Bye-Bye UTI

Purpose:
Nosocomial infections present a potential risk to the hospitalized patient. Catheter-associated urinary tract infections (CAUTI's) are the most common nosocomial infections and account for up to 40% of all such infections.

Significance:
To create a culture of safety by ensuring best practices are utilized in the assessment of need for foley catheters, utilization of alternatives to foleys, insertion techniques, bundle maintenance, and removal of foley catheters. Our Goal is to reduce CAUTI's by 25-50% for fiscal year 2009.

Strategy and Implementation:
The development of a UTI task Force at Pitt County Memorial Hospital (PCMH) has introduced innovative strategies to decrease the incidence of CAUTI's. The introduction of Best Practice Alerts into to the Computerized Provider Order Entry System has served as a reminder to the medical teams to reevaluate need for urinary catheter. Focus has been placed on hand hygiene, aseptic catheter insertion technique, and securement. Foley bundle has been developed to include criteria for insertion, daily assessment of need, and bag maintenance. Patient and family education includes the risk and benefits of urinary catheter and encourages their involvement in early removal and maintenance. Individual units utilized small test of change to develop and test techniques that may be unit specific. Executive leadership weekly rounding has been implemented at the unit level with positive feedback and results.

Evaluation:
The conjoined efforts to decrease CAUTI's at PCMH has lead to an increase in bundle compliance of up to 92% with a decrease in foley device days, an overall 28% reduction in raw number of CAUTI's, and cost savings over a 14 month period.

Implications for Practice:
Multiple strategies need to be employed to engage staff in assisting in CAUTI reduction. Sustainability can be maintained through collaboration of the medical and nursing staff. Patient involvement serves as a redundancy step in assuring early device removal, thereby decreasing infection rates.