Kicking CAUTI Campaign
Last updated
Share PrintAsymptomatic bacteriuria (ASB) is a benign and extremely common condition in Veterans in acute and long-term care and does not merit antibiotic treatment. Unfortunately, most healthcare providers confuse bladder colonization (ASB) with symptomatic urinary tract infection (UTI) in patients with urinary catheters, thus leading to overdiagnosis of CAUTI. Antibiotics given for ASB can cause harm to the Veteran receiving them, in terms of causing adverse side effects, C. diff colitis, or inducing resistant superbugs that can cause future infections. Overdiagnosis of CAUTI falsely elevates facilities’ healthcare associated infection rates. Our intervention helps reduce testing for and treatment of ASB with antibiotics, thus also saving VHA resources, while reducing CAUTI rates. Reducing CAUTI rates can lead to improved SAIL metrics for a facility.
Origin:
April 2010, Michael E. DeBakey Department of Veterans Affairs Medical Center (Houston)
Adoptions:
5 successful
Awards and Recognition:
VA HSR&R IIR funding (09-104 and 16-025), VA HSR&D Best Research Paper of the Year 2016 | https://www.hsrd.research.va.gov/for_researchers/awards/bestpaper2016.cfm
Partners:
Diffusion of Excellence, Health Services Research & Development
Recent Updates
Overview
The problem
The evidence base for neither screening for nor treating ASB is very strong, yet more than 70% of VA inpatients with ASB received antibiotics to treat it. The problem starts with seemingly innocuous lab tests—urine cultures and urinalyses—performed in patients without specific urinary symptoms. The results of these tests lead to reflexive use of antibiotic
...
The evidence base for neither screening for nor treating ASB is very strong, yet more than 70% of VA inpatients with ASB received antibiotics to treat it. The problem starts with seemingly innocuous lab tests—urine cultures and urinalyses—performed in patients without specific urinary symptoms. The results of these tests lead to reflexive use of antibiotics and downstream harms to Veteran patients.
See
more
The solution
We developed an intervention to help providers apply evidence-based, best practices guidelines on asymptomatic bacteriuria to their patients, at the point of care. These guidelines encourage providers to consider whether the patient has ASB, rather than UTI, and to think more deeply into what could be causing the patient’s symptoms, rather than reflexively o
...
We developed an intervention to help providers apply evidence-based, best practices guidelines on asymptomatic bacteriuria to their patients, at the point of care. These guidelines encourage providers to consider whether the patient has ASB, rather than UTI, and to think more deeply into what could be causing the patient’s symptoms, rather than reflexively order a urine culture and starting antibiotics. The components of our guidelines-implementation intervention are:
• An algorithm to help the providers distinguish ASB from UTI. The algorithm can be shared on paper as pocket cards or electronically. The algorithm has potential for integration into the electronic health record as well.
• A library of interactive teaching cases
• An implementation manual
The local project leads employ case-based teaching using actual cases from their site to teach their providers how to apply the algorithm to their own patients. This case-based teaching thus serves also as audit and feedback. See more
• An algorithm to help the providers distinguish ASB from UTI. The algorithm can be shared on paper as pocket cards or electronically. The algorithm has potential for integration into the electronic health record as well.
• A library of interactive teaching cases
• An implementation manual
The local project leads employ case-based teaching using actual cases from their site to teach their providers how to apply the algorithm to their own patients. This case-based teaching thus serves also as audit and feedback. See more
The results
The Kicking CAUTI intervention led to a 71% reduction in screening for ASB and a 75% reduction in treatment of ASB at the Houston VA Medical Center, the initial site of implementation. We have since rolled it out to four additional VAMCs. To date, our four intervention sites have logged a total 466 intervention sessions, reaching 2,037 medical providers in
...
The Kicking CAUTI intervention led to a 71% reduction in screening for ASB and a 75% reduction in treatment of ASB at the Houston VA Medical Center, the initial site of implementation. We have since rolled it out to four additional VAMCs. To date, our four intervention sites have logged a total 466 intervention sessions, reaching 2,037 medical providers in 5,028 minutes of intervention. Combined results from these four sites document improvement in all key clinical outcomes—decreased urine cultures, decreased days of antibiotic use, and decreased length of antibiotic use.
See
more
Links
- Our group's initial publication of results: Effectiveness of an Antimicrobial Stewardship Approach for Urinary Catheter-Associated Asymptomatic Bacteriuria
Metrics
- The Kicking CAUTI intervention led to a 71% reduction in screening for ASB and a 75% reduction in treatment of ASB at the Houston VA Medical Center, the initial site of implementation.
