North Carolina’s CaroMont Regional Medical Center Uses AHRQ Toolkit to Reduce Urinary Infections

Patient Safety

March 2016

CaroMont Regional Medical Center (CRMC), a 435-bed, not-for-profit hospital in Gastonia, North Carolina, significantly reduced catheter-associated urinary tract infections (CAUTI) after training staff with an AHRQ patient safety toolkit.

The Toolkit for Reducing CAUTI in Hospitals, used by facilities that have adopted AHRQ's Comprehensive Unit-based Safety Program (CUSP), helps hospitals prevent CAUTI by promoting teamwork and focusing on patient safety. It also promotes the judicious use of catheters, urine cultures, and antibiotics while encouraging best practices for catheter insertion, maintenance, and removal.

According to CRMC Infection Prevention Director Vicki Allen, M.S.N., R.N., the hospital had 87 CAUTI events in 100,272 patient days during 2009, before any elements of the CAUTI toolkit were introduced. "After focused efforts in 2010, CAUTIs dropped to 31 events in 96,299 patient days and rose slightly to 35 events in 97,533 patient days during 2011," she said.

The hospital's CAUTI rate has continued to decline. In 2015, there were just 9 CAUTIs identified in 93,453 patient days. Ms. Allen reported that both the CAUTI rate and the catheter utilization rate have seen a steady decline since focused improvement efforts began.

According to the Centers for Disease Control and Prevention, approximately 75 percent of CAUTIs are associated with an indwelling (inside the body) urinary catheter. Also called a Foley catheter, this is a tube inserted into the bladder through the urethra to drain urine.

At CRMC, Infection Preventionist Joan Merrill, R.N., has been providing updates for about a year to management staff about their unit's catheter use to support CAUTI prevention efforts. Every day, Ms. Merrill sends managers and directors a list that identifies patients who have catheters in place and the nurses caring for them. The management staff attends rounds with the nurses and speaks with them individually to discuss removal of catheters.

CRMC patients with indwelling catheters are also discussed during safety rounds and daily huddles, where alternatives are sought to decrease catheter use. In addition, drill-down exercises (repetitious exercises for teaching and perfecting a skill or procedure) are conducted with key unit personnel when CAUTIs are identified. Efforts are also made to raise general awareness about the need to remove catheters as soon as possible.

All the team efforts to improve patient safety—the daily rounding, emails, huddles, nurse-driven protocol for automatic stop standing orders, and Foley insertion criteria—have resulted in better quality care for CaroMont's patients.

The Infection Prevention Team reported that most CAUTIs found in 2015 were identified in the 84-bed critical care units. Infections are rare in the 218-bed medical/surgical units.

Among the sicker patients in the critical care units, the challenge has been identifying patients who really need a Foley catheter and whether they meet the criteria for continued use, Ms. Allen said. This challenge has led to searching for alternatives, such as super-absorbent pads that can provide protection for patients and prevent skin breakdown, as well as catheter-related problems.

"The very sick patients are more likely to have a catheter in place. Unfortunately, they are also more likely to get an infection, so it is imperative that a solution is found for each and every patient," Ms. Merrill noted.

The chart below quantifies CRMC's successes in reducing CAUTIs over a seven-year period beginning in 2009.

Year	Catheter Utilization Rate	Number of CAUTIs Identified	CAUTI Rate Per 1,000 Patient Catheter Days
2009	0.33	87	3.7
2010	0.26	31	1.6
2011	0.22	35	1.9
2012	0.21	26	1.3
2013	0.22	25	1.1
2014	0.20	23	1.2
2015*	0.19	9	0.5

* CAUTI reporting changed in 2015; yeast infections were no longer required to be included.

Impact Case Study Identifier:

2016-01

AHRQ Product(s): Comprehensive Unit-based Safety Program

Topics(s): Patient Safety, Quality

Geographic Location: North Carolina

Implementer: CaroMont Regional Medical Center

Date: 03/17/2016

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Page last reviewed March 2016

Internet Citation: North Carolina’s CaroMont Regional Medical Center Uses AHRQ Toolkit to Reduce Urinary Infections. March 2016. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/policymakers/case-studies/201601.html