System Culture Change Decreases CAUTI

Abstract

<h3>Background</h3> Across the healthcare system, catheter associated urinary tract infection (CAUTI) rates were escalating and the organization was not meeting goals. Facility assessments revealed; indwelling catheter placement without medical necessity, lack of alternative device use, broken sterile technique during insertion, improper maintenance, and unnecessary catheter longevity. Improvements in standardization of products, insertion techniques, and the development of nurse driven standing orders for removal were needed to eradicate system wide CAUTI. <h3>Methods</h3> A steering committee was formed and lead by a Chief Nursing Officer and Clinical Practice Specialists. A multidisciplinary team was developed consisting of fourteen facility leads, Clinical Nurse Educators, bedside nurses, Infection Prevention, Quality Improvement, data analysists, and sourcing representatives. Following in-depth review of CAUTI cases and analysis of the data, several evidence based practice CAUTI reduction strategies were implemented including, product standardization, focused education/validation, indwelling urinary catheter care teams (UCCT), buddy system, standardization of process including utilization of necessity forms, placement checklists, audit tools, and data collection. <h3>Results</h3> The nurse driven system CAUTI eradication plan has been successful. The incidence of CAUTI has decreased 27.8% from 2015-2019 with the initiation of an evidence based plan. Routine placement of indwelling urinary catheters has declined. Alternative device use has increased. Sterile technique during insertion has improved with the use of validated catheter teams and the implementation of the buddy system. Product Life Cycle Assessments conducted in 2017 and 2019 have demonstrated improvements related to indwelling catheter use and care. While the goal of eradication has not yet been achieved, the system has decreased CAUTIs drastically and continues to assess for areas for improvement. <h3>Conclusions</h3> Eradication of CAUTI aligns with the mission, vision and values of the organization. A system wide culture change based on evidence based practice, led by nursing leadership and all levels of nursing, has decreased CAUTIs in a large healthcare system.