Providence: Reducing CAUTI and CLABSI Using an Intensive, On-site Assessment Model

Catheter-associated urinary tract infections (CAUTI) and central line-associated bloodstream infections (CLABSI) occur in all health care settings, but understanding why they are more prevalent in some locations than others, begins with a quest for information and gathering the facts. That was exactly the approach employed by Providence, which operates 53 hospitals and over 1,000 clinics and offers a comprehensive range of health and social services across seven Western states.

Providence significantly reduced both CAUTI and CLABSI rates, which became elevated during the COVID-19 pandemic, by utilizing an intensive, on-site epidemiologic assessment model. Following these efforts, the systemwide standardized infection ratio for CAUTI declined from a high of 0.88 in 2021 to 0.70 in 2022 with a first quarter 2023 SIR of 0.66. Also, the systemwide standardized infection ratio for CLABSI declined from a high of 0.84 in 2021 to 0.75 in 2022, with a first quarter 2023 SIR of 0.58.

In practical terms, step one was the creation of a team — which included members of the infection prevention and nursing quality and practice teams — to conduct on-site assessments at 16 of 53 hospitals that reported higher rates of infection. This team traveled to each facility for up to three days of on-site assessment — conducting interviews, making observations, and reviewing data and policy with targeted units that reported the highest number of infections. Gaining a thorough understanding of the particulars at each location, the team then debriefed with the facility’s leaders on their findings and recommendations.

The final step for each identified facility of the Providence system was enrolling in a four-month performance improvement cohort. Cohort participants received resources and coaching for one of the opportunities identified during the on-site assessment.

The cooperative and collegial nature of the process may be traced to Providence’s long-standing commitment to infection prevention and control. Providence has a CAUTI and CLABSI prevention forum with regional representatives in which initiatives are created and implemented as a system. According to Rebecca Bartles, executive director of infectious disease management and prevention at Providence St. Joseph Health, “This forum is a partnership between nursing and infection prevention and the structure drives collaboration and trust.”