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

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.

Foley catheter with noble metal alloy coating for preventing catheter-associated urinary tract infections: a large, multi-center clinical trial

“…A recent systematic review and meta-analysis by Schreiber et al [28] reported that HAI reductions of 35-55% can be achieved with multifaceted interventions. In one study, the implementation of multiple measures for preventing CAUTI ("5-S CAUTI bundle", an approach that included education, catheter stabilization, correct positioning of the collection bag and daily evaluation) resulted in a statistically significant 80% reduction in CAUTI rate [29]. This is in the same range as the reduction achieved in the present study with the NMA-coated BIP Foley Catheter (69%).…”

Catheter-Associated Urinary Tract Infections among Trauma Patients: Poor Quality of Care or Marker of Effective Rescue?

“…To our knowledge, this is the first study to evaluate clinical outcomes in a national cohort of trauma patients with CAUTI since the CDC CAUTI surveillance definition change in January 2015 [6]. Several other studies have evaluated CAUTIs among trauma patients [8,9,[15][16][17][18]; however, only one study employed the current CDC surveillance definition for CAUTI [9]. The incidence of CAUTI observed in our study was 0.7%, which is similar to the rate of 0.3%-1.3% observed by Elkbuli et al [9] over a previous 4 years.…”

“…As a result, CAUTIs pose a significant burden on the healthcare system, and considerable effort has been put forth to reduce the CAUTI rates. Multiple studies have focused on reducing the rate of CAUTIs by decreasing catheter use, employing ''care bundles,'' and changing culturing practices [8][9][10][11][12]. These efforts have resulted in decreased catheter days, but the overall rate of CAUTI has remained similar [2,8,13,14].…”

“…The CAUTIs also pose a significant burden on patients. In general medical and surgical patients, CAUTI can lead to other complications, such as sepsis, bacteremia, and upper urinary tract infections, and result in an increased hospital length of stay (LOS), costs, and death [3,4,9]. Although the impact of CAUTIs on clinical outcomes in general is known, little data exist evaluating the impact of these infections in trauma patients, who are high risk for development of a CAUTI because of mobility restrictions, complex abdominal and pelvic injuries, and prolonged, and often multiple, procedures [15,16].…”

Management of blunt intraperitoneal bladder rupture: Case report and literature review

“…Antibiotic prophylaxis can reduce the incidence of CAUTI’s throughout the duration of an indwelling catheter [21], but further precautions are necessary. Nursing education for proper bladder bag placement and twice-daily perineal care reduces CAUTI’s as much as 70% in trauma patients [22]. On discharge, patients are instructed to continue these measures until one-week outpatient follow up.…”