Preventing Unnecessary Urinary Catheter Use

Tuesday, 8 July 2008: 1:15 PM
Denise P. Cedeno, BS, RN , Seton 1 Telemetry, Our Lady of Lourdes Memorial Hospital, Inc, Binghamton, NY
Teresa A. Harris, RN-C, CPHQ , Quality Services, Our Lady of Lourdes Memorial Hospital, Inc, Binghamton, NY

Learning Objective 1: Prevent catheter associated urinary tract infections (CAUTIs) by implementing best practice.

Learning Objective 2: Promote and maintain healthy bladder tone and function by eliminating the unnecessary use of indwelling bladder catheters.

The use of urinary catheters contributes up to 80% of hospital-acquired urinary tract infections (UTIs) and UTIs have a major impact on patient morbidity, mortality and health care costs. As part of a Priority for Action team dedicated to reducing nosocomial infections in our community hospital, we are focusing our efforts on eliminating one source of nosocomial UTIs unnecessary indwelling bladder catheters.

An 8-week study was conducted on our 30 bed telemetry and stroke unit as follows:

Pre-intervention phase (1 week): Baseline data were collected to determine the prevalence of indwelling catheter utilization. Intervention Phase (2 weeks): A designated Clinical Professional Practice Specialist from the Quality Department, unit charge nurse, case managers and staff nurses on our unit rounded daily for two weeks. All patients with catheters were reviewed and if there was no justified reason for the indwelling catheter, the RN contacted the physician to request discontinuation. Data collected during this phase included patient census, number of indwelling catheters, rationale for use, and whether a catheter was discontinued if requested. Maintenance phase (4 weeks): Staff on the unit continued rounding and reviewing each patient who had an indwelling bladder catheter. They were expected to contact physicians and request discontinuation if appropriate. Post Intervention Phase (1 week): The Clinical Professional Practice Specialist, charge nurse, case managers, and the staff nurses again rounded and collected data to compare with baseline data.

Indwelling urinary catheter utilization rates decreased steadily from baseline. Unnecessary indwelling bladder catheter use decreased from 69% at baseline to 14% at the post intervention phase, and 100% discontinuation of unnecessary bladder catheters was achieved by the post intervention phase. The incidence of nosocomial UTIs decreased accordingly. Based on the findings from this study, this project is being spread to all inpatient units.