Best practice REALLY does apply to you...changing the CAUTI culture

Purpose:
The translation of quality data into meaningful practice change for front-line staff requires creative, evidence-based leadership and innovation. Engaging clinicians is the key to successful reduction of Catheter-Associated Urinary Tract Infections (CAUTI).

Significance:
CAUTI is a leading healthcare acquired infection, contributing to pain and discomfort for patients and increased costs for organizations. An academic medical center (AMC) was not achieving national benchmarks for CAUTI in critical and acute care units.

Strategy and Implementation:
Evidence-based structure and process are required to meaningfully change clinical metrics. An interdisciplinary team shaped the creation of a CAUTI reduction protocol and program. A critical care unit that was refractory to previous CAUTI reduction efforts served as a pilot unit. Nurses became invested in prevention through education and clinical rounds. Individual feedback and unit accountability were emphasized. Pre and post implementation data demonstrated unit success. The model was next applied across the AMC. Frontline staff (FLS) were recruited to champion best practice and prevention. Involvement of FLS across all disciplines and departments was essential. Rapid resolution of system barriers increased engagement. Point prevalence surveys were used to measure best practices.

Evaluation:
Evidence based practice and real time feedback to FLS increased adherence to best practices for prevention. Critical care units reduced device utilization to below benchmarks. Reduction of CAUTI by 50% in the pilot unit and improved organizational performance achieved the quality improvement goals.

Implications for Practice:
CAUTI reduction is successful when based on scientific evidence and inclusive of FLS. Active involvement of FLS to prevent CAUTI influences the culture of their unit. Real-time feedback allows bedside clinicians to make critical connections between their personal practice and each patient.