Saving Lives and Reducing Harm: A CAUTI Reduction Program

Kerri Ann Scanlon, MSN, RN; Celia M. Wells, PhD(c), RN; Launette Woolforde, EdD, DNP, RN-BC; Aradhana Khameraj, MSN, RN; Jennifer Baumgarten, MBA


Nurs Econ. 2017;35(3):134-141. 

In This Article

Significance to Health Care

The CMS, Joint Commission, and other healthcare leaders identified prevention of hospital-associated infections (HAIs) as a priority patient safety issue. The Centers for Disease Control and Prevention (CDC) and the National Healthcare Safety Network (NHSN) (2013) estimate there were more than 93,300 urinary tract infections (UTIs) in acute care hospitals in 2011, accounting for 12% of acute care infections. Of these hospital-acquired UTIs, approximately 75% were related to the use of an indwelling urinary catheter, known as a catheter-associated urinary tract infection (CAUTI). CAUTIs can lead to a plethora of complications, including but not limited to gram-negative bacteremia, septic conditions, and even mortality (CDC, 2013). There are approximately 13,000 CAUTI-related deaths each year with related costs upwards of $500 million annually (CDC, 2013).

Financial implications for hospitals are two-fold: (a) overall savings in cost avoidance by preventing CAUTIs, and (b) overall savings related to CMS reimbursement. These savings, while not totally quantifiable, can alter the treatment course associated with CAUTIs. In a systematic review of the literature, research objectives were to estimate the cost associated with the most significant and targetable HAIs (Zimlichman et al., 2013). Authors were unable to identify studies that met their criteria for estimating attributable costs associated with length of stay. According to North Shore University Hospital (NSUH) performance and financial data, the average cost for a patient with a CAUTI is estimated at $1,642 per case. These costs are similar to findings reported by Zimlichman and associates (2013) who estimated the cost of CAUTIs as $603-$1,189 per case in 2012. Earlier studies included those costs and assumed a 0.5–1 day increase in hospital length of stay respectively (Bologna, Polansky, Fraimow, Gordon, & Whitmore, 1999; Saint, Veenstra, Sullivan, Chenoweth, & Fendrick, 2000). In addition, Umscheid and colleagues (2011) included a cost calculation of $1,200-$4,700 based on range estimates of studies included in their research. While cost estimates for CAUTIs are inclusive, hospitals who have improved CAUTI outcomes can expect to see the 1% Medicare penalty lifted in 2017, saving millions of dollars per year.

North Shore University Hospital is an 814-bed quaternary care, teaching hospital, which is academically affiliated with the Hofstra Northwell School of Medi cine and Graduate School of Nursing. In addition, NSUH is the flagship hospital for Northwell Health, retaining a staff of more than 6,000 employees including over 1,900 registered nurses. NSUH offers advanced care in all medical specialties, including open-heart surgery, neurosurgery, orthopedic surgery, urology, and maternal-fetal medicine. As the 14th largest healthcare system in the United States, it has had challenges associated with CAUTIs. Therefore, in 2013, a CAUTI reduction program was launched which focused on developing best practices transferable across Northwell Health.