Quality improvement project of a closed catheter system to reduce catheter-associated urinary tract infections during acute inpatient rehabilitation using stepped-wedge design

Abstract

Objective: To investigate if an indwelling catheter with a one-way valve (BioFlo® [BF]) reduces the incidence of catheter-associated urinary tract infections (CAUTIs). Methods: Prospective quality improvement project. Design: Stepped-wedge nursing unit enrollment in acute inpatient rehabilitation facility (IRF) was conducted over 9 months. All patients admitted to IRF that used an indwelling catheter at any time during admission were included, with all days and types of voiding methods collected when in the study period. Comparisons were between BF versus usual care (Foley catheter), with incidence of CAUTI as the primary outcome measure. Results: There were 227 patients: 21 using BF only, 146 using Foley only, and 60 using both. This resulted in 206 Foley users and 81 BF users. The BF group had a greater percentage of patients with CAUTI compared to the Foley group (30% vs. 17%, P = 0.021). Using generalized linear modeling and adjusting for confounders revealed an 89% increased risk of CAUTI in the BF group compared to the Foley group (odds ratio: 1.89, P = 0.033). Bayesian analysis determined that the probability of BF increasing the rate of CAUTI was 96% (95% credible interval: 0.95–2.7). Conclusions: Maintaining a closed catheter system with BF does not reduce the rates of CAUTIs during acute inpatient rehabilitation.

Keywords

• rehabilitation hospitals
• urinary catheterizations
• urinary tract infections