Guidance for Preventing CAUTIs: Insights from the 2022 Compendium Update

Recently, the Compendium of Strategies to Prevent Health Care-Associated Infections: 2022 Updates, added the guidance “The Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals” document that has been updated from its 2014 version. First published in 2008, it is sponsored by the Society for Healthcare Epidemiology (SHEA). It is a product of a joint effort from SHEA, the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and The Joint Commission, with contributions from several organizations and societies with content expertise. Over 100 experts worldwide collaborated on this guidance-writing initiative that spanned multiple years.

The Compendium represents a highly collaborative effort, bringing together concise recommendations for core infection prevention practices aimed at combating 6 significant health care-associated infections (HAIs) known to profoundly affect the quality and safety of patient care. This comprehensive resource not only synthesizes the latest evidence and expert consensus but also provides invaluable guidance on integrating best practices into healthcare delivery through effective implementation strategies. Additionally, the Compendium offers specific recommendations for the successful implementation and long-term sustainability of hand hygiene strategies within health care settings. The latest Compendium update includes strategies to prevent ventilator and nonventilator-associated pneumonia. The urinary catheter guidance is the final installment of the Compendium.

To get insight into what is in the guidance and how it came about, Infection Control Today^® (ICT^®) spoke with Payal K. Patel, MD, MPH, System Wide Medical Director of Antimicrobial Stewardship, Intermountain Health, Salt Lake City, Utah, and lead author of the guidance.

ICT: Would you please explain the new guidance and the significance of it?

Payal K. Patel, MD, MPH: The Compendium of Strategies to Prevent Health Care-Associated Infections (CAUTI) includes several documents that tell hospitals how to help prevent health care-associated infections in their patients, and it's usually updated every few years. The last update was in 2014. [There are] several documents that have just come out in this update. And I was the first author of the CAUTI Compendium, the Catheter-Associated Urinary Tract Infection Compendium.

ICT: Please provide key information on the latest developments in urine culture stewardship, implementation, and strategies.

PKP: One thing since the last Compendium is that there's been a lot of work combining the fields of antimicrobial stewardship, diagnostic stewardship, and UTI. One of the things we found in our literature review was a number of papers that focused on decreasing unnecessary urine cultures. We've referenced a lot of that work in the Compendium so that if you're interested in doing that in your own hospital, you can see what's been done before. We've also recommended to hospitals some ways—some strategies—that you could try to decrease those urine cultures. One way would be to ask why the urine culture is being drawn and then [provide] a list of appropriate indications for a urine culture to be drawn.

ICT: [The strategy] seems so simple. And yet, it probably happens all the time that they don't even ask; they do [the test].

PKP: What happens is to be helpful, people want to gather as much information as possible. But what literature has shown us, and a number of studies have shown us, is that…let's say you're in the ER, and a urine culture gets collected. You're there for eye pain, but someone gets urine cultures and blood cultures on you just in case they're going to be helpful.

A couple of days later, your urine culture is growing bacteria. Now we know that you were there for something completely unrelated. But the person who is reading that urine culture may not know why you came in. So, there can be a disconnect across that continuum of when that culture got collected and if that is actually causing what presented for that patient. So that's some of it. So, if we start being more appropriate about when we order urine cultures, we will probably be better about diagnosing as well as decreasing unnecessary antimicrobial use.

ICT: What specifically should infection prevention and control professionals, including infection preventionists, know about this guidance?

PKP: This set of papers is important to everyone in health care [with whom] a patient interacts with who could potentially help prevent these kinds of infections. The reason that they're updated every so often is to make sure that all of the recent literature that could be pertinent is included in these guidelines. Something that we have included in our Compendium is the idea that there are several ways to impact infection prevention, whether it's before a catheter goes in, or whether it's when the maintenance of that catheter is happening, or if you're trying to get catheters out. So there are a lot of ways to think about infection prevention in the way of a kadhi. That's specific to our paper, but one way to look at this document is to think about what you're doing in your own hospital, maybe what you could add, and [try] to focus on what part of that lifecycle of a catheter, do you need to work on in your hospital?

ICT: Do you think this will be appropriate for doctor's offices?

PKP: That is a great question. These sets of the Compendium are meant for inpatient acute care hospitals. However, there are a lot of settings where there isn't a guidance document in place. If you're involved in that continuum of care where a patient may get a catheter, it is worth looking at the Compendium. But it's important for infection prevention teams in the inpatient acute care setting to look at these and be familiar with up-to-date recommendations.

ICT: I noticed that the guidance layout is clear and easily transmissible to many facilities. Was that process and result difficult for the authors? How did it come about?

PKP: We appreciate that. One of the strengths of all the Compendiums, including the Carty Compendium, is its multidisciplinary nature. We have folks from the front lines. We have folks from academic medicine. We have a partner from the CDC. So, all sorts of people who are involved in infection prevention. I remember when the 2014 Compendium came out. And I was reading these as an ID [infectious disease] fellow trying to get in there. I took a weekend, and I said, “I'm going to read the Compendium this weekend.”

And it was tough, even for someone specializing in infectious diseases. So, my hope would be that even folks like internal medicine, residents, and potentially medical students who are interested in this space would be able to look at this document and then apply some of that [information] to their daily practice to do our best for our patients.

ICT: How did the Compendium come about?

PKP: This has grown to include more partners over time. But it's led by SHEA, the Society for Healthcare Epidemiology of America, and has continued to grow with the Infectious Disease Society of America becoming a partner. It's also supported by APIC [Association of Professionals in Infection Control and Epidemiology], a group of infection preventionists, and the CDC and The Joint Commission also look at these and make sure that the recommendations are in line. So, from a patient safety perspective, there are a lot of groups taking a look at this and agreeing on those recommendations before they come out. It's nice to have a guidance document with that much like agreement between groups because then it can come back and be used collaboratively.

ICT: Do you have anything else you would like to add or anything you'd like for an ICT audience to hear?

PKP: This is my first time being involved with the Compendium, but many times we think about things like this [and] they take a long time to come out. And the reason is because [we are] trying to be thorough and to make sure that there are so many parties involved. But at the end of the day, our aim is to help infection prevention continue to be one of the most important parts of a patient's stay at the hospital. So, my hope is that you can take a look at these guidelines. Extrapolate back to your practice, then augment some of your day-to-day to help that patient stay in the hospital. Be as straightforward as possible.

(This interview has been edited for clarity and length.)