Value Based Procurement Pilot Reduces Catheter Associated Urinary Tract Infections (CAUTI)

25 May 2022

* based on an average of 200 CAUTIs per year

The Challenge

Catheter Associated Urinary Tract Infections (CAUTIs) are not uncommon and can cause patients significant pain, discomfort, confusion and anxiety for family and friends. They further impact healthcare with increased antibiotic use, prolonged hospital stays, increased clinical activity and risk of complaints and litigation.

As part of ongoing quality metrics benchmarking, the University Hospitals of North Midlands NHS Trust audited its urethral catheterisation practice, and the way catheterised patients were cared for in clinical areas. The audit highlighted a wide variation in care delivery leading to inconsistent outcomes for patients and staff.

The Aim

The aim of this Value Based Procurement pilot was to improve the process delivery for catheterising patients by;

  • Reducing time to undertake the procedure
  • Reduce variations in clinical practice
  • Consistent use of equipment to reduce risk and ultimately improve patient experience.

The Solution

After reviewing the available options to address the above barriers, the University Hospitals of North Midlands NHS Trust decided to pilot the BARD® Tray to achieve best practice.

This system contains all the essential items to catheterise or re-catheterise a patient in one pack and includes the catheter with a pre-connected urine drainage bag. This unique ‘closed system’ prevents ingress of bacteria and helps avoid catheter related infection.

The introduction of an all-in-one system was supported by supplier training and an audit that enables clinicians to easily follow best clinical practice in the catheterisation and management of patients with Foley catheters.

We implemented the BARD® Tray for urinary catheter insertions fully across our trust after NHS Supply Chain and BD supported us with a pilot study. The initial pilot study shows how we reduced the number of patients who had infections, how we made improvements in our clinical practice, how we saved time for all our nurses and doctors involved in catheterising people. We achieved all this and were able to show cost savings too.

It is really advantageous to have everything in one tray including the catheter, the urine meter or leg bag, and everything else that is needed. Even the apron and sterile gloves are provided! It makes it easier for me and anyone who catheterises a patient to follow good practice with the aseptic non – touch technique process that we all follow and is endorsed by the national ANTT team and the Infection Prevention Society which means all our team have confidence in this new system

Katie Leek, Lead Nurse for Tissue Viability and Continence, University Hospitals of North Midlands NHS Trust

The Clinical Results

The pilot was a success and improved clinical practice and patient experience

  • Catheter related infection rates fell by 100% at the pilot site
  • Clinical compliance to best practice improved, including use of catheter fixation devices.

Patient experience improvements included a reduction in complaints, a reduced length of stay, a reduction in catheter associated urinary tract infections and a reduced likelihood of patient urethral meatus trauma.

Clinicians reported that the pack was intuitive and saved time of around 5 minutes per catherterisation, which during the pilot process saving 100hrs from 1,000 catheterisation procedures. Another reported benefit of the project was that it highlighted gaps in the patient discharge process, regarding the provision of products at home, and patient education, which the pilot site believe will avoid patient readmissions to ED for catheter related problems.

I recommend that trusts consider adopting a complete catheterisation tray solution as part of their patient catheter pathway and quality improvement programme.

Sian Fumarola, Head of Clinical Procurement (UHNM-RWT-WHT-BCPS-CHT)

Financial and Operational Benefits

The pilot site had a significantly lower than average CAUTI rate of 12 patients per year, which was reduced to zero after implementation of the Bard Trays. The overall savings for this small hospital was £47,162 per annum on consumables, £23,616 on CAUTI costs and £21,000 operation Productivity – Patient Length of stay (LOS).

Based on published data surrounding the expenditure associated with CAUTIs, if an NHS trust spend £250,000 on consumables recording an average of 200 CAUTIs per year, with an expected additional six-day inpatient stay for each one (NICE, 2014). Assuming use of this product will reduce infections by 80% (Cartwright, 2018; Palmer & Dixon, 2019), this would release additional capacity of 1,200 bed days per annum or applying a national figure of the cost of an excess bed day to £346 (NHS Improvement, 2018) would generate an additional £415,200 of cost avoidance savings, with £393,600 saving on CAUTI reduction (£1,986 per CAUTI EPIC 3, 2017) and a reduction in consumables spend of £48,000*.
*calculated from pilot results.

By working collaboratively with the trust and the supplier, we have identified and evidenced how a change in practice and usage of products can improve patient care and achieve substantial savings for the NHS.

The results from the pilot saw a significant reduction in incidence of CAUTIs and the associated recognised complications. Furthermore, consistency in care delivery improved and treatment time reduced, supporting pressures in healthcare delivery.

Lauren Field (MCIPS), Senior Category Manager, NHS Supply Chain: Rehabilitation, Disabled Services, Women’s Health and Consumables

Environmental Benefits

During the pilot, 465 catheterisations took place resulting in:

  • 83.16kg clinical waste saved
  • 11.2kg plastic waste avoided
  • 24kg was card/paper recycled.

Next Steps

For further information relating to this pilot please contact:

Lauren Field

Senior Category Manager, NHS Supply Chain: Rehabilitation, Disabled Services, Women’s Health and Associated Consumables

Please note:
This case study was carried out at University Hospitals of North Midlands NHS Trust in conjunction with Becton Dickinson. There may be other comparable solutions within the market that are suitable in addressing the challenges highlighted in this report.

Is the Safety Thermometer a reliable measure of a trust’s CAUTI rate?

For the purposes of tracking and measurement, it is important that each trust has an agreed baseline measurement of CAUTI for their organisation. This measurement system needs to be consistent and available throughout any implementation and measurement period. Provided this is the case then a reduction in CAUTI should be evident. In this pilot study, the agreed and available measurement of CAUTI was the NHS Safety Thermometer data. Other CAUTI definitions and data sets should also work.
There is currently no nationally accepted CAUTI definition.
Trusts are no longer required to collect and submit data for the Safety Thermometer, so an agreed measurement system for monitoring CAUTI numbers will be agreed with trusts wishing to take action.

How does the BARD® Tray compare to the price of the total cost of all the individual components that we currently purchase?

This pilot study demonstrated the clinical and financial value that was delivered by the Tray being implemented across an organisation.

If a procedure is done incorrectly, is the whole catheterisation tray wasted and must I start again?

This is a common concern; however, it is not necessary to dispose of the whole tray if an error occurs. Becton Dickinson can provide Guardian Stock Boxes for hospitals. These contain replacement catheters which can be substituted for contaminated catheters and the procedure continues as per protocol.
There are very limited reports of these incidents and the monitoring of usage of product from Guardian Stock Boxes supports the fact that errors are not frequently made.

Does the included lubrication gel help to reduce the pain of a catheter insertion?

Yes. The insertion gel provided in the pack is an effective lubricant and serves to dilate the urethra so that the catheter can be inserted without trauma. It does not dissipate and liquify at body temperature so retains functionality for the duration of the procedure. There are no contra-indications/side effects with the included lubrication gel and no requirement for a prescription.

What storage space is required to store BARD® Tray?

• The shape of the tray allows for easy storage.
• Just one code (SKU) per pack eliminates multiple ordering codes for the same procedure. It is clearly labelled with all content details.
• It is also common for a Trust using the Tray system to rationalise and streamline products used.
• The pack is larger than a foley catheter as a separate item, however when you consider all the items it replaces the space required in the storeroom is the same.