.  Despite this, the SIR decreases suggest that prevention actions in hospitals were making a difference. In 2015, the definition of a CAUTI was changed to better reflect true infections that pose a risk to patients. This change in definition dropped the SIR substantially, from 1.57 in 2014 to 0.62 in 2015.

Since 2016, Connecticut has been tracking CAUTIs using the national baseline that was reset in 2015. As expected, this re-baseling increased the SIR close to 1.0 nationally in 2016. In 2019, the SIR for CAUTI was 0.63, a decrease from 2018 (SIR 0.93), indicating that acute case hospitals' prevention efforts are reducing CAUTIs. 

Hospital medical and non-medical staff, especially infection prevention and control staff (infection preventionists and hospital epidemiologists). Connecticut Hospital Association. Qualidigm, the Connecticut CMS Quality Improvement Organization (QIO). The Connecticut Healthcare Associated Infections Advisory Committee. The Connecticut Chapter of the Infectious Diseases Society of America (CIDS). Centers for Disease Control and Prevention, Division of Healthcare Quality and Prevention. National Healthcare Safety Network. Council of State and Territorial Epidemiologists. The Association of Professionals in Infection Control, Inc. The Society for Healthcare Epidemiology in America. Connecticut Department of Public Health.  

To implement the “bundle”, healthcare facilities must track use of the best practices, and ensure that all staff involved in the insertion and maintenance of urinary catheters rigorously adhere to the protocols, despite the many competing priorities they address every day to care for patients. Dr. Peter Provonost and colleagues at Johns Hopkins University developed the “Comprehensive Unit-based Safety Program (CUSP).” This program can be adopted by healthcare facilities to ensure the routine use of the urinary tract bundle and checklist.  By doing so, changes in the culture of the organizations, and changes in logistics to support and maintain use of these best practices. The ultimate goal is preventing CAUTIs with the aim of eliminating them. The CUSP programs are developed and delivered in the overall infection control and prevention program of each healthcare facility.  

Facilities have adopted the best practices after many participated in the CUSP programs. We will continue to monitor the CAUTI SIR, to assess the effectiveness of this intervention.