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Sierra Vista Hospital, an 11-bed critical access hospital in Truth or Consequences, New Mexico, implemented practices from AHRQ’s Toolkit for Reducing Catheter-Associated Urinary Tract Infections (CAUTIs) in Hospitals. The result: the hospital reduced the number of indwelling urinary catheter days by more than 90 percent and has not had a recurrence of CAUTI in more than a year.

Sierra Vista is the only hospital in this rural community, which has a disproportionately high number of elderly and poor residents. In summer 2022, two patients were diagnosed with CAUTI in quick succession. This was enough to convince infection preventionist Bettina Fitzgerald, R.N., and chief nursing officer Sheila F. Adams, R.N., that they had a problem.

A quick analysis of records revealed that clinicians were inserting indwelling catheters at a rate of up to 250 patient days per month. "That's way too many," Fitzgerald said.

Fitzgerald, who recently had moved to the community, already was reviewing infection control policies when she noticed the high catheter use rate. She took the problem to Adams. "I told Bettina, 'Go to AHRQ. Everything there is going to be evidence-based,'" Adams recalled.

Fitzgerald reviewed AHRQ's Toolkit for Reducing CAUTI in Hospitals, which is based on AHRQ's Comprehensive Unit-based Safety Program. Steps from the toolkit include suggestions for appropriate catheter use; guidance for proper insertion, maintenance, and renewal; and antimicrobial stewardship. The toolkit’s summary of indications for appropriate catheter use were particularly important for Sierra Vista Hospital. Officials found that clinicians were inserting catheters for a variety of reasons, many of which were not considered clinically appropriate.

It took Fitzgerald 7 months to prepare clinicians and staff to revamp their procedures, including meeting with the hospital’s infection control committee and medical staff. In April 2023, the new policy went live. There was a little grumbling from staff accustomed to doing things “the old way,” but clinicians quickly adapted to the new approach, Adams said.

Change was immediate and the results have been sustained. The number of patient catheter days has not topped 26 per month since April 2023. Fewer catheter days means fewer opportunities for a CAUTI, and the hospital hasn’t had a recurrence of the infection since then. In many months, the total catheter days is closer to 10. Catheter utilization per 1,000 patient days fell from 0.42 in 2021 to 0.19 in 2023 and remained at 0.20 through the first half of 2024.

Appropriate catheter use has become part of the culture. "When we get new staff, we find our catheter days go up, and we send out a reminder," Adams said. "They quickly see that we’re serious about this."