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Tampa General Hospital staff participated in an ����APPproject and implemented several elements from AHRQ’s Comprehensive Unit-based Safety Program (CUSP) to reduce healthcare-associated infection rates. As a result, the 1,010-bed hospital reduced its indwelling urinary catheter utilization ratio by 23 percent among patients in its emergency department (ED). It also decreased the number of insertion-related catheter-associated urinary tract infections (CAUTI) attributed to the ED by 75 percent.

The CAUTI rate in the ED went from 6.9 infections per 1,000 catheters inserted to 1.7 per 1,000 in 18 months. Insertion-related CAUTI was considered any CAUTI occurring within 7 days of insertion of an indwelling urinary catheter; utilization ratio was based on the number of urinary catheters inserted per 1,000 ED visits.  

The effort to further reduce the hospital’s CAUTI rates started after an analysis revealed that a high volume of potentially unnecessary indwelling urinary catheters was being inserted in the ED. To address this, the hospital leadership agreed to participate in an AHRQ-funded project to reduce CAUTI in hospitals.

“It was great to see the ED leadership engaged in this project. They really wanted to make a change in their department to help reduce CAUTI within the hospital,” said Chaz Rhone, M.P.H., infection preventionist at Tampa General. Rhone is certified in infection control.

According to Rhone, the Assemble the Team video from the Core CUSP toolkit was particularly useful. It helped the hospital build a multidisciplinary team with clearly assigned responsibilities. The hospital team included ED leadership, the infection prevention department, nursing clinical quality staff, and research specialists, all working to reduce ED “insertion-related” CAUTIs. The “4 E's” method (engage, educate, execute, evaluate) served as a framework to engage everyone on the team during the CAUTI intervention rollout. 

The tools also helped spur staff engagement and led them to hardwire changes that could be sustained over time, Rhone said. The technical interventions provided information about proper catheter insertion and maintenance. “A great deal of this information was included in staff education,” Rhone noted. The CUSP method helps teams improve care by combining technical changes with adaptive changes that address attitudes, behaviors, and the organization’s culture of safety. 

The hospital team also designed an intervention that required two licensed personnel for inserting all urinary catheters in the ED. A safety time-out—a pause before inserting the indwelling urinary catheter—was included in the process to confirm catheter appropriateness and review insertion procedures.

“In speaking with staff, we learned they felt that having two staff members present for all insertions kept them accountable. It was also useful to have an extra hand, if needed,” said Yonatan “Ty” Breiter, M.S.N., clinical nurse leader and specialist for ED and psychiatric services.

Tampa General leadership found that using the ����APPtools to reduce CAUTI had a positive impact on the care patients received. The tools offered clear guidance for staff to implement interventions that helped change the culture of the hospital and reinforced the process for technical interventions.

“Using both socioadaptive and technical interventions together is an effective method that helps sustain the interventions,” Breiter added.