Reducing catheter-associated urinary tract infections in a large health system: a quality improvement approach using a fractal management system
Abstract Objective: Although preventable through established infection control practices, catheter-associated urinary tract infections (CAUTIs) remain prevalent in acute-care settings. Our goal was to improve the CAUTI rates through multiple hospitals through implementing sustainable practices, in...
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2024-01-01
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| Series: | Antimicrobial Stewardship & Healthcare Epidemiology |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2732494X24003863/type/journal_article |
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| _version_ | 1841526533953421312 |
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| author | Elie A. Saade Esther J. Thatcher Tina Lewis Susan Carr Marcia Cornell Rachel Arnold Lisa Bushong Zainab Albar Peter Pronovost |
| author_facet | Elie A. Saade Esther J. Thatcher Tina Lewis Susan Carr Marcia Cornell Rachel Arnold Lisa Bushong Zainab Albar Peter Pronovost |
| author_sort | Elie A. Saade |
| collection | DOAJ |
| description |
Abstract
Objective:
Although preventable through established infection control practices, catheter-associated urinary tract infections (CAUTIs) remain prevalent in acute-care settings. Our goal was to improve the CAUTI rates through multiple hospitals through implementing sustainable practices, including enhancing communication, provider engagement, accountability, and transparency in reporting to achieve long-term improvements.
Design:
Quality improvement with multiple levels of interventions
Setting:
A health system in northern Ohio with 21 affiliated hospitals across 16 counties.
Patients:
Adult patients admitted to the hospital between June 2020 and June 2023.
Methods:
A broad set of quality improvement (QI) strategies was developed by an interdisciplinary team and guided by the Fractal Management System framework to ensure accountability, communication, and alignment across teams and facilities. Key drivers were indwelling urinary catheter (IUC) alternatives, insertion, maintenance, removal, and smart diagnostics. The main outcome measures were standardized infection ratios (SIR) and standardized utilization ratio (SUR), comparing period 1 (P1, June 2020 to December 2021) and period 2 (P2, January 2022 to June 2023).
Results:
Enhanced communication and management played crucial roles in minimizing IUC placement. Updated policies and protocols, coupled with clear guidelines and decision support tools, facilitated effective urinary management. Performance tracking and visual management boards provided real-time insights, while collaborative efforts, including staff huddles and multidisciplinary teamwork, ensured consistent adherence to best practices.
Conclusions:
A systemwide QI initiative focused on enhanced communication, management, and collaboration contributed to improved SIR and reduced CAUTI rates across multiple hospitals, highlighting the impact of strong communication and proactive management in healthcare settings.
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| format | Article |
| id | doaj-art-e0742fa967cd48a98c681f42e9c0036c |
| institution | Kabale University |
| issn | 2732-494X |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Antimicrobial Stewardship & Healthcare Epidemiology |
| spelling | doaj-art-e0742fa967cd48a98c681f42e9c0036c2025-01-16T21:46:47ZengCambridge University PressAntimicrobial Stewardship & Healthcare Epidemiology2732-494X2024-01-01410.1017/ash.2024.386Reducing catheter-associated urinary tract infections in a large health system: a quality improvement approach using a fractal management systemElie A. Saade0https://orcid.org/0000-0002-2514-3820Esther J. Thatcher1https://orcid.org/0000-0002-3195-2894Tina Lewis2Susan Carr3https://orcid.org/0009-0009-5414-7036Marcia Cornell4https://orcid.org/0009-0002-7174-0420Rachel Arnold5Lisa Bushong6Zainab Albar7https://orcid.org/0000-0002-2685-7382Peter Pronovost8https://orcid.org/0000-0002-9740-3775Case Western Reserve University School of Medicine, Cleveland, OH, USA Division of Infectious Diseases and HIV Medicine, Department of Internal Medicine, University Hospitals, Cleveland, OH, USA Quality Institute, University Hospitals, Cleveland, OH, USAPopulation Health, University Hospitals, Cleveland, OH, USAQuality Institute, University Hospitals, Cleveland, OH, USAQuality Institute, University Hospitals, Cleveland, OH, USAGeauga Medical Center, University Hospitals, Chardon, OH, USA Kent State University College of Nursing, Kent, OH, USAQuality Institute, University Hospitals, Cleveland, OH, USAQuality Institute, University Hospitals, Cleveland, OH, USACase Western Reserve University School of Medicine, Cleveland, OH, USA Division of Infectious Diseases and HIV Medicine, Department of Internal Medicine, University Hospitals, Cleveland, OH, USACase Western Reserve University School of Medicine, Cleveland, OH, USA Chief Quality and Clinical Transformation, University Hospitals, Cleveland, OH, USA Frances Payne Bolton School of Nursing and Weatherhead School of Management, Case Western Reserve University, Cleveland, OH, USA Abstract Objective: Although preventable through established infection control practices, catheter-associated urinary tract infections (CAUTIs) remain prevalent in acute-care settings. Our goal was to improve the CAUTI rates through multiple hospitals through implementing sustainable practices, including enhancing communication, provider engagement, accountability, and transparency in reporting to achieve long-term improvements. Design: Quality improvement with multiple levels of interventions Setting: A health system in northern Ohio with 21 affiliated hospitals across 16 counties. Patients: Adult patients admitted to the hospital between June 2020 and June 2023. Methods: A broad set of quality improvement (QI) strategies was developed by an interdisciplinary team and guided by the Fractal Management System framework to ensure accountability, communication, and alignment across teams and facilities. Key drivers were indwelling urinary catheter (IUC) alternatives, insertion, maintenance, removal, and smart diagnostics. The main outcome measures were standardized infection ratios (SIR) and standardized utilization ratio (SUR), comparing period 1 (P1, June 2020 to December 2021) and period 2 (P2, January 2022 to June 2023). Results: Enhanced communication and management played crucial roles in minimizing IUC placement. Updated policies and protocols, coupled with clear guidelines and decision support tools, facilitated effective urinary management. Performance tracking and visual management boards provided real-time insights, while collaborative efforts, including staff huddles and multidisciplinary teamwork, ensured consistent adherence to best practices. Conclusions: A systemwide QI initiative focused on enhanced communication, management, and collaboration contributed to improved SIR and reduced CAUTI rates across multiple hospitals, highlighting the impact of strong communication and proactive management in healthcare settings. https://www.cambridge.org/core/product/identifier/S2732494X24003863/type/journal_article |
| spellingShingle | Elie A. Saade Esther J. Thatcher Tina Lewis Susan Carr Marcia Cornell Rachel Arnold Lisa Bushong Zainab Albar Peter Pronovost Reducing catheter-associated urinary tract infections in a large health system: a quality improvement approach using a fractal management system Antimicrobial Stewardship & Healthcare Epidemiology |
| title | Reducing catheter-associated urinary tract infections in a large health system: a quality improvement approach using a fractal management system |
| title_full | Reducing catheter-associated urinary tract infections in a large health system: a quality improvement approach using a fractal management system |
| title_fullStr | Reducing catheter-associated urinary tract infections in a large health system: a quality improvement approach using a fractal management system |
| title_full_unstemmed | Reducing catheter-associated urinary tract infections in a large health system: a quality improvement approach using a fractal management system |
| title_short | Reducing catheter-associated urinary tract infections in a large health system: a quality improvement approach using a fractal management system |
| title_sort | reducing catheter associated urinary tract infections in a large health system a quality improvement approach using a fractal management system |
| url | https://www.cambridge.org/core/product/identifier/S2732494X24003863/type/journal_article |
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