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Multimedia
Images
Above:
Dr. Barbara Trautner delivers a Kicking UTI intervention session at Grand Rounds, Minneapolis VAMC September 2019
Above:
Side 1 of the Kicking UTI algorithm card
Above:
Side 2 of the Kicking UTI algorithm card
Implementation
Timeline
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Months 1-3 On-Ramp
Identify the local team, determine which units are the focus of the intervention, achieve buy-in from leadership and stakeholders, work with external facilitators to establish access to outcomes data in VINCI, complete on-ramp training modules. Collect baseline data (both in VINCI and by chart review). Local teams would typically include a physician champion and a pharmacist, with the addition of a nurse practitioner or nurse educator if available. Local teams may wish to have both an infectious diseases physician and a hospitalist physician to increase reach. Participate in monthly calls with other participating sites to share best practices. -
Months 4-9 Active Intervention
Deliver case-based education using the library of teaching cases in a wide variety of settings on the relevant units, with the relevant healthcare providers. During each session, share the algorithm with all participants (on paper or electronically). Intervention delivery options include team rounds, in-services, educational conferences, grand rounds, online chat (via Teams), and 1:1 detailing. Continue to collect data via case collection, while the external facilitation team will continue to gather data on outcomes available in VINCI. Continue to participate in monthly calls with other participating sites. -
Months 10-12 Sustainability
Work with external facilitation team to summarize and report data. Share lessons learned with the practice community. Integrate the intervention and the algorithm into ongoing workflow, either electronically, or as part of orientation, or as part of a quarterly education session.
Departments
- Emergency care
- Pharmacy
- Geriatrics
- Quality control
- Infectious disease
- Internal medicine
Core Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
|
PROCESSES |
|
TOOLS |
|
Files
- Pocket card of our group's teaching algorithm to manage ASB/UTI treatment UTI Pocket Card
- An implementation guide to our group's practice at a new site Less is More - Getting Started Guide
- a library of the Teaching Cases used in our Group's practice Teaching Case Library
- Teaching Case of ASB case management in the VA CLC Nightmare on Fuller Street
Optional Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
|
PROCESSES |
|
TOOLS |
|
Files
- VHA directive specifying infection control and preventions programs in VA VHA Directive 1131
- VHA 1031 mandate specifying the provision of antibiotic stewardship programs in the VA VHA 1031 Mandate
Risks and mitigations
| Risk | Mitigation |
|---|---|
| Some complexity to implement | Implementation workbook, with detailed models of implementation materials is available |
| Buy-in from multiple stakeholders needed |
VHA directive 1031 requires all facilities to have an antibiotic stewardship program Decreasing CAUTI rates will improve SAIL metrics |
| Lack of time and competing priorities for local team | VHA directive 1131 mandates staffing for infectious diseases and infection prevention programs at each facility |
About
Origin story
Dr. Trautner, VA infectious diseases physician, attended a conference on preventing medical device-related infections in June 2008. One of the speakers announced that on October 1, 2008, Medicare would no longer pay hospitals for certain hospital-acquired conditions, including CAUTI, because these events in theory could be prevented by application of eviden
...
Dr. Trautner, VA infectious diseases physician, attended a conference on preventing medical device-related infections in June 2008. One of the speakers announced that on October 1, 2008, Medicare would no longer pay hospitals for certain hospital-acquired conditions, including CAUTI, because these events in theory could be prevented by application of evidence-based guidelines. Dr. Trautner was electrified, because she recognized that a high percentage of what is diagnosed and reported as CAUTI is really asymptomatic bacteriuria. She started thinking about how she could teach providers the difference between ASB and CAUTI, and how she could help them learn when to withhold urine cultures and antibiotics in patients with ASB. Sitting there in the 2nd row of the conference auditorium, she began to type up a proposal. The proposal was eventually funded by VA HSR&D as investigator-initiated research, and thus the Kicking CAUTI campaign was born.
Original team
Barbara Trautner, M.D., Ph.D
Infectious diseases clinician-investigator
Larisa Grigoryan, M.D.,Ph.D
Epidemiologist
Aanand D. Naik
Geriatrician and quality improvement scientist
P. Adam Kelly, Ph.D
Psychometrician
Nancy Petersen, Ph.D
Senior biostatistician
Sylvia Hysong, Ph.D
Industrial and organizational psychologist
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