A Multifaceted Nursing Process to Reduce Catheter-Associated Urinary Tract Infections in a Medical Intensive Care Unit in the Era of COVID-19

Background: The catheter-associated urinary tract infection (CAUTI) rate started to rise in October 2020 in our medical intensive care unit (ICU) during the early months of COVID-19 pandemic. A multidisciplinary taskforce therefore took the initiative in developing the CAUTI reduction process.

Methods: In this quality improvement initiative, the effectiveness of the CAUTI reduction process was examined retrospectively during the 25-month period from October 2020 to October 2022 in the medical ICU. The processes utilized a multifaceted approach, incorporating nurse-driven protocol for the removal of indwelling urinary catheters (IUCs). The urinary catheter device utilization ratios (DURs) and CAUTI rates from pre-intervention and post-intervention were monitored and compared.

Results: The DUR decreased significantly from 0.59 in the pre-intervention period to 0.39 in the post-intervention phase 1 (33.9% reduction, P =.002). The significant reduction continued through the post-intervention phase 2. In association with decline in DUR, the CAUTI rates reduced significantly from 3.14 in the pre-intervention period to 0.57 CAUTI per 1,000 catheter days in the post-intervention phase 2 (81.8% reduction, P =.029).

Conclusions: The CAUTI reduction process effectively decreased the DURs, and in turn, the CAUTI rates. Our effort highlights the success achieved through sustained multidisciplinary team participation.