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Catheter-associated urinary tract infections (CAUTI) are the most common type of health care-associated infection. As many as one-fourth of all hospital inpatients may have a short-term, indwelling urinary catheter placed during their hospital stay. A significant portion of these catheters are placed without appropriate indications. Complications associated with CAUTI result in increased length of stay, patient discomfort, excess health care costs, and sometimes mortality. An estimated 13,000 deaths are associated with CAUTI each year. However, most cases of CAUTI are preventable.

On the CUSP: Stop CAUTI aims to reduce mean rates of CAUTI in U.S. hospitals. The initiative is working with state organizations and hospitals across the country to implement the Comprehensive Unit-based Safety Program (CUSP) and CAUTI reduction practices in hospital units.

On the CUSP: Stop CAUTI is funded by the Agency for Healthcare Research and Quality (AHRQ) and is led by the Health Research and Educational Trust (HRET) of the American Hospital Association. HRET’s National Project Team consists of the Michigan Health & Hospital Association’s Keystone Center for Patient Safety & Quality (MHA Keystone), The University of Michigan Health System, St. John Hospital and Medical Center, and the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality (formerly the Johns Hopkins University Quality and Safety Research Group). The project is also working closely with the Society of Hospital Medicine (SHM), the Association for Professionals in Infection Control and Epidemiology (APIC), the Society for Healthcare Epidemiology of America (SHEA), Emergency Nurses Association (ENA), and the American College of Emergency Physicians (ACEP).

CAUTI reduction is a priority in the field. Expansions in public reporting, policies of non-payment for hospital-acquired conditions, and the emphasis of the U.S. Department of Health and Human Services (HHS) Action Plan to Prevent Healthcare-Associated Infections are all impelling factors in the fight to reduce CAUTI. The Partnership for Patients, a public-private partnership led by HHS, identified CAUTI as one of ten hospital-acquired conditions to be reduced by December 2014.

Participation of Hospital Unit Teams

On the CUSP: Stop CAUTI is helping hospital units to launch or refocus efforts to reduce CAUTI and to implement CUSP, a proven, effective culture change model. Hospital unit teams that have joined the project commit to the following activities:

  • Participation of at least one team member in content and coaching teleconferences
  • Attend state-level, in-person learning sessions
  • Comply with data collection and submission requirements
  • Learn and implement collaborative improvement tools
  • Hold monthly safety meetings to review CAUTI process and outcome data and teamwork and communication data

Participating units collect and submit the following data:

  • CAUTI readiness assessment
  • CAUTI outcome data (CAUTI rate)
  • CAUTI process data (urinary catheter prevalence and appropriateness)
  • Team Checkup Tool
  • AHRQ culture survey, the Hospital Survey on Patient Safety Culture (HSOPS), twice during the project cycle

By participating in On the CUSP: Stop CAUTI, hospital units can learn to use the CUSP framework to operationalize process improvement and expand their capacity to address unit-based safety issues. Teams also have opportunities to network and learn together with other hospitals enrolled in the project, and participants have access to expert faculty and data collection and monitoring support throughout the state’s eighteen-month participation.

The Role of State-Level Leadership

A key focus of On the CUSP: Stop CAUTI is the expansion of state-level capacity to carry out future quality and patient safety improvement projects. State leads play a critical role in helping hospital unit teams succeed in the program. State leads are also instrumental in coordinating activities among state-level organizations such as hospital associations, QIOs, and patient safety organizations. The initiative also works closely with an Extended Faculty Network, which provides support in coaching project leads and hospital teams and serves as faculty for calls, meetings, and site visits.

Preliminary Data

AHRQ, the program funder, released an interim report of data from the project in September 2013. Overall, preliminary outcome data show a 16 percent average decrease in CAUTI rates among hospital units that have participated in the program at least 14 months. Visit the report online to learn more.