AHRQ Toolkit Helped NorthShore Health Track Data to Keep Infection Rates Low

Chicago’s NorthShore University Health System was on a mission to maintain low rates of catheter-associated urinary tract infections (CAUTI). Then NorthShore infection preventionist Mona Shah, M.P.H., C.I.C., learned of AHRQ’s Toolkit for Reducing CAUTI in Hospitals from an email from the Association for Professionals in Infection Control and Epidemiology (APIC), a stakeholder group that was co-promoting the CAUTI resources with AHRQ.

Shah combed through the toolkit and seized on the device risk checklist as a tool that could provide immediate value to NorthShore’s CAUTI prevention efforts.

One way Shah had been working to address CAUTI was by reducing the use of indwelling urinary catheters in the first place. Shah reviewed urine culture orders and canceled orders for catheters that did not meet criteria requiring the use of one. “By eliminating a number of unnecessary catheters, we had already seen a major decrease in the number of CAUTI cases,” Shah said, noting that CAUTI cases had dropped from 43 in 2012 to 7 in 2015.

Now the goal was to keep the infection rate low. Shah saw an opportunity to customize the AHRQ toolkit’s device risk checklist to account for a number of variables that could identify patterns that led to CAUTIs in patients who needed a catheter. The modified checklist, consisting of 46 data measures for each patient, allows Shah to keep track of all relevant data in a central location.

“I love that document. It gives me all the variables in one place, and in many cases allows me to determine whether a CAUTI could be preventable,” Shah said.

NorthShore’s modified checklist contains four sections of color-coded data:

• Demographics: This section has personal information, such as the patient’s age and sex, along with data on hospital locations and event dates. This allows Shah not only to determine whether certain types of patients are at a higher risk for CAUTI, but also to identify referring clinics that may require additional scrutiny or training.
• Information on indwelling urinary catheters: Here, Shah can identify whether the use of an indwelling catheter is considered appropriate and consider whether an infection may have occurred due to insertion practice. This section also tracks how long the catheter was used and physical attributes of the catheter itself, including kinks, loops, and how it was secured. By identifying specific personnel, along with any mistakes that increase the risk of CAUTI, Shah can focus education efforts on staff or departments that may need additional training.
• Specifics about the urine culture: The reason for the culture, ordering physician, and a variety of symptom data are collected, which Shah uses to determine whether the ordering of the culture met requisite criteria.
• Potential pre-contamination risks: Everything from prior incontinence, antibiotic use, and basic hand hygiene of the unit in question are recorded. In cases where other procedures are done correctly, this may identify the possibility that a urinary infection was present before the catheter was inserted.

The modified checklist has helped Shah to identify perineal care—or peri-care—as an area where daily care and maintenance practices could be improved.

“The AHRQ checklist has facilitated the improvement of peri-care practices. We learned that wipes are regarded as a highly safe and effective alternative to the standard perineal care method of soap and water,” Shah said. This focused attention has been effective in continuing to prevent infection, she noted, explaining that CAUTI cases dropped further to just six cases in 2016.