AHRQ patient safety toolkit helps reduce catheter-associated infections


The Agency for Healthcare Research and Quality (AHRQ) has released a new toolkit to help hospitals prevent catheter-associated urinary tract infections (CAUTIs).

CAUTIs are healthcare-associated infections (HAIs) that cause suffering for approximately 250,000 hospital patients each year at a cost of about $250 million.

The new Toolkit for Reducing CAUTI in Hospitals was developed as part of a four year AHRQ project launched in 2011 to promote the use of the Comprehensive Unit-based Safety Program (CUSP).

Preliminary results indicate that CAUTI rates were reduced by approximately 15 percent. CUSP also has been proven to reduce other HAIs such as central line-associated bloodstream infections.

"This toolkit is a significant medical and public health advance that will prevent suffering for many patients and reduce the need for them to take antibiotics," said AHRQ director Dr Richard Kronick. "The CUSP toolkit is particularly important given that providers nationwide have been struggling to reduce CAUTIs in recent years."

The new toolkit helps hospitals apply the CUSP principles to prevent CAUTI in patients and improve safety culture at the unit level.

The toolkit is the latest in a series of AHRQ tools and training materials that help frontline providers go beyond the "what" of improving care to actually show them "how" to make changes in workflow processes to keep patients safer. 

CUSP is a customizable program that combines clinical best practices with an understanding of the science of safety, improved safety culture, and an increased focus on teamwork. It was developed by Johns Hopkins researchers with AHRQ funding and used to significantly reduce central line-associated bloodstream infections in ICUs before being applied to CAUTI in this project.

The new toolkit builds on the framework of the core CUSP Toolkit to help ensure that hospital teams adhere to guidelines from the Centers for Disease Control and Prevention (CDC) that call for urinary catheters to be removed as soon as possible or no later than 24 hours if the patient is mobile.

It includes checklists and modifiable teaching tools and resources to help clinical teams specifically address questions about whether catheters need to be used, and, if so, to place them safely and to remove them before patients develop infections. It also includes special resources for resident physicians and nurses in intensive care units (ICUs) and emergency departments.

The toolkit was developed based on the experiences of more than 1,200 hospitals in 42 States, Puerto Rico, and the District of Columbia that successfully reduced CAUTI while participating in AHRQ's nationwide project.

"We used this toolkit to take a fresh look at our entire approach to the use of catheters," said Cheryl Davis, senior nurse epidemiologist in the infection prevention department of Saint Luke's Hospital, Kansas City, MO. "Not only have we reduced CAUTI rates, but we've also reduced catheter use overall, which makes patients significantly safer and more comfortable."

A team at INTEGRIS Baptist Medical Center, Oklahoma City, OK, also used the toolkit to improve patient safety.

"This toolkit was essential to our efforts to reduce CAUTI rates across our hospital," said Derek Biggs, a bedside ICU nurse at the facility. "We dramatically reduced our CAUTI rates, and, just as importantly, we've been able to keep those rates down."

Agency for Healthcare Research and Quality, Dr Richard Kronick, US