Professional Practice-Clinical Practice Outcomes; Standards of Care; Clinical Pathways

Abstract

Hospital-acquired urinary tract infections account for approximately 40% of all hospital-acquired infections, resulting in over 900,000 incidences per year and the loss of millions of dollars to the healthcare industry. In addition, hospital-acquired catheter-associated urinary tract infections (CAUTI) results in incidences of bacteremia, septicemia, death, and frequently serve as a source for antibiotic resistant organisms such as VRE, MRSA, and multi-drug resistant gram-negative rods. In 1992, Classen et al, in a well-designed case control study, demonstrated a cost difference of $3,803 between patients who acquired catheter-associated UTI vs. patients who did not. Due to healthcare cost inflation since that time, current costs may approach $5,000–$7,000. On April 13, 2007, CMS issued a proposed rule change that would disallow payment for hospital-acquired urinary tract infection. Education on universal precautions, avoiding unnecessary catheterizations, training on proper technique for placement of catheters, removal of the catheters as soon as possible, maintaining a closed system and minimizing manipulations of the catheter system have shown to prevent CAUTIs. The CDC (1981) strongly recommended educating personnel in correct techniques of catheter insertion and care. A group of nurses including the WOCN nurses at a university hospital in the southwest set out to reduce the incidence of CAUTI in their inpatient population. At the same time the hospital implemented the use of silver- and hydrogel-coated catheters, the advanced practice nurses began an educational intervention for the staff. The education was offered to staff on the hospital's intranet site. The information included the following: indications for Foley, pathways of infection, Foley catheter and proper aseptic technique, Foley catheter protocol, male catheterization, female catheterization, monitoring, urine sampling, and a self-learning module. Quarterly rounds have been conducted and the incidence of CAUTIs is being followed with the assistance of the Infection Control Department.