Success in Preventing Catheter Associated Urinary Tract Infections- What works?

Purpose:
The general medical unit at a community Magnet hospital had a total of 10 Catheter Associated Urinary Tract Infections (CAUTIs) in 2008 and 2009 combined, a rate of 1.79. The goal of the CAUTI Prevention Team was a 25% reduction in CAUTI for 2010 and 2011, with a stretch goal of zero infections.

Significance:
CAUTIs are the most common healthcare-associated infection, and can lead to bloodstream infections and sepsis. A patient's risk of developing a CAUTI increases 3-7% for every day the Foley catheter is in place. The cost of treating a CAUTI can range from $1,000-$2,800, which is non-reimbursable.

Strategy and Implementation:
An interdisciplinary CAUTI Prevention Team was created and rapidly implemented innovative interventions to reduce CAUTIs. 1) A physician routine order tool for Foley insertion was adapted and approved for implementation. 2) A daily line review process was created, which included a shared spreadsheet for case managers, who both review and advocate for removal at the earliest point appropriate. 3) The team determined that heightened awareness and a multifaceted approach to staff education would increase the success in reducing CAUTIs. We accomplished this by involving direct caregivers and management throughout the organization in the educational efforts and developing teaching methods specific to each discipline. Frontline staff shift huddles, bathroom blitz flyers, face-to-face physician education and a “Back to Basics” Foley care campaign are examples of the education provided. 4) Foley necessity is now discussed during bedside shift report and interdisciplinary bedside rounding.

Evaluation:
Efforts proved successful as the medical unit experienced only a 0.9 CAUTI rate (N=2) in 2010. Furthermore, the stretch goal was obtained as no CAUTIs occurred in 2011 among medical inpatients. The routine order for Foley insertion is now utilized in every department throughout the organization.

Implications for Practice:
Process change requires an interdisciplinary team of stakeholders. Education initiatives should be tailored to the target audiences and their specific learning needs. As the need for practice changes are identified, it is imperative to make rapid Plan, Do, Study, Act (PDSA) cycle improvements.