Improving the Flow: Decreasing CAUTI

Purpose:
The goal of the initiative was to address the Joint Commission National Patient Safety Goal to reduce CAUTI. This was adopted as an organizational collaborative effort. It was accomplished through identification and implementation of best practices.

Relevance/Significance:
CAUTI has been designated as a National Patient Safety Goal by the Joint Commission because of its significant impact on patient outcomes. The approach to improving CAUTI outcomes in the facility involved translating current research to change practice. It also included driving evidence-based solutions specific to the acute care population. Cultural change and interprofessional collaboration were key factors in disseminating new information and attaining improved quality outcomes.

Strategy and Implementation:
An interdisciplinary CAUTI Committee evaluated current literature, existing products, and clinical processes. The process for catheter care was revised to only use Castile soap and water based on evidence. Patients' personal bathing products were eliminated as they contain emollients, which raise the risk for the formation of biofilm and bacterial growth. Closed catheter drainage systems replaced individual catheter supply options throughout the organization. Education was integrated into orientation, competency, and ongoing learning via an online Learning Management System. A nurse-driven protocol for insertion, continuation, and removal was developed with input from physician champions. Compliance surveillances were conducted with immediate feedback to unit staff. The initiatives and protocol contributed to a significant reduction in CAUTI incidence.

Evaluation:
CAUTI rates fell from 92 in 2011, 24 in 2012, 15 in 2013, and 7 in 2014, due to an evidence-based approach. This demonstrates an overall 92% reduction in CAUTI rates. The reduction translated to lower morbidity and mortality, prevention of delayed discharges, and readmissions. Cost of care was positively impacted, as the average cost of one CAUTI infection is estimated to be $1,000.00 per case.

Implications for Practice:
The evidence-based changes and nurse-driven protocol provided guidance to nurses and physicians for insertion, continuation, and removal of urinary catheters. The reduction in CAUTI rates clearly indicated the value of applying best practices.