2119. Reducing Catheter-Associated Urinary Tract Infections Using an Evidence-Based Urine Culture Algorithm at an Academic Medical Center

Catheter-associated urinary tract infections (CAUTIs) are among the most common hospital-acquired infections. CAUTIs have gained attention due to public reporting and reimbursement implications. Urine cultures are often obtained for inappropriate indications, which can falsely elevate CAUTI rates. Our objective was to determine the impact of a new evidence-based urine culture algorithm on our CAUTI rates. This quality improvement project was implemented at a 1,541 bed academic medical center in New Haven, CT. Our CAUTI performance improvement (PI) team, a collaboration between nurses, infectious disease physicians and urologists developed a urine culture algorithm for catheterized patients in October 2017. This algorithm recommends directed evaluation of fever in a catheterized patient based on Infectious Disease Society of America guidelines (Figure 1). Education about appropriate culturing and catheter utilization was initiated November 2017, the algorithm was approved on December 27, 2017, and included in the electronic medical record February 2018. The incidence rates (IR) of CAUTI per 1,000 catheter days (CD), urine cultures ordered, urinary catheter days and central line-associated bloodstream infection (CLABSI) rates were compared for the quarter pre- and post-algorithm implementation. Our CAUTI IR decreased by >40% from 1.4 to 0.8 per 1,000 CD for the quarters pre- and post-algorithm implementation, respectively (Figure 2). Average monthly urine cultures ordered in catheterized patients decreased by 28% from 120 (fourth quarter, 2017) to 84 post algorithm implementation (first quarter, 2018, Figure 3). The average monthly catheter days decreased by 1.5% (4,409 days in fourth quarter, 2017 to 4,342 in first quarter, 2018). Despite the decrease in urine cultures ordered, we did not see a compensatory increase in CLABSI rates during the post implementation period. Thoughtful culturing through algorithm-directed evaluation of fever based on signs and symptoms combined with staff education about culturing and catheter utilization led to reduction in unnecessary urine culture orders and CAUTIs. Our next steps are to evaluate the impact of this algorithm on antibiotic utilization and C. difficile rates, and examine the sustainability of these interventions over time. M. Juthani-Mehta, Iterum Therapeutics: Scientific Advisor, Consulting fee.