We are the champions: engaging clinical nurses in innovative strategies for sustained CAUTI reduction

Purpose:
Catheter Associated Urinary Tract Infection (CAUTI) rates at a large urban teaching hospital were above national benchmarks and needed an innovative plan to achieve a sustained reduction. Creative educational methods were led by clinical nurse champions as a way to implement evidence based practice.

Significance:
Per the Center for Disease Control, CAUTI is a concern in healthcare causing increased mortality, morbidity, and financial burden. Infections are a focus of The Joint Commission, as shown in the 2012 national patient safety goals which include reducing the risk of health care associated infections.

Strategy and Implementation:
Practice changes related to urinary catheter care were researched and translated to an updated policy; however this lacked widespread implementation and adaptation. Clinical nurse champions of the CAUTI Evidence Based Practice (EBP) Group were integral to implementing, auditing, and sustaining these EBP changes. Initially, the clinical nurse champions' competency was validated for catheter insertion (of males and females) and peri-care using simulation models. Champions and clinical nurse specialists (CNS) facilitated a competency validation fair as a strategy to transform policy into practice. The fair created a hands-on learning environment for clinical nurses and nursing assistants. Sessions were held over three weeks to capture staff on all shifts. Participants received didactic information and validation of skills. Champions initiated daily catheter care audits of practice standards. Data from daily audits was used to identify areas for improvement and education.

Evaluation:
537 staff attended the fair and evaluations rated a mean score of 4.4 on a likert scale of 1-5. Over 4000 audits were completed which demonstrated improved or sustained compliance with 8 of 9 new EBP standards. Since January 2009 the hospital CAUTI rate per 1000 catheter days was reduced by 47%.

Implications for Practice:
Engaging clinical nurses in every stage of CAUTI reduction efforts is crucial for positive outcomes and sustained improvement. Providing creative competency-based educational programs and utilizing champions as teachers were effective strategies in sharing practice changes and improving outcomes.