Evaluation of the HOUDINI Protocol Implementation

Abstract

Background: Catheter-associated urinary tract infections account for more than 30% of hospital infections, leading to increased morbidity and mortality in hospitalized patients. For every day an indwelling urinary catheter is in place, there is up to a 7 percent increased risk of CAUTI. It costs hospitals approximately $758 per CAUTI, and CAUTIs not eligible for reimbursement per Centers for Medicare and Medicaid Services guidelines. Standardized infection ratios (SIR) are used to assess the incidence of CAUTI, and all hospital-acquired infections, compared to the national, state, or local average. An intensive care unit in Scottsdale, Arizona implemented a CAUTI bundle to reduce CAUTI SIRs. Methods: This DNP project is a formative program evaluation of the program directed at reducing CAUTIs using a CAUTI bundle implemented at an ICU in a level-one trauma, stroke, and academic healthcare facility in Scottsdale, Arizona. CAUTI SIRs were assessed one-year pre-implementation and one-year post-implementation to assess the effectiveness of the program. Findings: The program demonstrated improvement. The one-year pre-implementation CAUTI ICU SIR average was 1.98, with an average of 4 CAUTIs per 1541 catheter device days. The one-year post-implementation CAUTI ICU SIR was 0.76, with an average of 1.25 CAUTIs per 1270.5 catheter device days. 718 of the 5,082 indwelling catheters did not meet HOUDINI criteria and were removed, and the fill-and-pull method of removal was used in 100% of indwelling catheter removals. Conclusion: The effectiveness of the CAUTI reduction program is evidenced by the decreased CAUTI SIRs post-implementation. More data should be trended over the next year post-implementation to continue to assess its effectiveness. If the program continues to result in decreased CAUTI SIRs, the program may be considered for local or national use to ultimately improve patient outcomes and reduce morbidity, mortality, and hospital costs.