Nurse-driven catheter-associated urinary tract infection (CAUTI) prevention project

Abstract

An indwelling urinary catheter (IUC) is a tube that is placed into the bladder through the urinary tract, left in place and connected to a closed system drainage bag. Catheter placement in the urinary tract increases the risk of bacteria ascending the catheter and causing an infection, known as a catheter-associated urinary tract infection (CAUTI) (Center of Disease Control [CDC], 2019; Fekete, 2020). Healthcare-associated infections (HAI) are the most common complication of healthcare treatment and are a major cause of mortality and morbidity. CAUTIs are the most common and preventable HAI, making up over 30% of the HAI in the United States (Agency of Healthcare Quality and Research [AHRQ], 2015; CDC, 2019; Centers for Medicare & Medicaid Services [CMS], 2008). CAUTIs cause increase pain and discomfort, and increase patients' hospital length of stay (AHRQ, 2017; CDC, 2019). IUCs are frequently placed without appropriate indication and remain in longer than medically necessary (CDC, 2019). Problem statement: Critical care patients are most vulnerable to acquiring a CAUTI from an IUC due to their weakened immune systems and underlying co-morbidities (CDC, 2019). The intensive care unit (ICU) setting has the highest reported rates of CAUTIs (CDC, 2019). Purpose statement: The purpose of this project was to reduce CAUTIs by implementing a nurse-driven algorithm to avoid IUC insertion, decrease IUC duration, and strengthen existing CAUTI prevention measures. Methods: Kotter's change management theory combined with the Plan-Do-Study-Act (PDSA) model served as the project's framework. The project was designed to foster a collaborative approach to reduce CAUTI incidences by empowering nurses to work at the highest level of their scope of practice, standardizing care, and strengthen existing CAUTI prevention. Results: CAUTIs were measured pre/post-implementation, and an absolute reduction from 2 to 0 was observed. The standard infection ratio (SIR) decreased to 0 post-implementation and the standard utilization ratio (SUR) decreased by 2.17%. ICU nurses were very likely (92%) to implement the algorithm into practice, and 81% indicated they implemented the algorithm on 75% of their patients. Conclusion: Although many studies have looked at reducing CAUTIs and have shown the benefit of avoiding insertion and using alternatives, there are few that have examined the standardization and combination of alternative measures, appropriate indications, and acute urinary retention measures into one nurse-driven algorithm. This quality improvement project implemented evidence-based practice in a nurse-driven algorithm and observed a decrease in CAUTI incidence.