Medline's ERASE CAUTI Program Helps Hospitals Reduce Catheter Use by 20 Percent

Medline Industries, Inc.'s ERASE CAUTI Foley catheter management system, featuring a revolutionary one-layer tray design, is helping hospitals "get to zero" -- reducing healthcare-associated infections (HAIs) through improved education about evidence-based practices. Launched just 18 months ago, the ERASE CAUTI program is used by more than 250 hospitals across the country, helping to significantly reduce the risk of catheter-associated urinary tract infections (CAUTIs) and cut Foley catheter use and related costs by an average of 20 percent.

Urinary tract infections (UTIs) are the most common HAIs; 80 percent of these infections are attributable to an indwelling urethral catheter. The ERASE CAUTI Foley catheter management system helps providers reduce the risk of infection by combining evidence-based principles and training with an innovative one-layer tray design.

Arkansas Methodist Medical Center

Clinicians at Arkansas Methodist Medical Center (AMMC), one of the first hospitals to implement the ERASE CAUTI system, are using the program to change the way they assess and perform urinary catheter insertions. Since implementing the program a year ago, the Paragould, Ark., hospital has seen a 21 percent reduction in catheterizations and CAUTIs.

"The one-layer tray design is labeled in a specific sequence that helps guide our nurses during the catheterization process to adhere to current CDC recommendations, including aseptic technique," says Lisa Bridges, RN, infection preventionist for AMMC. "To help us reduce catheterizations, we are requiring our entire nursing staff to take the program education on the alternatives to catheterization. Plus, the new tray has a checklist to help the nurse make a decision on whether catheterization is appropriate for the patient and to assure the education transfers into everyday clinical practice."

As measured by the number of catheterizations performed in March and April 2009 versus the same time in period in 2010, AMMC reduced the number of catheterizations from 192 to 151, a 21 percent drop (based on adjusted patient day). This decrease contributed to the hospital achieving zero CAUTIs in April 2010, compared to three in April 2009, according to Bridges.

Another leading factor causing CAUTI is leaving a catheter in place for more than two days after surgery. The Surgical Care Improvement Project (SCIP) recommends removal of catheters within 24 to 48 hours post-operatively. In the first quarter of 2009, only 20 percent of the catheters AMMC placed in the OR were being removed within two days. With the implementation of the ERASE CAUTI program, the removal rate increased to 50 percent in the first quarter of 2010.

"With the Foley InserTag and checklist sticker placed on the patient's chart, nurses and physicians knew exactly when the catheters had been placed," says Bridges, "and were able to remove them in the necessary 24-48 hours after surgery."

Also, inserted in the tray is a patient education care card that looks like an actual get well card. According to Bridges, the card is a more effective way to educate patients about the procedure, including the risks and complications associated with closed system Foley catheters.

"Before, we had to print our education from the computer, and it was not something the patient or the clinician normally took time to review," says Bridges. "The patient care card has significantly improved our ability to provide patients and families with a tool to help them better understand the proper care and maintenance of the catheter, signs and symptoms of CAUTI and how they can help reduce the chances of developing CAUTI."

Floyd Medical Center

To help reduce its CAUTI rates, Georgia-based Floyd Medical Center is utilizing the innovative tray, along with facility-wide physician and nurse education on the appropriate use of catheters and the importance of avoiding catheters when not medically necessary. The initiative has led to an 83 percent reduction in CAUTIs and a 23 percent decline in the number of catheterizations performed at the hospital. In recognition of its accomplishments, the 304-bed non-profit teaching hospital in Athens, Ga., earned first place in VHA Georgia's 2010 Clinical Excellence award category.

"We forged a hospital-wide initiative focused on reducing catheter use and related urinary tract infections," says Darrell Dean, DO, MPH, medical director for clinical and operational performance improvement at Floyd Medical Center. "The Medline tray has many design elements and product enhancements that were integral in our program to reduce variation in practice and achieve our goal of reducing CAUTI."

Dean cited the kit's larger sterile barrier drape and one-layer tray design (versus the industry standard two-layer tray) as important factors to helping the nursing staff maintain aseptic technique. He also pointed to the tray's checklists as vital tools to CAUTI prevention -- one that helps document a valid clinical reason for inserting a catheter and another that reviews the proper steps to catheter insertion. Upon completion, the checklists are then added to the patient's chart for proper documentation of insertion.

Unity Hospital

Unity Hospital, a 340-bed nonprofit facility in Rochester, N.Y., is experiencing similar results with the ERASE CAUTI program. According to data from the hospital, the facility reduced its urine nosocomial infection markers (NIMs) 32 percent in August 2010 compared to the same time period in 2009. The associated cost for each urine NIM marker is $3,637, which demonstrates a significant cost-avoidance following the introduction of the ERASE CAUTI program, according to Unity Hospital. Urine NIMs are an electronic marker that uses sophisticated algorithms to analyze existing microbiology laboratory and patient census data to identify HAIs.

"Although we had a low CAUTI rate in 2009, after implementing the ERASE CAUTI program, rates continue to trend downward," says Erica Perez, Unity's clinical educator. "The program ties in education, nursing power and a new industry product that promotes best processes by reinforcing the CDC guidelines to decrease the opportunity for a CAUTI to develop."

According to Perez, the hospital began using the ERASE CAUTI program because it identified gaps in standardization and knowledge regarding the proper insertion technique and clinical indications for using a Foley catheter.

"The Medline program offered the tools to reduce the inconsistencies we observed in the technique nurses used to insert catheters due to differing protocols at previous facilities where nurses have practiced, variance in how nurses were initially taught the procedure and different types of Foley trays nurses have used in the past," Perez says.

Perez emphasized that Medline's one-layer tray presents the procedure components in an intuitive manner, guiding the nurse through the procedure from left to right. The innovative tray also makes it easier to maintain aseptic technique since all the components are in one tray versus the traditional two layers.

The hospital staff also took advantage of the program's online education, which reinforced aseptic technique through learning modules and an interactive competency tool the clinicians used to demonstrate knowledge of proper Foley insertion technique. To date, more than 500 nurses at Unity have completed the education classes via Medline's e-learning site Medline University ( These online modules have been added to the hospital's clinical orientation as a mandatory core competency for new nursing staff.

Following a successful trial period last summer, the program was rolled out facility-wide to all acute care units in August 2010.

"The implementation of the ERASE CAUTI program has helped us improve the standard of care for patients receiving a Foley catheter and has reduced the risk of CAUTI," says Perez. "The reduction in urine NIMs indicates fewer patients may be at risk for developing a CAUTI."