Preventing Urinary Tract Infections in Rehabilitation Through Effective Nursing Driven Algorithms

Purpose:
Our team has developed evidence based algorithms using bladder scan technology to reduce the incidence of urinary tract infection in 5 different populations of rehabilitation patients. These algorithms will be presented with meaningful data to support a reduction in urinary tract infection.

Significance:
Although urinary tract infections (UTIs) have been identified as an avoidable complication of institutional health care, there are many challenges, especially during transitions of care.

Strategy and Implementation:
On our musculoskeletal rehabilitation unit, our nursing team created nursing algorithms which are initiated at time of admission, and through an evidenced-based approach, we have dramatically reduced the incidence of UTIs on our unit. According to the CDC, most adults produce approximately 60 mL of urine every hour, and the risk of a UTI escalates when 240 mL of urine remain in the bladder. Through the use of algorithms and effective management through progressive ambulation and bladderscan technology, our nurses are able to identify and manage patients in a systematic fashion which has led to a dramatic decrease in UTIs. This presentation will demonstrate the genesis of nursing driven algorithms for overflow incontinence, retention in both men and women, and protocols following removal of urethral catheters. Data prior to and after implementation will be presented, along with challenges to implementation.

Evaluation:
Data presented will identify the presence of UTI by gender, patient type and related reduction in UTI rate using the new protocol.

Implications for Practice:
Use of bladderscan technology has traditionally been conducted every 6 hours. More frequent assessment may be warranted to reduce avoidable hospital acquired urinary tract infections, however follow up research studies could be performed in other populations to determine generalizability.