An Evaluation of Methods to Reduce IV Catheter Related Bloodstream Infections

Abstract

ISSUE: Urinary tract infections (UTIs) are the most common type of healthcare associated infection reported, with 80% attributed to the presence of an indwelling urinary catheter. Catheter associated UTIs (CAUTIs) result in increased morbidity, mortality, length of stay, health care costs, and patient pain and inconvenience. PROJECT: A multidisciplinary team was formed to research and review nursing best-practices, guidelines, and evidence-based recommendations for the prevention of CAUTI. The team’s objective was to identify and implement best-practice nursing initiatives for the reduction of CAUTIs throughout the organization. Organizationwide education was developed and carried out to heighten awareness and highlight CAUTI prevention strategies. Education was delivered using a variety of methods (i.e. table tents in the staff cafeteria, posters in staff lounges, attendance at unit/department staff meetings, articles in the organization newsletter, and educational information provided to the medical staff). A nursing assessment tool that included criteria for catheter continuation, daily assessment of all urinary catheters, and documentation of the reason for catheter continuationwas developed and implemented. A nursedriven urinary catheter discontinuation protocol for the early removal of unnecessary urinary catheters was also developed. The Intensive Care Unit (ICU) was chosen to conduct a two-month trial of the protocol, followed by a two-month trial on all in-patient nursing units. To support the elements of the urinary catheter discontinuation protocol, additional bladder scanners were purchased for inpatient units. Full implementation of the discontinuation protocol occurred after final approval by the Medical Executive Committee and Nursing Shared Leadership Committees. RESULTS: CAUTI rates were reduced following implementation of evidence-based prevention measures. Initiatives resulted in an overall 30% reduction in the number of CAUTIs in 2011 (6) as compared to 2010 (9) in the organization. Also, to date, there have been zero CAUTIs identified in the ICU for over two years (last CAUTI reported June, 2010). LESSON LEARNED: Staff buy-in was essential for the success of our CAUTI prevention initiatives and required ongoing education and support throughout the process. Don’t assume that fundamental infection prevention strategies are being followed (e.g., proper hand hygiene, safe handling of indwelling catheters, aseptic technique for catheter insertion, and daily catheter care). Reinforcement of these important nursing concepts must be included early and throughout the CAUTI prevention education. For optimal success of CAUTI prevention initiatives, the urinary catheter discontinuation protocol must be truly nurse-driven. Nursing staff need encouragement to take ownership of their practice and understand the important role they have in patient safety initiatives.