Can we really make cauti a never event? a level 1 trauma center's experience with prophylactic antibiotic bladder irrigation

Hospital-acquired catheter associated urinary tract infections (CAUTI) are considered "never events" and are reportable to CMS as a quality indicator. Despite protocols to determine appropriate removal of urinary catheters as soon as possible, severely injured trauma patients often require prolonged catheterization during ongoing resuscitation or develop retention requiring catheter replacement, exposing them to risk for CAUTI. We evaluated whether prophylactic antibiotic bladder irrigation reduces the incidence of CAUTI in critically ill trauma patients.As a quality initiative, gentamicin bladder catheter irrigation (GBCI) was performed on a level 1 trauma center's patients at risk for CAUTI in 2021, defined by indwelling foley catheterization for a minimum of three days. We then conducted a retrospective study using a comparison cohort of 2020 admissions as the control group. CAUTI rates per 1000 catheterized days were compared between these two groups. Patients with traumatic bladder injuries were excluded.Our cohort included 342 patients with median hospitalization of 11 (7-17) days, ISS 17 (10-26), and days catheterized 6 (4-11). 86 patients, catheterized for 939 at-risk days, received twice-daily GBCI compared with 256, catheterized for 2114 at-risk days, who did not. Zero patients in the GBCI group versus nine patients in the control group developed CAUTI. The incidence of CAUTI in the GBCI group was significantly less than in the control group (0/1000 versus 4.3/1000 catheterized days, P = 0.018).Prophylactic antibiotic bladder irrigation was associated with a zero incidence of CAUTI among trauma patients at risk for CAUTI. This practice holds promise as effective infection prophylaxis for such patients. The optimal duration and frequency of irrigation remains to be determined.Therapeutic/care management, level IV.