Catheter-Associated Urinary Tract Prevention: Implementation of a Nurse-Driven Protocol

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Primary Author:</td>
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Alicia Lintner, RN</td>
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Co-Principal Investigators/Collaborators:</td>
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<p>Anna Gillman, RN, BSN, Noelle Davis, CRNP, Emily Sawyer, CRNP, D. N. Chason, CRNP</p>
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Organization:</td>
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University of South Alabama Medical Center</td>
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Abstract</h2>
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Purpose</h3>
<p>The goal was to reduce catheter-associated urinary tract infection (CAUTI) rates in the Intensive Care Units at the University of South Alabama Medical Center (USAMC). </p>
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Background</h3>
<p>A urinary tract infection (UTI) is considered the most common type of hospital-acquired infection. Approximately 75% of hospital acquired UTI’s are associated with a urinary catheter (CDC, 2012). The biggest risk factor for developing a CAUTI is prolonged use of the urinary catheter (CDC, 2012). Each day the catheter remains, the risk of a CAUTI increases by 5% (Saint, Meddings, Calfee, Kowalski, & Krein, 2009). A CAUTI is diagnosed based on a positive urine culture in addition to the presence of signs and symptoms of infection (CDC, 2014). Each CAUTI can cost from $600 to $2800 to treat depending on the presence of associated bacteremia (Saint et al., 2009). Additionally, CAUTI’s are one of the hospital-acquired infections (HAI’s) that are not reimbursed by Medicare and Medicaid.</p>
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Materials & Methods</h3>
<p>A collaborative approach was established utilizing the University of South Alabama College of Nursing faculty and the Evidence-Based Practice team to implement a practice change. This process began with a bundle approach including implementation of a nurse-driven protocol for indwelling urinary catheter management. The intensive care units were chosen based on increased urinary catheter use with higher risk for urinary tract infections related to acuity level of patients.</p>
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Results</h3>
<p>Data after six months of implementation showed an eight-three percent reduction in incidence of CAUTI’s per 1000 catheter days. </p>
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Conclusion</h3>
<p>Limitations of the project are related to the bundle approach and the short evaluation period. The bundle approach makes it difficult to determine which specific tool or strategy worked best or contributed to the decreased incidence of CAUTI’s. With regard to the population size, only patients who developed a CAUTI were analyzed. This is a small population in comparison to the number of patients with urinary catheters. Future goals include supporting the sustainability of the hospital wide use of the nurse-driven protocol and continued engagement of the academic partnership between USAMC and the University of South Alabama College of Nursing to facilitate the infusion of evidence into nursing practice. </p>
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Bibliography</h3>
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Center for Disease Control. (2014). Catheter-Associated Urinary Tract Infection (CAUTI) Event. Retrieved from http://www.cdc.gov/nhsn/pdfs/pscmanual/7psccauticurrent.pdf</li>
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Center for Disease Control. (2012). Catheter-Associated Urinary Tract Infections (CAUTI). Retrieved from http://www.cdc.gov/HAI/ca_uti/uti.html</li>
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Saint, S., Meddings, J. A., Calfee, D., Kowalski, C. P., & Krein, S. L. (2009). Catheter-associated urinary tract infection and the Medicare rule changes. Annals of Internal Medicine, 150(12), 877–884.</li>
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<p>© Improvement Science Research Network, 2012</p>
<p>The ISRN published this as received and with permission from the author(s).</p>