Catheter-Associated Urinary Tract Infection Prevention Initiative on a Progressive Care Unit

Purpose:
The overall goal of this practice initiative is to eliminate catheter-associated urinary tract infection (CAUTI) not only on a Progressive Care Unit (PCU) but in all patient care settings where this problem is prevalent.

Relevance/Significance:
We believe that this initiative is in alignment with the general theme of the conference goals addressing quality and safety to improve patient outcomes. Healthcare is continuously battling against healthcare-associated infections (HAIs) that are affecting our patients' health and recovery, cost of care, and reimbursement. CAUTI is the most common HAI but it is also the most preventable. We believe that this initiative applies to all patient care settings: acute, short-term, and long-term.

Strategy and Implementation:
The timeline of the project was more than 12 months, from January 5, 2014 to February 10, 2015. Phase 1 involved developing a CAUTI Prevention Workgroup, conducting a needs assessment, data collection, and literature review. In phase 2, we developed and implemented the following interventions: a)a 1-hour education for all staff involved in patient care, discussing the risk factors and complications of CAUTI, indications for Foley insertion and continued use, and implementation of evidence-based practice to prevent CAUTI; b)CAUTI prevention form; c)informational poster that supplemented the presentation; and d)weekly audits by workgroup to monitor staff compliance with the CAUTI prevention protocol and use of CAUTI prevention form. Phase 3 included implementation of new CAUTI Prevention Protocol, utilization of CAUTI forms, and chart audits for compliance. In phase 4, we evaluated the overall outcome of the project and developed strategies to sustain its continued implementation.

Evaluation:
Our project resulted to zero CAUTI rate in 2014 up to the present, compared to our baseline rate of 3 in the 4th Qtr. of 2013, with a national benchmark of 1.80. Foley days decreased by 34%. We have 95% staff compliance with the use of the CAUTI prevention protocol & CAUTI form. Collaboration increased between RNs, nursing aides, physical therapists,& providers. Accountability & teamwork improved.

Implications for Practice:
This initiative supports our core value, “The needs of the patients come first”. It had a positive impact on patient outcomes related to length of stay, cost, & patient satisfaction. It increased nurse satisfaction, collaboration between teams, & awareness about evidence-based practice.