1159. Multidisciplinary Leadership Rounds Are Associated with Decreased Urinary Catheter and Central Venous Catheter Device Utilization at a Tertiary Care, Academic Hospital

Abstract

BackgroundOptimizing use of urinary catheters (UCs) and central venous catheters (CVCs) is crucial to prevent catheter-associated urinary tract infections (CAUTIs), central line-associated bloodstream infections (CLABSIs), and other complications. Despite education and adoption of catheter removal protocols, indwelling devices not meeting approved indications were still noted.MethodsTwice a week, UC and CVC surveillance rounds were conducted by a team of directors from nursing, vascular access, infection prevention, and hospital epidemiology. Different hospital units were selected each week in random distribution. Rounds emphasized face-to-face discussion with nurses and device observations to identify any removal opportunities and appropriate maintenance. Device utilization was monitored using CDC National Healthcare Safety Network (NHSN) standardized utilization ratio (SUR) and CAUTIs and CLABSIs were monitored using NHSN definitions. Relative ratios of SURs during pre-intervention (pre-INT) and post-intervention (post-INT) time periods for UCs and CVCs were compared using an exact binomial test and mid-P 95% confidence interval (CI). CAUTI and CLABSI rates were compared using Fisher’s exact test using mid-P value.ResultsA baseline time period A of 12 months pre-INT (June 2017-May 2018) was used to compare with the 10-month post-INT time period B (June 2018-March 2019). The UC SURs for periods A and B were 0.813 and 0.696 (Figure 1). The relative ratio shows a post-INT UC SUR that was 85.6% of the pre-INT period (95% CI: 84.1%, 87.2%, P < 0.001). CAUTI rates for periods A and B were not statistically significantly different at 2.276 vs. 2.164/1000 catheter days (P = 0.803). The CVC SURs for periods A and B were 1.244 and 1.081 (Figure 2). The relative ratio shows a post-INT CVC SUR that was 86.9% of the pre-INT period (95% CI: 85.7%, 88.0%, P < 0.001). CLABSI rates for periods A and B were statistically significantly different at 1.27 vs. 0.804/1000 central line days (P = 0.0335).ConclusionLeadership rounds were associated with a significant decrease in utilization of UCs and CVCs. A significant decrease was noted in CLABSI rates but not in CAUTI rates. Multidisciplinary oversight improved adherence to existing policies and should be considered for optimizing device utilization. Disclosures All authors: No reported disclosures.