Diverse Educational Initiatives to Prevent Catheter-Associated Urinary Tract Infection in Critical Care

Critical care units demonstrate the highest prevalence of Catheter Associated Urinary Tract Infection (CAUTI) and greatly impact acceptance of catheter use within a facility (Elpern et. al, 2009).  The Critical Care department at Flagstaff Medical Center (FMC) encompasses an intensive care unit (20 beds), cardiovascular intensive care unit (11 beds) and step-down unit (18 beds). Changing the culture of urinary catheter care among these units is challenging in regards to re-focusing nurses to think critically about the current state of catheter use, evidence-based catheter indications, and situations that potentiate the development of a CAUTI.  Addressing education for staff started with catheter kit standardization and standards of care education. Weekly audits and bedside education were provided directly to staff based on the physical presentation of the catheter and patient condition. A hands-on, interactive approach elicited open-ended questions and assessment of nurse understanding of best practice. Evaluation of initial audits of staff performance pointed to clear deficits and need for further education. Common themes for improvement included defining a “dependent loop”, how to use sheeting clips, ensuring securement devices were applied for optimal drainage, prevention of further harm, and the importance of the maintenance phase (i.e. peri-care, use of graduated cylinders, prevention of catheters from touching the floor, keeping drainage bags out of the bed, awareness of catheter days). After assessing these educational needs, nurses in critical care were provided a 30-45 minutes hands-on, skills lab station over a period of 3 months to review appropriate catheter care, techniques and discuss CAUTI prevention specific to the assessed deficits. In combination with skills-lab education and continuing CAUTI audits, education has been adapted specifically to audited performance.

References

Elpern, E. H., Killeen, K., Ketchem, A., Wiley, A., Patel, G., & Lateef, O. (2009). Reducing use of indwelling

urinary catheters and associated urinary tract infections. American Journal of Critical Care, 18

(6), 535-541.  doi: 10.4037/ajcc2009938

Halm, M.A. & O’Connor, N. (2014). Do system-based interventions affect catheter-associated urinary

tract infection? American Journal of Critical Care, 23(6), 505-509.