(1244) Can Decreased Urinary Catheters Be Sustained in the Intensive Care Unit?

Introduction: Indwelling urinary catheter (IUC) use remains high in the surgical Intensive Care Unit (SICU) despite targeted, national efforts to decrease catheter associated urinary tract infections (CAUTI). Even when hospital-based initiatives occur, it is unclear if there are sustained decreases in utilization. In 2021, we used an implementation science approach to develop a program (DUCKI) to decrease IUCs in patients with acute kidney injury (AKI) with oliguria or end stage renal disease (ESRD). 3 years later, we evaluate the effectiveness of the DUCKI (Decreasing Urinary Catheters In Kidney Injury) program in the SICU.

Methods: DUCKI was developed using the Consolidated Framework In Implementation Research framework to understand barriers to early IUC removal in appropriate surgical patients. Implementation strategies, such as 1) Assessment for Readiness, 2) Implementation Team, 3) Algorithm Use, 4) Education and Training, and 5) Audit and Feedback were selected based on common barriers in the SICU. Research team members evaluated eligibility on daily ICU rounds and encouraged use. Concurrent patient chart review was conducted daily for 6 months post-implementation in 2021. After 3 years of DUCKI, additional chart review is conducted for 1 month to evaluate for sustainability. Primary outcome measures include catheter days saved and population catheterization rate. Secondary measures were overall catheterization rate and CAUTI incidence.

Results: For 6 months post implementation, 72 patients in 2021 and roughly 20 in 2023 (thus far) met criteria for DUCKI. The average portion of the ICU population eligible for DUCKI post-implementation was 9%. The average IUC rate among DUCKI patients was 10%. Now in 2023, the IUC rate in DUCKI eligible patients remains at 12%. Overall IUC rates in the SICU declined from 74% in 2020 pre-implementation to 70% in 2021 and now 66% in 2023. This 8% reduction in overall IUC rate (9% DUCKI eligible x 12% IUC) is attributed to decreased rates in DUCKI patients. CAUTI rate/1000 days declined from 1.5 in 2021 to 0.8 in 2023.

Conclusions: Low IUC rates in patients with oliguric AKI or ESRD is sustained in the SICU with the DUCKI implementation program. This program decreases IUC in a target group and has contributed to sustained decrease in overall SICU catheterization.