Reducing Catheter Associated -Urinary Tract Infections

Purpose:
Catheter Associated Urinary Tract Infections (CA-UTI) reduction is a priority goal at Franciscan St. Francis Health therefore, the purpose is to decrease and/or eliminate the incidence of CA-UTI in hospitalized patients by implementing evidence based practice interventions.

Significance:
CA-UTI accounts for approximately 40% of HAI's, in which 80% of these infections are attributable to urinary catheters. Complications such as cystitis, pyelonephritis, gram-negative bacteremia, and prostatitis along with, patient discomfort can prolong hospital stay and increase cost and mortality.

Strategy and Implementation:
Inappropriate use of urinary catheters puts patients at risk for CA-UTI. Evidence based practices are designed to reduce these risks. Effective prevention strategies are only as good as nurses' application of these practices. A CA-UTI educational intervention, of 5 best practices, was implemented in inpatient units and emergency departments. Next, an interdisciplinary CA-UTI Team formed to review current practices and hardwire evidence based changes to impact hospital policies, practices and physician order sets. The team completes monthly audits, purposeful rounding of catheter appropriateness, root cause analysis on all CA-UTIs and current/new product evaluation related to CA-UTI. In addition, the CA-UTI Team decreased the standard urinary catheter size and is standardizing urological products. These interventions have contributed to a culture change that has not only heightened awareness of CA-UTI but the perception of nursing's significant role to ultimately eliminate CA-UTI.

Evaluation:
The effectiveness of the interventions is demonstrated in the CA-UTI rates: 2008 .75/ 86 patients, 2009 .31/36 patients, 2010 .22/ 24 patients and currently 2011 0.06/ 1 patient. In addition, an approximate 25% reduction of urinary catheters utilization in all nursing units was achieved.

Implications for Practice:
Implications for practice increases nursing knowledge and continual nurse-initiated activities to effect change and empower nursing to eliminate the causative factors that contribute to CA-UTI. Therefore, nurses can place their patients in the optimal environment to heal and to achieve health.