Preventing Catheter-Associated Urinary Tract Infections in Medical-Surgical/Telemetry Units: Five Units, Five Cultures, One Goal

Flagstaff Medical Center’s (FMC) effort to combat CAUTI in its Medical/Surgical-Telemetry (MST) units is as multifaceted as the five units themselves.  Each unit is tasked with being able to care for any patient ordered to be MST status. One of the biggest obstacles all these units faced is the historical view that there must be a physician order to remove the catheter (Fakih et al., 2014).  This has been a primary issue on the orthopedic surgery specialty unit.  The unit is well-known as having a unique culture.  The nurses were aware that the facility has a nurse-driven urinary catheter removal protocol but were driven by the history of pulling the catheters when the physician ordered removal.   The other units’ nurses knew the CAUTI prevention evidence but their biggest obstacle was providing task–driven care.  The nurses often would wait until the end of the shift to discontinue the catheter because toileting patients increased nursing workload.   The educators’ initial approach was staff education regarding CAUTI complications and reinforcement of the nurse-driven urinary catheter removal policy.  The real change did not occur until the nursing staff were shown the “so what factor”.  Productivity is a main factor in the hospital’s short term incentive program, which is a yearly bonus focused on goals set by administration for each fiscal year.  Nurses were shown each CAUTI has the potential to cost the hospital over $2700 dollars per episode and decrease productivity (Gokula et al., 2012).  In addition to emphasizing the financial impact of CAUTI, peer to peer education through educational audits was the final positive change to decrease CAUTI rates (Meehan & Beinlich, 2014).  

References:

Fakih, M. G., Krein, S. L., Edson, B., Watson, S. R., Battles, J. B., & Saint, S. (2014). Engaging health care workers to prevent catheter-associated urinary tract infection and avert patient harm. American Journal of Infection Control, 42, S223-S229.   doi:10.1016/j.ajic.2014.03.355

Gokula, M., Smolen, D., Gasper, P. M., Hensley, S. J., Benninghoff, M. C., & Smith, M. (2012). Designing a protocol to reduce catheter-associated urinary tract infections among hospitalized patients. American Journal of Infection Control, 40, 1002-1004.   doi:10.1016/j.ajic.2011.12.013

Meehan, A., & Beinlich, N. (2014). Peer-to-peer learning/teaching: An effective strategy for changing practice and preventing pressure ulcers in the surgical patient. International Journal of Orthopedic and Trauma Nursing, 18, 122-128.   doi:10.1016.org/10.1016/j.ijotn.2013.12.004