Background: Catheter-associated urinary tract infections (CAUTI) increase morbidity, longer lengths of stay, and higher health care costs. Best practices recommend assessing the need for indwelling urinary catheters (IUC), implementing evidence-based maintenance interventions, and removing catheters no longer indicated.
Problem: The Centers for Disease Control and Prevention (2020) reported CAUTI prevalence decreased 7% nationally. Unfortunately, the acute care division of a tertiary medical center experienced a 167% increase in CAUTI from 2018 to 2019, with the trend continuing into 2020.
Methods and interventions: The project was implemented on two inpatient surgical units that accounted for 65% of the acute care division’s CAUTI rates over a 36-month period. An organizational needs assessment was conducted using a fishbone diagram and SWOT analysis to determine areas of focus for interventions. The assessment revealed a lack of knowledge of the nurse-driven protocol (NDP) and variation in CAUTI maintenance practices among units and individual nurses. To understand nurses’ knowledge of CAUTI prevention interventions and use of NDP, a baseline survey was administered to identify educational needs of staff. Survey data affirmed staff understood elements of the maintenance bundle, but only 12% of respondents could explain the NDP process. Survey response data informed the development of a badge buddy with a quick response (QR) code that contained educational resources on CAUTI maintenance bundle practices and NDP outlined in the hospital policy. Using a smartphone, the nurse could access the QR code to obtain just-in-time education. Best practices, established in the literature, were adapted and used to create CAUTI champions. Acting as unit experts and resources, champions were educated on prevention techniques. Unit CAUTI champions rounded on patients weekly, auditing maintenance bundle adherence. Champions also collaborated with assigned nurses to determine if IUC were indicated. If no indication was identified, the nurse either removed the IUC using the NDP or requested a discontinue order from the provider. Educational handouts and monthly CAUTI rates were disseminated to increase adherence to bundle interventions. Bundle audit data was abstracted from a cloud-based system and reviewed monthly for commonly missed interventions, and implementation strategies were adjusted to improve practice. Unit-specific CAUTI rates, maintenance bundle adherence, IUC utilization ratio, NDP utilization, nurse satisfaction with access to educational resources, and knowledge improvement of CAUTI prevention were measured.
Results: The project aim was to reduce CAUTI rates, improve adherence of the catheter maintenance bundle, and enhance knowledge and use of the NDP. CAUTI rate decreased from 1.29 to 0.64, with a risk ratio of 0.3 on the exposed surgical units compared to the unexposed acute care units. The mean maintenance bundle adherence rate was 67% and NDP use increased 2%.
Conclusions: The project was designed to enhance quality care through the standardization of CAUTI prevention practices and staff education. The data reflects a positive effect on reduction in CAUTI rates and increased NDP use.
Reference 1. Centers for Disease Control and Prevention. (2020). 2019 National and State Healthcare-Associated Infections Progress Report. https://www.cdc.gov/hai/data/portal/progress- report.html#2018