Exchanging Catheters After Initial Positive Urinalysis Improved CAUTI Rates, Study Shows

A study published in Critical Care Nurse demonstrated that “exchanging indwelling catheters after an initial positive urinalysis improved diagnostic accuracy and contributed to two consecutive quarters with no catheter-associated urinary tract infections (CAUTIs) in a step-down unit at a New York specialty hospital.” AACN has the news.

This nurse-led quality improvement initiative detailed in the study “led to a new evidence-based workflow that included replacing an indwelling catheter when a urinalysis came back positive for bacteria, nitrates, and leukocytes and then immediately collecting a urine culture from the sample port of the newly replaced urinary catheter.”

A dramatic increase in indwelling urinary catheter use and placement duration, “followed by a seven-fold increase in CAUTI rates,” was observed in 2020 when this step-down unit was converted to a popup COVID-19 ICU. A CAUTI diagnosis is made when “a urinary catheter has been in place for at least two consecutive days, and the microbiological evaluation of urine cultures reveals specific quantities of bacteria.”

Adopting the catheter exchange workflow detailed in the study “helped improve diagnostic distinction between CA-ASB and CAUTI and reduce false-positive test results, thus improving patient care and safety.” The pilot program ran over three consecutive quarters, and the full catheter exchange workflow showed promising results across all seven patients on whom it was used. Additionally, “a review of a reported CAUTI case during the pilot period revealed that the initial sample collected did not follow the new workflow and tested positive.” Implementation of the new protocol “resulted in a major reduction in the diagnosis of CAUTI, with no incidents occurring for two consecutive quarters.”