Reducing Catheter Associated Urinary Tract Infections With A Clinical Nurse Champion Model And Tracer Methodology

Purpose:
Our 48-bed cardiac progressive care unit had a high rate of urinary tract infections (UTIs). Our goal was to prevent UTIs by using a unit based Clinical Nurse (CN) UTI champion model to improve teamwork, review data using tracer methodology and implement evidenced-based practice (EBP) guidelines.

Significance:
Centers for Medicare and Medicaid Services stopped paying for hospital-acquired UTIs. More importantly, it was unclear why our patients were developing UTIs when the protocols were being followed. It was imperative that we investigate the cause and improve our nursing care.

Strategy and Implementation:
A CN UTI champion was chosen to attend institution-based UTI EBP meetings. The champions were educated on changes in products and policies related to urinary catheters. In return they provided authentic leadership and education to their nurses on proper catheter care and maintenance. The champion partnered with the Clinical Nurse Specialist (CNS) to trace all UTIs with an electronic clinical informatics software surveillance system for infection detection. This data was used to analyze vulnerabilities and provide patient-centered care through individual analysis. Tracers included who placed the catheter, catheter dwell time, peri-care, and catheter security. By instituting tracer methodology, we discovered the target populations who were most vulnerable to suffer UTIs. This enabled us to partner with the nursing team placing the indwelling urinary catheters (IUCs) and implemented EBP guidelines in this area.

Evaluation:
Implementing CN UTI champion and tracer methodology drastically reduce our catheter associated UTI rate. We had an 88% reduction of UTIs over a 2 year period. We are quickly moving toward our goal of zero UTIs.

Implications for Practice:
Collaboration with unit champions and CNSs, supports an environment of teamwork and promotes continued staff education and practice changes. EBP and real time tracer methodology can expose any issues, problems, or breach in protocol.