| Principal Investigator: | Clifford Bray, RN |
| Organization: | Inova Health System |
Abstract
Problem
Catheter-associated urinary tract infections (CAUTIs) continue to be the most common hospital-acquired infection: 80% are attributable to an indwelling urinary catheter. In our neuroscience ICU (NSICU) monthly audits by hospital epidemiology showed CAUTI rates that we believed could be reduced.
Evidence
Monthly audits and physician reviews pinpointed specific patients who acquired CAUTIs. These cases were reviewed and specific and common causative factors were identified that led to infection. From these, practice changes were identified that could reduce the rates and incidence of CAUTIs.
Strategy
The task of reducing CAUTIs in the NSICU was given to the NSICU Practice Committee whose membership is comprised of staff RNs in the NSICU. A literature search was conducted and the protocols and recommendations of the 2007 and 2009 Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Center for Disease Control (CDC).
A CAUTI Bundle was developed and a poster presentation was displayed in the staff lounge area for all to see. Safety huddles are done at each shift change and the presentation was reviewed and supported until all staff were introduced to practice changes.
Practice
The staff was enthusiastic about reducing infection rates. Changes in practice were not that difficult and compliance was 100% after only 2 months. Continued updating of progress and improvement and discussion of individual cases continues to be the best prevention tool. The critical care physicians also play a big part in the process by evaluating the need for an indwelling catheter during daily patient rounds.
Result
The rate and incidence of CAUTIs has been reduced using all these measures. A hospital-wide program is now being implemented based on our work using the CAUTI Bundle and in collaboration with Epidemiology and Infectious Disease.
Recommendation
Staff involvement of RNs, techs and the physicians has been the primary reason for success. The CAUTI Bundle components were simple and basic and did not involve major changes in practice, cumbersome documentation or time-consuming processes. Keeping everyone updated in progress toward improvement and the positive effects of practice change has promoted interest and compliance.
Lessons Learned
An evidence-based development of practice change and involvement of the staff and physicians has been the key to success. Changes in practice that are simple and makes sense result in high compliance and improved patient outcomes.
Recognition
- 2nd place poster winner, 2010 Summer Institute on Evidenced-Based Practice
Bibliography
- Lo E, Nicole L, Clasen D, et.al. Strategies to prevent catheter-associated urinary tract infections in acute hospitals. Infect Control Hosp Epidemiol 2008; 29: S41–S50.
- Munasinge RI, Yazdan H, Appropriateness of use of indwelling urinary catheters in patients admitted to the medical service. Infect Control Hosp Epidemiol 2001; 22(10) 647–649.
- Gould C, Limshied C, et.al. Guideline for Prevention of Catheter-Associated Urinary Tract Infections 209; HICPAC/CDC 2009.