Reducing Catheter-associated Urinary-tract Infections in Cancer Patients: A Nurse and Infection Preventionist-led Interprofessional Program

Abstract

Background : Catheter-associated urinary tract infections (CAUTI) is a common and preventable hospital-acquired infection (HAI). Cancer patients are at higher risk for developing CAUTI, and evidence-based strategies are needed to reduce CAUTI-associated morbidity and mortality. The purpose of this Quality Improvement project was to describe a nurse and infection preventionist (IP)-led interprofessional program to reduce CAUTI at a National Cancer Institute-Designated Comprehensive Cancer Center. Methods : Awareness of CAUTI-prevention efforts, protocols, and support from MDs/APPs was obtained through presentations of the program across various clinical committees. The program involved the following strategies: 1) a newly developed urinary catheter removal protocol implemented by unit nursing staff; and 2) IP managed external urinary catheters to reduce the usage of indwelling urinary catheters (IUC). The IP reviewed daily IUC reports and alerted unit nursing managers on inappropriate catheter indications or prolonged IUC cases. In collaboration with the institutional Nursing Excellence Department, Proactive Leadership Attention to Outcome (PLATO) rounds were implemented to increase unit-based awareness. Results : The interprofessional program was implemented over approximately four months (October 2019 to February 2020). Clinical committee presentations took place between November 2019-January 2020; PLATO rounds took place between December 2019-February 2020 and assisted with increasing unit-based compliance. The Nurse-IP collaboration resulted in overall CAUTI reductions across 11 inpatient units from 0.80 in 2019 to 0.37 in 2020. The IUC utilization rates were reduced from 1.02 in 2019 to 0.91 in 2020. The improvement continued despite COVID-19. Conclusions : An interprofessional, nurse-IP collaborative program was effective in reducing unit-level CAUTI. PLATO rounds, clinician champion, and meaningful use of unit based IUC and CAUTI reports should be considered for program sustainability. : Catheter-associated urinary tract infections (CAUTI) is a common and preventable hospital-acquired infection (HAI). Cancer patients are at higher risk for developing CAUTI, and evidence-based strategies are needed to reduce CAUTI-associated morbidity and mortality. The purpose of this Quality Improvement project was to describe a nurse and infection preventionist (IP)-led interprofessional program to reduce CAUTI at a National Cancer Institute-Designated Comprehensive Cancer Center. : Awareness of CAUTI-prevention efforts, protocols, and support from MDs/APPs was obtained through presentations of the program across various clinical committees. The program involved the following strategies: 1) a newly developed urinary catheter removal protocol implemented by unit nursing staff; and 2) IP managed external urinary catheters to reduce the usage of indwelling urinary catheters (IUC). The IP reviewed daily IUC reports and alerted unit nursing managers on inappropriate catheter indications or prolonged IUC cases. In collaboration with the institutional Nursing Excellence Department, Proactive Leadership Attention to Outcome (PLATO) rounds were implemented to increase unit-based awareness. : The interprofessional program was implemented over approximately four months (October 2019 to February 2020). Clinical committee presentations took place between November 2019-January 2020; PLATO rounds took place between December 2019-February 2020 and assisted with increasing unit-based compliance. The Nurse-IP collaboration resulted in overall CAUTI reductions across 11 inpatient units from 0.80 in 2019 to 0.37 in 2020. The IUC utilization rates were reduced from 1.02 in 2019 to 0.91 in 2020. The improvement continued despite COVID-19. : An interprofessional, nurse-IP collaborative program was effective in reducing unit-level CAUTI. PLATO rounds, clinician champion, and meaningful use of unit based IUC and CAUTI reports should be considered for program sustainability.