Reducing catheter-associated urinary tract infections (CAUTI) is an opportunity to decrease patient discomfort and length of stay and reduce unnecessary costs of care. Public reporting and the Centers for Medicare & Medicaid Services policy of non-payment for selected hospital-acquired conditions further encourage CAUTI reduction. CAUTI is the most common of all health care-associated infections. An estimated $565 million in excess health care costs and approximately 13,000 deaths are associated with CAUTI each year. The good news is that most CAUTIs are preventable.

Hospitals and health systems that have been most successful in achieving — and sustaining — reductions in infection rates have taken a two-pronged approach combining best clinical practices with meaningful culture change. The clinical, or "technical," interventions to reduce CAUTI are clearly defined and straightforward: pPlace catheters only when necessary, use aseptic insertion technique and appropriate maintenance, and remove catheters promptly when they are no longer indicated. However, fully operationalizing these best practices is fraught with challenges and complexities of the care environment.

Reducing CAUTI through technical interventions requires a simultaneous cultural approach to create an environment that facilitates and encourages improvement. Checklists, policies and procedures are necessary to improve safety, but sustaining use of these tools demands strong working relationships where open communication is the norm. Long-term improvement demands a culture that ensures that the technical work will actually will be effective.

The On the CUSP: Stop CAUTI initiative, funded by the Agency for Healthcare Research and Quality and led by the Health Research & Educational Trust (HRET) of the American Hospital Association, provides crucial coaching and data -collection support for organizations that are striving to reduce CAUTI. Stop CAUTI is an extension of the highly successful On the CUSP: Stop BSI initiative that reduced central line-associated bloodstream infections by 40 percent in participating hospital units. Stop CAUTI implements the Comprehensive Unit-based Safety Program, or CUSP, an effective culture change model. It combines CUSP implementation with educational support on appropriate indications for catheter placement, best practices in catheter maintenance, and approaches to discontinue catheter use where possible.

Project fatigue is a very real challenge in quality improvement practices, and hospitals have found that the CUSP model combines very well with other change models such as the Kotter "Leading Change"Eight-Step Process for Leading Changemodel, the Kouzes and Posner Leadership Challenge, the IHI Model for Improvement, and TeamSTEPPS implementation. What's more, CUSP can be seamlessly integrated with routine procedures on the unit, such as daily rounds and debriefing. CUSP also provides streamlined tools for makingto analyze root causes and failure modes and effects analysesso that this becomes part of the mindset of front-line staff.

On the CUSP: Stop CAUTI is working toward reducing CAUTI by 25 percent in participating hospital units. The project is leveraging proven improvement methods, nationally recognized faculty, regional coaching support by national stakeholders, focused support for emergency departments and significant data monitoring support to ensure success. Faculty include experts from the Association for Professionals in Infection Control and Epidemiology, Emergency Nurses Association, Society for Healthcare Epidemiology of America, and the Society of Hospital Medicine. To learn more about bringing the support offered by On the CUSP: Stop CAUTI to your organization, contact your state hospital association or Deborah Bohr of HRET at To learn more, visit

Jenna Rabideaux is a research specialist at the Health Research & Educational Trust.

On the web

Davis Is TRUST Award recipient

Karen Davis will receive the 2013 HRET TRUST Award at a reception July 25 in San Diego on July 25, during the Health ForumAHA/ and Health ForumAHA Leadership Summit. Davis is the Eugene and Mildred Lipitz Pprofessor in the Ddepartment of Hhealth Ppolicy and Mmanagement, and director of the Roger C. Lipitz Center for Integrated Health Care at the Johns Hopkins University Bloomberg School of Public Health at Johns Hopkins University. She served as president of Tthe Commonwealth Fund from 1995– to 2012. The TRUST Award recognizes individuals who have exhibited visionary leadership in the health care field. For more information, including sponsorship opportunities and a list of pastformer recipients, visit

HPOE Resources for Leaders

The Hospitals in Pursuit of Excellence website is a one-stop portal for health care leaders:. It provides resources forto implementing quality and performance improvement strategies and addressing the challenges and opportunities of transforming care delivery systems. HPOE.orgThe site features reports and examples on bundled payments, e-metrics for the second curve of health care, and physician- and team-based leadership. Recent guides cover such topics as hospitals and care systems of the future, health care user engagement, and population health. For information and to download free reports and case studies, visit

Improving Community Health

More than 375 community health professionals attended the 10th annual Association for Community Health Improvement conference in St. Louis in March. An AHA personal membership group, ACHI aims to strengthen community health through education, peer networking and practical tools. Its website features news, case studies and links to other resources and funding sources. ACHI members have free access to the Community Health Assessment Toolkit and getreceive discounts for ACHI Career Center job postings and webinars. For information, visit