Changing the Culture: Catheter-Associated Urinary Tract Infection Prevention in the Progressive Care Unit

Purpose:
Our aim was to maintain the successes of recent catheter-associated urinary tract infection reduction efforts and support culture change through reducing process variability, accountability,and interdisciplinary collaboration.

Relevance/Significance:
Catheter-associated urinary tract infections are one of the most common hospital acquired infections, and have a significant impact on patients, families, and health care organizations. Catheter-associated urinary tract infections lead to increased length of stay, medical costs,and morbidity and mortality. In 2012, the annual cost of these infections was estimated to be $450 million. In 2008, Centers for Medicare and Medicaid Services stopped reimbursement for hospital acquired infections.

Strategy and Implementation:
In 2013, the progressive care unit participated in the Comprehensive Unit-based Safety Program, an eighteen month long national program which aims to reduce patient harm related to hospital acquired infections. A team including bedside staff, the clinical nurse specialist, and the nurse manager was assembled. There was a perception of practice variability, which prompted the development of a checklist for bedside nurses. This tool addressed critical components of indwelling catheter utilization, and was later integrated into an audit tool in 2014. Process audits are completed weekly by bedside nurses, and work to facilitate peer review. Feedback on compliance with the measures is shared with team members at the time of the audit, during weekly huddles, and monthly staff meetings. In addition to surveillance, catheter related education was included in our annual skills fair, as well as new staff orientation.

Evaluation:
The presence of catheter orders improved from 50% to 84%; catheter care performance improved from 44% to 78%; presence of catheter securement averaged 97% in the final quarter; review of necessity on the day of the audit ranged from 38% to 69% throughout the year. Our multifaceted approach proved effective in maintaining zero catheter-associated urinary tract infections in 2013 and 2014.

Implications for Practice:
Unnecessary patient harm has been prevented on the progressive care unit. The work of the catheter-associated urinary tract infection prevention team has shown that a positive change in culture can be sustained through staff engagement, ongoing real time peer review, and continued surveillance.