Intentional Leadership Rounds: A Proactive Approach to CAUTI Reduction

Abstract

Background Catheter-associated urinary tract infections (CAUTI) are the most common preventable hospital-acquired infection. Our facility's rate of CAUTI was above the risk adjusted expected rate. Using intentional leadership rounds, we sought to reduce indwelling urinary catheter (IUC) utilization and thus reduce CAUTI events. Methods Using the Plan-Do-Study-Act model and a Pareto tool for data collection, intentional leader rounds were completed by an Infection Prevention (IP) nurse on two 20-bed medical-surgical units (Neuro-Oncology and Surgical). Units were identified using the National Healthcare Safety Network (NHSN) targeted assessment for prevention (TAP) strategy as units with excess burden of CAUTIs. An IP nurse rounded with nurse providers on each of these units daily (Monday – Friday) for five months, interacting with the nurse to determine if the indication for the IUC was appropriate, if care and maintenance were completed, and if the catheter could be removed or an external catheter placed. The standardized utilization ratio (SUR) was used to determine a decrease in catheter utilization and the standardized infection ratio (SIR) was used to track CAUTIs over time. Results After five months of leadership rounding on Neuro-Oncology and Surgical, the SUR decreased 22% and 12% respectively on each of these units. There were no additional CAUTI events identified during this time frame. Observations from leader rounds identified collaboration between IP and staff nurses to discover barriers on the units and engaged staff in problem-solving. In addition, sustained change was facilitated through the building of interpersonal relationships between IP and the bedside nurse. Conclusions Urinary device utilization was reduced on each unit and there were no additional CAUTI events identified. Integrating leader rounds as an added strategy to reduce CAUTIs connects leaders with clinical staff. Intentional leader rounding along with evidence-based practices to reduce preventable infections and patient harm should be integrated as a proactive overall prevention strategy.