Effect of an Educational Intervention on Hospital Acquired Urinary Tract Infection Rates

Purpose:
This evidence-based project was to determine if HA-UTI rates among patients admitted to an acute care facility could be improved through staff education and consistent application of nursing care using selected perineal infection control interventions.

Background/Significance:
In today's hospital environment, good care is synonymous with positive patient outcomes. Marring this is the alarming rate of HA-nosocomial infections. Urinary tract infection is the most common hospital acquired infection. The major cause associated is the use of indwelling urinary catheters. Bacteria invade the lower urinary tract by ascending through or around the catheter. Morbidity associated with CA-UTI can be minimized by prudent decisions concerning catheter usage/good catheter care.

Methods:
An implementation of an EBP change using Clinical Guideline for the Prevention of CA-UTI, recommended hand hygiene guidelines, and Shea guideline. The sample consisted of RNs and PCTs. Targeted in-services: general nosocomial infection information, perineal care, hand hygiene, and catheter dwell time notification protocol were developed. Practice changes included development/implementation of: educational modalities for staff; dwell time notification system to alert physicians; (c) an audit and feedback system related to catheter care, hand washing, and perineal care; and (d) annual competency assessment for catheter care, hand washing and perineal care with remediation as needed.

Results:
HA-UTI Rates 11.17 pre-intervention (197 patients) 10.53 during Phase I (133 patients) 0.018 during Phase II (53 patients) 0.018 during Phase III (277 patients) The average dwell-time was 7.25 days pre-intervention, 5.71 during Phase I, 5.68 during Phase II and 5.95 during Phase III. There were significant differences in dwell time before and after the educational intervention (Chi-square = 12.56; p = <.002). The overall infection rate per 1000 patient days was 3.88 pre-intervention, 3.36 during Phase I and 0.89 during Phase II. There were no differences by dwell time, patient characteristic or co-morbidity.

Conclusions and Implications for Practice:
The goal was measuring education's impact on CA-UTIs. While knowledge r/t catheter, perineal care and skin care did increase, there was negligble change in hand washing behavior. This was not unanticipated, reinforces the theory that behavior changes rarely occur from increased knowledge alone.