Get the Foley Out! An Intensive Care Unit's Journey to Zero Catheter Associated Urinary Tract Infections

Purpose:
The goal of this project was to take an interdisciplinary, collaborative, multi-modal approach to reducing catheter-associated urinary tract infections in the intensive care unit of a 206 bed community hospital.

Relevance/Significance:
Catheter-associated urinary tract infections have been associated with increased length of stay, costs of care, morbidity, and mortality for hospitalized patients. The Centers for Disease Control and Prevention guideline for catheter-associated urinary tract infection prevention includes a recommendation for quality improvement programs that target appropriate insertion, care, and removal of urinary catheters.

Strategy and Implementation:
The team's approach included nursing education, informatics modification, auditing for metric compliance, and real time feedback to front line staff. Urinary catheter insertion was included in the nursing annual skills competency conducted in December 2013. Catheter-associated urinary tract infection prevention education was included in new nurse orientation in 2014. The intensive care unit physicians worked with the informatics specialist to un-hide the continuing catheter indication checkbox in the template for daily progress notes. Weekly audit metrics included compliance with presence of catheter order with approved indication, catheter care documented daily for the duration of catheter dwell, presence of securement device, and documentation of appropriate continued indication in physician progress note. The frontline team was given real time feedback on audit results, and trends were shared monthly in the critical care task force and unit practice council.

Evaluation:
Presence of catheter order improved from 69% in February 2014 to 100% in the fourth quarter. Catheter care documentation for the final quarter was 85%. Presence of securement device was 100% for nine months. Physician documentation of indication improved from 0% in August to 81% in the fourth quarter. The unit did not have a catheter associated urinary tract infection for 386 days.

Implications for Practice:
The multi-modal, interdisciplinary approach utilized in this project was successful at reducing catheter-associated urinary tract infection and proved feasible in a community hospital intensive care unit. Improved collaboration enhanced the unit's safety culture and helped to prevent patient harm.