Successful reduction in catheter-associated urinary tract infections: Focus on nurse-directed catheter removal

Abstract

Despite using sterile technique for catheter insertion, closed drainage systems, and structured daily care plans, catheter-associated urinary tract infections (CAUTIs) regularly occur in acute care hospitals. We believe that meaningful reduction in CAUTI rates can only be achieved by reducing urinary catheter use. We used an interventional study of a hospital-wide, multidisciplinary program to reduce urinary catheter use and CAUTIs on all patient care units in a 300-bed, community teaching hospital in Connecticut. Our primary focus was the implementation of a nurse-directed urinary catheter removal protocol. This protocol was linked to the physician's catheter insertion order. Three additional elements included physician documentation of catheter insertion criteria, a device-specific charting module added to physician electronic progress notes, and biweekly unit-specific feedback on catheter use rates and CAUTI rates in a multidisciplinary forum. We achieved a 50% hospital-wide reduction in catheter use and a 70% reduction in CAUTIs over a 36-month period, although there was wide variation from unit to unit in catheter reduction efforts, ranging from 4% (maternity) to 74% (telemetry). Urinary catheter use, and ultimately CAUTI rates, can be effectively reduced by the diligent application of relatively few evidence-based interventions. Aggressive implementation of the nurse-directed catheter removal protocol was associated with lower catheter use rates and reduced infection rates.