Interdisciplinary Collaboration in the Reduction of Catheter Associated Urinary Tract Infections (CAUTI)

Purpose:
CAUTI were above benchmark in this academic medical center. An interdisciplinary clinical improvement workgroup reviewed CAUTI incidence and monitored compliance to bladder management and catheter removal algorithms. The goal was to reduce CAUTI by education and practice changes.

Significance:
Approximately 80% of nosocomial infections are attributed to CAUTI. Duration of catheter is linked to CAUTI. CAUTI are associated with patient discomfort, antibiotic use, increased lengths of stay and costs, potential for skin breakdown, risk for falls and potential for co-morbid conditions.

Strategy and Implementation:
Two Clinical Nurse Specialists rounded and completed audits on 2 units. Nurses stated they understood the bladder management and catheter removal algorithms but many failed to remove the catheter because of a lack of knowledge of best practice. Auditing on the surgical unit revealed catheters remained in place until the epidural was discontinued. Strategies included modifications to the algorithms, innovative changes in the electronic medical record, equipment changes and education of 63 registered nurses, 13 nurse managers and 12 clinical nurse specialists. The electronic record was enhanced by the addition of icons that allow nurses and physicians to identify patients with an indwelling urinary catheter. A toolbox located on the hospital's intranet includes the algorithms, catheter management videos, patient education literature, policies and nursing education materials. A monthly report monitors indwelling urinary catheter duration. CAUTI incidence is reported on unit scorecards.

Evaluation:
Reduction in catheter duration has been seen in surgical patients because many are removed after surgery. There has been a 2% reduction in the rate of CAUTI with a decreasing trend line. Most catheters are being removed earlier in patients with epidurals with minimal urinary retention noted.

Implications for Practice:
Empowering the nurses to change practice will lead to better patient outcomes and nursing satisfaction. There has been increased collaboration between physicians and nurses and increased patient ownership in their bladder management program.