Utilizing Technology to Enhance Evidence Based Practice in the Prevention of Hospital Acquired Urinary Tract Infection

Purpose:
In FY 2008, the urine Nosocomial Infection Marker (NIM) rate for CHRISTUS St. Michael Health System was 2.34%, the highest of any hospital acquired infection at the facility. The goal was to reduce this rate by 10% house-wide during the next fiscal year.

Significance:
At Christus St. Michael, each UTI causes an additional $2,682 in direct variable cost and 4.12 days length of stay. These infections comprised 36% of all HAI creating a large cumulative effect for the facility. UTIs also cause discomfort for patients and may lead to decreased patient satisfaction.

Strategy and Implementation:
A detailed assessment of patient laboratory data using an electronic surrogate measure and computer algorithm was implemented. From this data and based upon the presence or absence of specific clinical criteria, the NIM algorithm excludes contaminants, duplicates, community-acquired conditions, and non-infected clinical states. This information provides a concurrent quality marker to staff alerting to the possibility of the patient developing a UTI. A nursing team from the units with high NIM rates reviewed evidence based practices and developed a UTI Prevention Bundle which includes using alcohol hand gel prior to gloving for urinary catheter insertion, not inflating the balloon prior to insertion, and thoroughly washing the perineal area with soap and water prior to insertion. Finally, all patients were evaluated for timely discontinuation of catheterization. All staff were educated and the UTI Prevention Bundle was adopted as the standard of care for the hospital.

Evaluation:
Using electronic surveillance, NIMs were tracked house-wide. In FY 2009 the overal NIM reduction was 12.6%. Outstanding results include a 60% reduction in CVICU and 20% in SICU. These reductions avoided 35 possible UTIs and represent $93,870 in direct variable cost and 144.2 days LOS.

Implications for Practice:
Implementation of real-time NIMs surveillance coupled with an EBP UTI Prevention Bundle proved beneficial in reducing both NIMs and UTIs. To maintain nursing focus on device-related infections, monthly NIM and UTI rates are shared with nursing staff and nursing leadership.