Patient Safety & Quality Improvement USMLE Step 1 Practice Question
A 62-year-old man is admitted to the ICU with sepsis secondary to pneumonia. His hospital course is complicated by acute kidney injury requiring vasopressor support. On hospital day 9, he develops fever (38.9°C), tachycardia (HR 118 bpm), and hypotension (BP 92/58 mmHg). Urinalysis obtained from his indwelling urinary catheter shows pyuria and positive nitrites; blood cultures remain sterile. The patient has been catheterized continuously since admission for accurate urine output monitoring. A review of the medical record shows no documented reassessment of ongoing catheter need. The hospital's quality improvement committee is tasked with reducing the incidence of catheter-associated urinary tract infections (CAUTIs) across the ICU. Which of the following interventions has the strongest evidence base for reducing CAUTI rates?
Answer choices
- ASwitching to suprapubic catheterization for all patients expected to require drainage beyond 7 days
- BImplementing a daily catheter necessity assessment protocol with prompt removal when indication no longer existsCorrect answer
- CAdministering prophylactic fluoroquinolones to all patients with indwelling catheters for more than 5 days
- DIncreasing the frequency of routine catheter tube changes from every 30 days to every 14 days
- EApplying topical antimicrobial ointment (chlorhexidine-silver sulfadiazine) around the catheter insertion site twice daily
- FUsing only larger-gauge (18-20 Fr) indwelling catheters to reduce bacterial biofilm formation on smaller-diameter tubes
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