A cluster of catheterized urinary isolates associated with opening the closed system of urinary drainage: Identification, investigation, and correction

BACKGROUND: This 586-bed acute care facility in Birmingham, Alabama, was alerted to a significant increase in hospital-associated catheterized urine isolates from June through July 2004. OBJECTIVES: Identify processes putting patients at risk, correct process breakdowns, and share information for future prevention with other clinical staff. METHODS: Data-mining services are provided to the medical center. Monthly reports are generated to detect unsuspected patterns of infection within the hospital and community. In July 2004, infection control (IC) received an alert describing a 700% increase (p=0.013) in patients with non-duplicate hospital-associated catheterized urine isolates from patients in the surgical intensive care unit (SICU). In addition to data-mining, the IC department maintains traditional surveillance for device-related infections. An increase in urinary tract infection (UTI) rates corresponded to the pattern reported by the data-mining service. Upon IC investigation it was discovered that during a recent product conversion, the surgical packs did not include urometer trays. The SICU nurses were breaking open the closed system to add urometers. During the investigation into this cluster, it was discovered that the patients on the rehabilitation unit were also experiencing an unacceptably high incidence of UTIs. The rehabilitation staff routinely disconnected the urinary drainage tubing to utilize leg bags. RESULTS: Interventions included adding drainage bags with urometer trays to the standard surgical packs. Education was provided to the SICU staff about the importance of maintaining a closed system. Education was also provided for the rehabilitation staff. Emphasis was placed on the importance of maintaining closed systems and hand hygiene. After the intervention, periodic feedback on the occurrence of positive urine isolates and UTI rates was provided to the unit director to share with the staff. CONCLUSION: Investigation of a cluster of hospital urinary isolates revealed previously unsuspected practices in additional hospital units. Interventions reduced or eliminated the incidence of UTIs in both areas.