The effects of criteria-based Foley catheter guidelines in a 642 suburban hospital medical/surgical intensive care unit

Abstract

BACKGROUND: The critical nature of patients in an intensive care unit (ICU) makes the use of indwelling Foley catheters an inevitable "standard of care." The use of indwelling Foley catheters is quite common in the hospital setting and can cause many complications. They are used in 15%–25% of all hospitalized patients. Urinary tract infections (UTIs) are the most common problem associated with their use. The risk of developing UTI, bacteriuria, and bacteremia is directly related to the length of catheterization. OBJECTIVE: The objective of this study is to investigate the appropriate use of Foley catheters in an ICU and develop guidelines that will lead to criteria-based medical reasons for their use, thus decreasing the mean Foley catheter device days as well as the variation of their use. METHODS: Based on a sample size calculation (n=124), the pre-intervention mean Foley catheter device days in the ICU (95% confidence) was 4.72 with a standard deviation of 7.67 days. Nurse-driven surveillance was implemented using criteria-based Foley catheter (CFGC) guidelines. An algorithm for Foley catheter decision-making and a CFGC checklist were developed. Program was implemented following extensive education. After implementation, 83 charts were needed to review for a 95% confidence. Positive change was created by using a collaborative approach from all disciplines. Nurses, physicians, residents, management, and infection control all had a role to play. The goal was to reduce Foley catheter device days in this 22-bed mixed medical/surgical/trauma ICU. RESULTS: Six sigma techniques were used to isolate the root causes, measure capability, and define variables. After implementation of the program, the mean for device days was 2.98 and the standard deviation was 3.17 (n=83). CONCLUSIONS: Pre-intervention, only 6% of the Foley catheters were removed before the patient was transferred out of the ICU; post-intervention, 20% of the Foley catheters were removed prior to ICU transfers, which may ultimately lead to a decrease in hospital-acquired UTIs.