Reduction of nosocomial catheter-associated urinary tract infection (CAUTI) in a U.S. Southeastern teaching facility with an all-silicone silver Foley catheter

BACKGROUND: In this 600-plus-bed teaching hospital with multiple services, catheter-associated urinary tract infections (CAUTIs) was measured in the ICU only. A hospital-wide algorithm has been in place to assist healthcare workers in discontinuing Foley catheters. The rate of CAUTI infection in other units was unknown at the time the study was initiated. The catheter in use was an uncoated latex Foley. The epidemiology department sought to determine the rate of CAUTI hospital-wide and to make interventions to lower the hospital-wide CAUTI rate by introducing an all-silicone silver Foley catheter. The economic impact was also measured. METHODS: A retrospective review was done of all adult inpatients with an indwelling Foley catheter and a positive urine culture >105 cfus collected at least 72 hours post catheterization. The Centers for Disease Control and Prevention (CDC) definitions for nosocomial UTI were used to determine infection. Data were collected during a baseline period of May–July 2003, and a trial period of June–October 2004. The average cost to treat CAUTI at the hospital was determined through a review of patient charges and estimated at $2200. The additional cost of the all-silicone silver Foley catheter was considered. RESULTS: During the baseline period, there were 39 CAUTIs in 23,738 risk-adjusted patient days (1.6 CAUTIs/1000 risk-adjusted patient days). During the trial period, the incidence of CAUTI was reduced to 13 CAUTIs in 37,933 risk-adjusted patient days (0.39 CAUTI/1000 risk-adjusted patient days). A 73.8% reduction in CAUTI incidence was evident. CONCLUSIONS: A 73.8% reduction in nosocomial CAUTI represents a significant improvement in patient safety. In addition, the economic savings of $229,000 in direct patient care costs is significant to the organization. Another added benefit is the replacement of a latex Foley catheter with the all-silicone Foley catheter, thereby reducing the potential of latex sensitivity in both patients and staff. Further study and evaluation of the Foley catheter at the hospital is warranted.